Medicare Proposes 2012 Outpatient Audiology Rates Medicare reimbursement rates for most hospital outpatient audiology services will change only slightly—from a decrease of 2% to an increase of 4%—under proposed 2012 payment rates. Rates for some procedures, however, including cochlear implantation and evoked otoacoustic emissions testing, are proposed to drop significantly. The Centers for Medicare and Medicaid ... Bottom Line
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Bottom Line  |   August 01, 2011
Medicare Proposes 2012 Outpatient Audiology Rates
Author Notes
  • Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.
    Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.×
Article Information
Hearing Disorders / Practice Management / Bottom Line
Bottom Line   |   August 01, 2011
Medicare Proposes 2012 Outpatient Audiology Rates
The ASHA Leader, August 2011, Vol. 16, 4. doi:10.1044/leader.BML2.16102011.4
The ASHA Leader, August 2011, Vol. 16, 4. doi:10.1044/leader.BML2.16102011.4
Medicare reimbursement rates for most hospital outpatient audiology services will change only slightly—from a decrease of 2% to an increase of 4%—under proposed 2012 payment rates. Rates for some procedures, however, including cochlear implantation and evoked otoacoustic emissions testing, are proposed to drop significantly.
The Centers for Medicare and Medicaid Services (CMS) published the proposal in the July 18, 2011, Federal Register [PDF]. Regulatory comments are due Sept. 16.
Unlike rates for speech-language pathology services, which are determined under the annual Medicare Physician Fee Schedule, rates for audiology outpatient services are determined by the hospital outpatient prospective payment system (OPPS). Under OPPS, audiology procedures are assigned to ambulatory payment classifications (APCs) that comprise services that are comparable clinically and with respect to cost.
Although reimbursement for most audiology CPT™ codes (Current Procedural Terminology, © American Medical Association) will likely change only slightly, several vestibular function tests may increase by as much as 29%. These annual shifts in values are based almost entirely on national hospital cost records, although reportedly inaccurate recordkeeping often contributes to cost fluctuations that are unrelated to inflation and other CMS considerations.
CMS proposes that CPT 92561 (Bekesy audiometry) and 92570 (acoustic immittance) be shifted to a higher-level APC (Level II Audiometry). This shift raises the payment level to $85, more than 250% of the current rate. This change was made because the median cost for these procedures has increased well beyond the median cost of their current APC.
Conversely, CPT 92588 (evoked otoacoustic emissions) is proposed to shift to a different APC (Level I Otorhinolaryngologic Function Tests), reducing its payment level by 35% to $66. The shift is due to a significant reduction in the national median cost of the procedure. Other procedures in this APC include positional nystagmus tests and evoked otoacoustic emissions, limited, tests. It will be difficult for ASHA to contest this proposed change because the revision is based on hospital cost records.
The proposed 2012 rate for auditory osseointegrated devices (i.e., bone-anchored hearing aids) with implantation is $9,056, a 5.35% increase.
The payment rate for cochlear implantation (including the device) is proposed to drop by 12%, despite increases of more than 7% and 9% over the past two years, respectively. The proposed rate, $27,430, is based on hospital cost records. ASHA has, in the past, indicated to CMS that the lower reimbursement rate for cochlear implants will affect the accessibility of the procedure if outpatient programs are forced to close because of lack of financial viability.
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August 2011
Volume 16, Issue 10