Professional Work for Audiology Services: ASHA Advocates for Changes in Medicare Valuation A major breakthrough in professional recognition of services delivered by audiologists occurred this year when the Centers for Medicare and Medicaid Services (CMS) accepted the American Medical Association (AMA) Relative Value Update Committee (RUC) recommendations for professional recognition for nine audiology procedures, which are currently considered “technical” codes. ASHA has ... ASHA News
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ASHA News  |   December 01, 2007
Professional Work for Audiology Services: ASHA Advocates for Changes in Medicare Valuation
Author Notes
  • Robert Fifer, is an audiology member of ASHA’s Health Care Economics Committee.
    Robert Fifer, is an audiology member of ASHA’s Health Care Economics Committee.×
  • Thomas Rees, is an audiology member of ASHA’s Health Care Economics Committee.
    Thomas Rees, is an audiology member of ASHA’s Health Care Economics Committee.×
Article Information
Hearing Disorders / Practice Management / ASHA News & Member Stories / ASHA News
ASHA News   |   December 01, 2007
Professional Work for Audiology Services: ASHA Advocates for Changes in Medicare Valuation
The ASHA Leader, December 2007, Vol. 12, 5-6. doi:10.1044/leader.AN.12172007.5
The ASHA Leader, December 2007, Vol. 12, 5-6. doi:10.1044/leader.AN.12172007.5
A major breakthrough in professional recognition of services delivered by audiologists occurred this year when the Centers for Medicare and Medicaid Services (CMS) accepted the American Medical Association (AMA) Relative Value Update Committee (RUC) recommendations for professional recognition for nine audiology procedures, which are currently considered “technical” codes.
ASHA has long advocated that services of audiologists be reflected in the professional component (known as physician work) rather than the technical component (practice expense) of Current Procedural Terminology© (CPT) code procedures. Through its seat on the AMA’s RUC Health Care Professionals Advisory Committee (HCPAC), ASHA has discussed the inequity of the situation, supported by other HCPAC members who are qualified non-physician health care professionals.
Medicare recognizes the work of physical therapists, occupational therapists, and clinical psychologists as professional rather than technical. CMS said that these professions could bill as private practitioners and that audiology should follow suit.
As a result, physician/professional work will be assigned for the first time in 2008 to nine CPT codes, including comprehensive audiometric assessment (CPT 92557), tympanometry (CPT 92567), and cochlear implant programming (CPT 92601-92604).
Reimbursement Goals
ASHA had two goals for moving away from the technical component to the professional component: to stabilize the methodology and reimbursement formula for CPT procedures that are now valued as practice expense and to ensure that the conversion from a non-physician work pool protects current levels of reimbursement and offers the possibility of improving reimbursement for certain codes.
CMS announced in 2005 that the non-physician work pool would be eliminated. Audiologists were reimbursed mainly from this pool, a specific group of procedures created by Medicare as a temporary reimbursement mechanism for several services.
ASHA responded to CMS asking to have audiology (and speech-language pathology) codes included in the five-year review, and CMS subsequently included those codes in the process. Only representatives from the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) objected to the RUC about the change, saying that the RUC had no assurances that CMS would accept the new recommendations.
The RUC agreed that it needed a written response from CMS before committing resources to revaluing audiology procedures. In November 2006, CMS announced that if the RUC recommended the use of work values, CMS would consider it.
Two Surveys, Different Data
ASHA selected nine audiology procedures, including comprehensive audiometry, to submit to the RUC. ASHA, in collaboration with the American Academy of Audiology (AAA), held a Web-based seminar on the RUC survey process that led to an online survey; data was collected from more than 140 responses on services such as comprehensive audiometry, visual reinforcement audiometry, tympanometry, and diagnostic analysis of cochlear implants. These codes are frequently reported by otolaryngology practices.
However, because physicians have a role in these procedures, any recommendations concerning the codes have to be presented to the RUC rather than the Health Care Professionals Advisory Committee.
AAO-HNS conducted a separate survey of the same procedures, collecting 21 responses. There was considerable disparity between the results of the two surveys. Consequently, at the April 2007 RUC meeting, ASHA and AAO-HNS were advised to reconcile the data differences. ASHA and AAA representatives met with AAO-HNS representatives during an all-day meeting to negotiate agreeable values. Because little progress was made toward an agreement, the RUC formed a subcommittee to explore the issues.
The subcommittee made it clear that the survey data were only one reference point and that comprehensive audiometry was mostly reported by otolaryngologists. The subcommittee viewed the audiometry procedures as tests rather than evaluations. ASHA/AAA and AAO-HNS reconvened and established times and values for the nine codes that were considerably different from those that came from the ASHA/AAA survey but, apparently, are consistent with “tests” performed by other health care practitioners. The evaluation aspect audiologists reported in the survey was eliminated because physicians are able to report evaluation and management codes that cover this aspect of the service.
Audiologists should be alert to future changes in the Medicare Physician Fee Schedule and respond to any surveys that are related to current or new CPT codes. Contact reimbursement@asha.org with any questions or comments.
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December 2007
Volume 12, Issue 17