Medicare Fee Schedule 2003 CMS Releases Proposed Rates, Will Be Final in November News in Brief
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News in Brief  |   August 01, 2002
Medicare Fee Schedule 2003
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Practice Management / Regulatory, Legislative & Advocacy / News in Brief
News in Brief   |   August 01, 2002
Medicare Fee Schedule 2003
The ASHA Leader, August 2002, Vol. 7, 1-23. doi:10.1044/leader.NIB1.07142002.1
The ASHA Leader, August 2002, Vol. 7, 1-23. doi:10.1044/leader.NIB1.07142002.1
In late June, the Centers for Medicare and Medicaid Services (CMS) released the proposed revisions to payment policies updating payment rates under the 2003 Medicare physician fee schedule. (See chart below for changes in specific rates.)
The final rates, which are due to be issued in early November, will be affected by several factors external to CMS. First, Congress could enact legislation that would boost fee schedule payment levels. H.R. 4954 has passed the House and would increase the proposed rates by about 2% in 2003. However, action in the Senate is unpredictable.
The second factor relates to the health of the U.S. economy. If there is a poor showing of certain economic indexes near year-end and no legislative intervention, the conversion factor (the annual figure that, when multiplied by a procedure’s total Relative Value Units, or RVUs, yields the fee) could be 5% or 6% lower than the 2002 conversion factor. Note that the table below assumes a 2003 conversion factor that is 4.4% below the 2002 figure.
If the proposed changes remain intact for the 2003 fee schedule, audiologists and speech-language pathologists will feel the impact in the following areas of clinical practice:
  • Audiometric procedures. The RVUs for all audiometric procedures increase by 7% to 9%. CMS has proposed revising the formula that determines RVUs for those procedures with no physician component or “work value.” ASHA has urged CMS to establish a more equitable fee determination methodology for diagnostic tests that do not have a physician component. ASHA has advocated strongly to address this problem through the American Medical Association’s (AMA) relative value update process and with CMS in the design of an alternative to this “zero work pool.”

  • Other audiologic procedures. The RVUs for all vestibular function procedures increase by 5% to 7% (except 92546, which increases 19%). The ABR (92585) increases by 6%, while the ABR limited (92586) increases by 9%.

  • Speech-language pathology group treatment (92508). The large reduction in RVUs balances large increases in 2000 and 2001 that resulted in the 2002 fee ($73.85) that is only $2.00 less than individual treatment (92507).

  • Dysphagia evaluation and instrumental assessment. The RVUs for procedures G0195 and G0196 each increase by 3%. However, the RVUs for the fiberoptic evaluation of swallowing (FEES, G0193) and with sensory testing (FEESST, G0194) will not be released until early November when the final fee schedule is published. In 2000 and 2001, the FEES and FEESST procedures were priced locally by Medicare intermediaries and carriers. New CPT codes will replace these Medicare codes in 2003. ASHA helped to coordinate data to be used by CMS in the determination of these RVUs.

  • Augmentative and alternative communication (AAC) device procedures. The RVUs for procedures G0197–G0201 are reduced by 1% to 3%. These Medicare codes will be replaced by CPT codes in 2003. ASHA participated in the AMA process by which data was submitted to CMS as a basis for the determination of RVUs.

Proposed Fee Changes
Based on the proposed revision of total Relative Value Units (RVUs) for each audiology and speech-language pathology procedure, examples of revised payment rates appear below:
  • CPT Code, Description, 2003 % Change(in RVUs), Fees % ChangeProposed 2003*, Fees % Changew/H.R. 4954*
  • 92557, Comprehensive hearing test, +8%, +3%, +10%
  • 92567, Tympanometry, +7%, +2%, +9%
  • 92541, Spontaneous nystagmus test, +5%, +0.4%, +7%
  • 92506, Speech/hearing evaluation, -5%, -9%, -3%
  • 92507, Speech/hearing therapy, -2%, -6%, 0%
  • 92508, Speech/hearing therapy, group, -19%***, -23%, -17%
  • 92526, Dysphagia therapy, +6%, +1%, +9%
  • G0195, Dysphagia clinical evaluation, +3%, -2%, +5%
  • G0196, Dysphagia evaluation - MBS, +3%, -3%, +5%
  • G0197, Speech gen. device - evaluation, -3%, -7%, -1%
  • G0198, Speech gen. device - adaptation, -1%, -5%, +1%
* Based on current law and economic conditions.
** Assumes federal law change to increase the conversion factor by 2% in 2003.
*** One potential explanation for the reduction in the 92508 RVU is that it represents a technical correction for increases in 2000 and 2001, which were 41% and 26%, respectively. ASHA will be following up with CMS on the rationale for this change.
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August 2002
Volume 7, Issue 14