Medicare Payment Rates Rise in 2004 Reimbursement Increases for Part B Services Bottom Line
Bottom Line  |   February 01, 2004
Medicare Payment Rates Rise in 2004
Author Notes
  • Marat Moore, managing editor of The ASHA Leader, can be reached at
    Marat Moore, managing editor of The ASHA Leader, can be reached at×
  • Steven White, is ASHA’s director of health care economics and advocacy. Contact him at
    Steven White, is ASHA’s director of health care economics and advocacy. Contact him at×
Article Information
Hearing Disorders / Swallowing, Dysphagia & Feeding Disorders / Practice Management / Bottom Line
Bottom Line   |   February 01, 2004
Medicare Payment Rates Rise in 2004
The ASHA Leader, February 2004, Vol. 9, 1-16. doi:10.1044/leader.BML2.09022004.1
The ASHA Leader, February 2004, Vol. 9, 1-16. doi:10.1044/leader.BML2.09022004.1
Payment rates for speech-language pathology and audiology services provided to Medicare beneficiaries under Part B will be going up this year following a revision in the 2004 Medicare Physician Fee Schedule for Part B services. The revision by the Centers for Medicare and Medicaid Services (CMS) reflects policy changes from the recently passed Medicare legislation, which appeared in its entirety in the Jan. 7 Federal Register.
CMS announced a conversion factor of $37.3374 in 2004, which represents a 1.5% increase in overall reimbursement rates. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (PL 108-173) saved providers from a 4.5% rate reduction.
Analysis of the 2004 Medicare Fee Schedule reveals substantial increases for some undervalued speech-language pathology services, while audiology rates rose modestly overall. The 2004 rates apply to all speech-language pathology and audiology Medicare Part B services, except for audiology services provided in a hospital. (Audiology diagnostic services are paid under the Medicare Outpatient Prospective Payment System.)
Dysphagia Rates Rise
The 2004 rate for a clinical dysphagia evaluation is $131.43 (3.52 RVU), a remarkable increase over the 2003 rate of $42.30 (1.15 RVU). In addition, the motion fluoroscopic evaluation of swallowing has climbed to the same rate of $131.43 from the 2003 rate of $45.98 (1.25 RVU).
’ASHA aggressively lobbied CMS to rectify major reductions made in these procedures in the 2003 fee schedule,” noted Kate Gottfred, vice president for governmental and social policies.
CMS apparently linked the significant increase in the rate for swallowing evaluation with that for speech-language pathology evaluation; the 2004 rate for 92506 increased to the identical rate of $131.43 or 30% above the 2003 rate.
’ASHA’s Health Care Economics Committee-a group of extremely dedicated people-did an enormous amount of work to bring this about. They provided CMS with the updated survey data that led to this increase,” said Gottfred, adding that the survey data includes time with the patient, post-visit time, and the cost of various supplies and equipment.
Reimbursement for speech-language pathology treatment, however, was reduced to $62.35 from $77.25-although this rate is per session and not time-based, and the time can be adjusted appropriately. The reduction would have been worse, but CMS tentatively agreed with ASHA’s position that the vignette used to determine the RVU was inappropriate because it reflected treatment with a child.
ASHA is pursuing changes in the example case that describes the procedure and related practice expenses to reflect a more equitable reimbursement rate.
Group speech-language treatment also was reduced significantly to $29.50 from $63.27. The new group therapy rate is somewhat more logical if consideration is given to the total reimbursement rate for seeing three patients in a group (3 x $29.50 = $88.50) versus a single patient ($62.35).
Audiology Rates
For the most part, the audiology rates received modest increases because of the new conversion factor. For example, the comprehensive hearing test rate rose by 4% to $48.91 from $47.09, tympanometry increased to $21.66 from $20.97 and electrocochleography rose to $100.81 from $99.32.
There will be a new temporary procedure code (G0268-Removal of Impacted Cerumen, one or both ears) to be used by a physician on the same date of service as audiologic function testing. According to CMS, the new code is to be used only in those unusual circumstances when an employed audiologist who bills under a physician uniform provider identifier number performs audiologic function testing on the same day as removal of impacted cerumen requiring physician expertise for the removal.
Easy-to-Use Rate Finder
To provide speech-language pathologists and audiologists with the most concise and accurate information available in one location, ASHA has analyzed more than 1,000 pages of CPT codes and payment policies from the Federal Register and AMA CPT Manual.
ASHA’s 2004 Medicare Fee Schedule for Audiologists and 2004 Medicare Fee Schedule for Speech-Language Pathologists are available to ASHA members on the ASHA Web site (see sidebar). These two ASHA documents provide a listing of all the procedures used by audiologists and SLPs, cite the actual national average payment amounts, and describe three methods for accessing the exact payment figure based on your geographic location.
For more information, contact Mark Kander by e-mail at or through the Action Center at 800-498-2071, ext. 4139.
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February 2004
Volume 9, Issue 2