UPDATE: July 19, 2023
On Thursday, July 13, the Centers for Medicare and Medicaid Services (CMS) posted proposed rules for both the 2024 Medicare Physician Fee Schedule (MPFS) and the 2024 Hospital Outpatient Prospective Payment System (OPPS).
The Academy has analyzed both rules and provided payment tables with proposed payment rates for 2024.
The text of both proposed rules may be viewed at: Federal Register: Federal Register Documents Currently on Public Inspection.
Initial MPFS highlights for audiology include:
- Auditory Osseointegrated Device Services (CPT codes 926X1 and 926X2)
In February 2022, the AMA CPT Editorial Panel created CPT code 926X1 (Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes) and 926X2 (Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes (list separately in addition to code for primary procedure) for calendar year (CY) 2024. CPT code 926X2 serves as the add-on code for base CPT code 926X1.
In this proposed rule, CMS proposes the RUC-recommended work RVU of 1.25 for CPT code 926X1 and 0.33 for CPT 926X2. CMS also proposes the RUC-recommended direct PE inputs for both codes.
Additionally, CMS proposes to add CPT codes 926X1 and 926X2 to the list of audiology services that can be billed with the AB modifier, that is personally provided by audiologists without a physician/non-physician practioner (NPP) referral for non-acute hearing conditions. For more information about the AB modifier, refer to CMS guidance.
CMS would extend Medicare telehealth flexibilities through December 31, 2024, including allowing Medicare telehealth services to be furnished to patients located anywhere within the U.S.; continuing the expanded scope of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists, and audiologists; extending payment for telehealth services furnished by FQHCs and RHCs.
- Quality Reporting
CMS proposes modifications to quality reporting with proposed additions to the Audiology Specialty Measures Set for the CY 2024 Performance Period/2026 Merit-Based Incentive Payment System (MIPS) payment year and future years. Specifically, CMS proposes to add two new measures as options for reporting: screening for high blood pressure and connection to community service providers for health-related social needs.
CMS proposes a new MIPS Value Pathway (MVP) for Quality Care for the Treatment of Ear, Nose, and Throat Disorders. It focuses on the clinical theme of providing care for patients experiencing some of the most common otolaryngology conditions such as, but not limited to: otologic conditions, chronic rhinosinusitis (CRS), age-related hearing loss (ARHL) and otitis media. This proposed MVP would be most applicable to clinicians who treat patients within the practice of otolaryngology, including NPPs such as audiologists, nurse practitioners, and physician assistants.
The proposed rule for the Medicare Physician Fee Schedule (MPFS) for calendar year 2024 (CY24) shows another year of Medicare cuts for most providers, as reflected in the extensive red of the audiology code table included with a recent update from the Academy. The projected impact is a -2 percent cut overall for audiology codes…
The Academy’s Coding and Reimbursement Committee (CRC) has developed an updated, editable superbill template for 2023 to serve as a guide for audiologists working to prepare a superbill for their own practices. The CRC recognizes not all ICD-10 codes found on this template will be utilized in all practice settings. The template is designed to help you…
The Academy has learned from members across the country about denials they are receiving for Medicare claims submitted using the AB modifier. The denials relate specifically to Box 17 on the claim form, which asks for a referring provider. Effective January 1, 2023, the new Medicare policy for limited direct access allows audiologists to see…