The MPFS is released annually and updates payment policies, payment rates, and other provisions for services in Medicare. The most recent proposal was issued July 6, 2022, and includes a proposal for limited direct access to audiology services in Medicare.
Under this proposal, “non-acute,” non-vestibular services (36 codes) may be provided without a physician order and creates new GAUDX code for these 36 codes. Under this approach, a “blended” reimbursement rate would apply for all of these services. Beneficiaries could receive one GAUDX coded services every 12 months.
The Academy submitted comments to CMS and provided the following recommendations:
- Utilize existing CPT codes with existing fee schedule reimbursement rate + a new modifier to identify services provided without physician order (rather than GAUDX).
- Make time-limited patient eligibility to these services available in existing on-line tools (MAC portals) to assist audiologists.
- Remove “acute” criterion from the proposal. Audiologists are skilled at care coordination and necessary referrals.
- Remove commentary in proposal that references presumptive safety concerns with direct access to audiology services. These claims lack documentation or citations supporting patient “safety.”
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…
CMS issued additional guidance regarding the new provision for limited direct access to audiology services that will go into effect on January 1, 2023. As stated by CMS in this guidance, This modification in our finalized policy requires multiple changes to our claims processing systems which will take some time to fully operationalize, possibly by July…
Updated Guidance November 9, 2022 Late November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule on the 2023 Medicare Physician Fee Schedule (MPFS). The Academy has compiled a chart of 2023 reimbursement values for audiology codes, available here. This Final Rule contains significant provisions for the delivery of audiology services….