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 American Academy of Audiology commends the Centers for Medicare & Medicaid Services (CMS) on the decision to expand the eligibility criteria for cochlear implementation (CI) coverage for adults with aided sentence recognition scores of up to 60%. CMS released today the final decision memo announcing the change in national coverage determination for CI….
Late July 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule on the 2023 Hospital Outpatient Prospective Payment System (OPPS). Under this proposal, CMS proposes a 2.7 percent increase in the OPPS payment rate for 2023. The OPPS provides technical component (TC) reimbursement (non-physician costs such as supplies, equipment, and…
2023 Propose Rule on the Hospital Outpatient Prospective Payment System (OPPS) Tables 1-7 see below for Ambulatory Payment Classification (APC) assignments, status indicators (SI), and reimbursement amounts for audiology codes. An “S” status indicator denotes a “Separate APC Payment,” where regardless of services performed on the same date of service, the CPT code is paid…