On January 11, Health and Human Services (HHS) Secretary Alex Azar extended the COVID-19 Public Health Emergency (PHE) declaration effective January 21, 2021, for an additional 90 days. This means that all of the telehealth and other waivers and flexibilities that have been implemented during the PHE will remain in effect until at least April 21, 2021.
In addition, the Consolidated Appropriations Act that was signed into law on December 27, 2020, included provisions that offset most of the 10.2 percent budget neutrality adjustment that had been slated to take effect for Medicare-covered services provided as of January 1, 2021. This changes the CY2021 conversion factor from $32.36 to $34.89 and is accomplished by:
- An increase in the payment schedule of 3.75 percent. This is applied across the board and without distinction to all payments under the Medicare physician payment schedule.
- Extending the two percent Medicare sequester moratorium through March 2021.
- Suspending payments for HCPCS code G2211 for three years (through the end of December 2023). G2211 is the complexity add on code for E/M services.
The Center for Medicare and Medicaid Services (CMS) has now confirmed that it is implementing the above provisions of this legislation and that there will be no delay in claims processing for 2021 services; that is, claims will be paid on time at the correct 2021 rates that reflect this legislation. A projected impact table by specialty and updated CY2021 audiology services fee schedule can be located here.
The Academy remains committed to fighting any cuts to Medicare reimbursement. We are pleased that based on the provisions in the legislation, the revised impact calculations show Audiologists potentially with a three percent increase in CY2021 Medicare reimbursement. This is based on the individual mix of services provided at each practice, but a much-welcomed improvement from the projected 6 percent decrease cuts to CY2021 Medicare reimbursement. If you should have any questions, please contact the Academy’s advocacy team.
Academy Updates Superbill Template 2023
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…
Medicare Claims Processing with AB Modifier for Limited Direct Access
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…
Limited Direct Access to Audiology Services Under Medicare: Updated Information
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…