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 personnel) for services provided in the outpatient setting. Under the OPPS, services are assigned to an Ambulatory Payment Classification (APC) group, and all services in the group are reimbursed at the same rate. Services included in an APC are supposed to be clinically similar and similar in resource use.
For calendar year 2023 rate setting, CMS proposes to use CY 2021 claims data. Additionally, CMS proposes to use cost report data from the June 2020 Healthcare Cost Report Information System (HCRIS), which only includes cost report data through CY 2019, predating the Public Health Emergency (PHE). This is the same cost report extract used to set OPPS rates for CY 2022. CMS believes using the CY 2021 claims data, with cost reports data through CY 2019 for CY 2023 OPPS rate setting, is the best approximation of expected costs for CY 2023 hospital outpatient services.
The Academy will continue to analyze this proposed rule for policy changes that may have an impact on audiology.
2023 Proposed Hospital Outpatient Prospective Payment System Rule Text: 2022-15372.pdf (federalregister.gov)
The November 16, 2023, issue of MLN Matters provides the updated information to the Centers for Medicare and Medicaid Services (CMS) guidance “Allowing Audiologists to Provide Certain Diagnostic Tests Without a Physician Order.” The revised guidance now adds two new audiology codes to use with the AB modifier for direct access without a physician or non-physician…
Late November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (MPFS) and 2024 Hospital Outpatient Prospective Payment System rules. The rules take effect January 1, 2024. MPFS High-Level Take-Aways Quality Payment Program (QPP) Provisions CMS has added two new measures (317 and 498) to the…
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…