2018 Hospital Outpatient Prospective Payment System (OPPS) Final Rule Changes
On November 1, 2017, the Centers for Medicare and Medicaid Services (CMS) released the 
Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems final rule with comment period. The final rule updates Medicare payment policies and rates for services performed in hospital outpatient departments.
Hospital-based outpatient audiology services are paid under the OPPS. Individual services are assigned to Ambulatory Payment Classification (APC) groups. By law, the APC groups are to be comprised of services that are similar clinically, in resource use, and cost. Payments are then calculated for the APC with each service within a respective APC receiving the same rate of reimbursement.
OPPS Conversion Factor Update
For 2018, CMS finalized to update the OPPS rates by 1.35 percent. This is a slight decrease from the proposed rule, which was 1.75 percent. CMS estimates that the policies in this final rule will result in a 1.4 percent overall increase in OPPS payments to providers.
Comprehensive APCs
For CY 2018, CMS did not propose to create any new C-APCs or any extensive changes to the already established methodology used for C-APCs, so there will be a total number of 62 C-APCs as of January 1, 2018, the same number of C-APCs in 2017.
2018 APCs for Audiology Codes
Tables 1-6 see below for APC assignments, status indicators, 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 at the APC rate. A "Q1" status indicator represents "STV-Packaged Codes" where APCs and CPT codes are billed on the same date of service as those assigned a status indicator of "S," "T," or "V," are packaged and not paid for separately. If billed with without the "S," "T," or "V," service, payment is made at the APC rate.
Table 1: APC 5721-Level I Diagnostic Tests and Related Services ($136.31)
| CPT Code | Code Descriptor | Status Indicator |
| 92537* | Caloric vestibular test with recording, bilateral; bithermal* moved here from APC 5722 |
S |
| 92538* | Caloric vestibular test with recording, bilateral; monothermal* moved here from APC 5722 |
S |
| 92540 | Basic vestibular evaluation |
S |
| 92544 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recording |
S |
| 92545 | Oscillating tracking test, with recording |
S |
| 92546 | Sinusoidal vertical axis rotational testing |
S |
| 92584 | Electrocochleography |
S |
| 92586 | Auditory evoked potentials, limited |
S |
| 92601 | Cochlear Implant initial programming <7 years old |
S |
| 92602 | Subsequent programming <7 years old |
S |
| 92603 | Cochlear implant initial programming > 7 years old |
S |
| 92604 | Subsequent programming >7 years old |
S |
| 92640 | Auditory brainstem implant programming |
S |
| 92550 | Tympanometry & reflex threshold |
Q1 |
| 92553 | Audiometry air and bone |
Q1 |
| 92557 | Comprehensive hearing evaluation |
Q1 |
| 92562 | Loudness balance test |
Q1 |
| 92570 | Acoustic immittance testing |
Q1 |
| 92572 | Staggered spondaic word test |
Q1 |
| 92579 | Visual audiometry (VRA) |
Q1 |
| 92582 | Conditioning play audiometry |
Q1 |
| 92620 | Auditory function test (60 min) |
Q1 |
| 92625 | Tinnitus assessment |
Q1 |
| 92626 | Evaluation of auditory rehab status |
Q1 |
*New APC Placement for CY 2018
Table 2: APC 5722- Level II Diagnostic Tests and Related Services ($248.81)
| CPT Code | Code Descriptor | Status Indicator |
| 92585 | Auditory evoked potentials (ABR), comprehensive |
S |
| 92587 | OAEs, limited |
S |
| 92588 | OAEs, comprehensive |
S |
Table 3: APC 5723- Level III Diagnostic Tests and Related Services ($444.36)
| CPT Code | Code Descriptor | Status Indicator |
| 92577 | Stenger test, speech |
Q1 |
Table 4: APC 5731- Level I Minor Procedures ($17.47)
| CPT Code | Code Descriptor | Status Indicator |
| 92564 | SISI hearing test*moved here from APC 5732 |
Q1 |
| 92700 | Unlisted otorhinolaryngological service or procedure |
Q1 |
Table 5: APC 5732- Level II Minor Procedures ($31.80)
| CPT Code | Code Descriptor | Status Indicator |
| 92555 | Speech threshold audiometry |
Q1 |
| 92556 | Speech threshold and discrimination |
Q1 |
| 92563 | Tone decay hearing test |
Q1 |
| 92565 | Stenger test, pure tone |
Q1 |
| 92567 | Tympanometry |
Q1 |
| 92568 | Acoustic reflex threshold |
Q1 |
| 92571 | Filtered speech test |
Q1 |
| 92575 | Sensorineural acuity test |
Q1 |
| 92576 | Synthetic sentence test |
Q1 |
| 92583 | Select picture audiometry |
Q1 |
| 92596 | Ear protection measurement |
Q1 |
Table 6: APC 5734- Level IV Minor Procedures ($105.03)
| CPT Code | Code Descriptor | Status Indicator |
| 92541 | Spontaneous nystagmus test |
Q1 |
| 92542 | Positional nystagmus test |
Q1 |
| 92548 | Posturography |
Q1 |
| 92552 | Pure tone audiometry air |
Q1 |
| 92561 | Bekesy audiometry diagnosis |
Q1 |
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