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2018 Hospital Outpatient Prospective Payment System (OPPS) Final Rule Changes

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

Resources:

CMS OPPS CY 2018 Fact Sheet

Academy OPPS CY 2018 Proposed Rule Comments

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