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Proposed 2020 OPPS Rule: Audiology Impacts

Proposed 2020 OPPS Rule: Audiology Impacts

CY2020 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) published the proposed 2020 Hospital Outpatient Prospective Payment System (OPPS) rule.  This proposed rule contains payment and policy changes for services provided in the OPPS setting.

The Academy has compiled the chart below to show Ambulatory Payment Classification (APC) assignments and reimbursement impacts for audiology codes.  We are continuing our analysis of the proposed rule with a specific focus on the change in Status Indicators for certain audiology codes.  If you bill under the OPPS and are interested in participating in audiology-wide efforts to analyze the proposed Status Indicator changes, please contact Carrie Kovar at carrie@korrisgroup.com.

Overall, CMS proposes a 2.7 percent increase in the OPPS conversion factor for 2020.  Other highlights of this proposed rule include provisions to require hospitals to make public a list of gross charges and payer-specific negotiated charges for items and services, posted online in a machine-readable format.  CMS would also finalize the phase-in of its site-neutral payment policy, meaning that certain services currently paid under the OPPS will be paid under the Medicare Physician Fee Schedule.

For more information, view the CMS Fact Sheet on the proposed OPPS rule, or read the entire proposed rule.  The Academy will submit comments to the Agency by the September 27, 2019, deadline.

2018/2019 Final APCs for Audiology Codes; Proposed 2020 APC Assignments

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 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. Status indicator “N” indicates payment is packaged into payment for other services, therefore no separate APC payment will be allowed. Note: The Academy is continuing to analyze the proposed CY 2020 OPPS rule to determine additional impacts on audiology codes.

Table 1:
APC 5721-Level I Diagnostic Tests and Related Services (2018 final = $136.31)
(2019 final = $135.95)
(2020 proposed = $140.33)
 

CPT Code

Code Descriptor

Status Indicator 2018

Status Indicator 2019

Status Indicator 2020 proposed

92537

Caloric vestibular test with recording, bilateral; bithermal* moved here from APC 5722

S

S

S

92538

Caloric vestibular test with recording, bilateral; monothermal* moved here from APC 5722

S

S

S

92540

Basic vestibular evaluation

S

S

S

92544

Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recordingp

S

S

S

92545

Oscillating tracking test, with recording

S

S

S

92546

Sinusoidal vertical axis rotational testing

S

S

S

92584

Electrocochleography

S

S

S

92586

Auditory evoked potentials, limited

S

S

S

92601

Cochlear Implant initial programming <7  years old

S

S

S

92602

Subsequent programming <7  years old

S

S

S

92603

Cochlear implant initial programming > 7 years old

S

S

S

92604

Subsequent programming >7 years old

S

S

S

92640

Auditory brainstem implant programming

S

S

S

92550

Tympanometry & reflex threshold

Q1

Q1

N

92553

Audiometry air and bone

Q1

Q1

N

92557

Comprehensive hearing evaluation

Q1

Q1

N

92562

Loudness balance test

Q1

Q1

N

92570

Acoustic immitance testing

Q1

Q1

N

92572

Staggered spondaic word test

Q1

Q1

N

92579

Visual audiometry (VRA)

Q1

Q1

N

92582

Conditioning play audiometry

Q1

Q1

N

92620

Auditory function test (60 min)

Q1

Q1

N

92625

Tinnitus assessment

Q1

Q1

N

92626

Evaluation of auditory rehab status

Q1

Q1

N

 

Table 2:
APC 5722- Level II Diagnostic Tests and Related Services

(2018 final = $248.81)
(2019 final = $252.31)
(2020 proposed = $256.60)

 

CPT Code

Code Descriptor

Status Indicator 2018

Status Indicator 2019

Status Indicator 2020 proposed

92585

Auditory evoked potentials (ABR), comprehensive

S

S

S

92587

OAEs, limited

S

S

S

92588

OAEs, comprehensive

S

S

S

 

Table 3:
APC 5723- Level III Diagnostic Tests and Related Services

(2018 final = $444.36)
(2019 final = $455.27)
(2020 proposed = $486.65)

 

CPT Code

Code Descriptor

Status Indicator 2018

Status Indicator 2019

Status Indicator 2020 proposed

92577

Stenger test, speech

Q1

Q1

N

 

Table 4:
APC 5731- Level I Minor Procedures

(2018 final = $17.47)
(2019 final = $17.17)
(2020 proposed = $23.57)

 

CPT Code

Code Descriptor

Status Indicator 2018

Status Indicator 2019

Status Indicator 2020 proposed

92564

SISI hearing test*moved here from APC 5732

Q1

Q1

N

92700

Unlisted otorhinolarngological service or procedure

Q1

Q1

 

 

Table 5:
APC 5732- Level II Minor Procedures

(2018 final = $31.80)
(2019 final = $32.12)
(2020 proposed = $34.33)

 

CPT Code

Code Descriptor

Status Indicator 2018

Status Indicator 2019

Status Indicator 2020 proposed

92555

Speech threshold audiometry

Q1

Q1

N

92556

Speech threshold and discrimination

Q1

Q1

N

92563

Tone decay hearing test

Q1

Q1

N

92565

Stenger test, pure tone

Q1

Q1

N

92567

Tympanometry

Q1

Q1

N

92568

Acoustic reflex threshold

Q1

Q1

N

92571

Filtered speech test

Q1

Q1

N

92575

Sensorineural acuity test

Q1

Q1

N

92576

Synthetic sentence test

Q1

Q1

N

92583

Select picture audiometry

Q1

Q1

N

92596

Ear protection measurement

Q1

Q1

N

 

Table 6:
APC 5734- Level IV Minor Procedures

(2018 final =$105.03)
(2019 final = $106.48)
(2020 proposed = $109.98)

 

CPT Code

Code Descriptor

Status Indicator 2018

Status Indicator 2019

Status Indicator 2020 proposed

92541

Spontaneous nystagmus test

Q1

Q1

N

92542

Positional nystagmus test

Q1

Q1

N

92548

Posturography

Q1

Q1

N

92552

Pure tone audiometry air

Q1

Q1

N

92561

Bekesy audiometry diagnosis

Q1

Q1

N

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