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2005 Medicare Fee Schedule (MFS) and Hospital Outpatient Prospective Payment System (OPPS) for Audiologists

The 2005 Medicare Fee Schedule (MFS) and Hospital Outpatient Prospective Payment System (OPPS) for Audiologists is now available to ASHA members. This ASHA document provides an overview of both the MFS and the OPPS and comments on relevant revisions. It also lists all procedures used by audiologists, the actual national average payment amounts, and descriptions of three methods for accessing the exact payment figure based on your geographic location. To give audiologists the most concise and accurate information available in one location, ASHA carefully analyzes over 1000 pages of CPT codes and payment policies from the Federal Register and AMA CPT Manual.

ASHAs Health Care Economics Committee (HCEC) was successful in negotiating three new Current Procedure Terminology (CPT) codes for tinnitus assessment and central auditory function assessment, resulting in another coding gain for audiologists. The 2005 Medicare Fee Schedule includes these three procedures and their reimbursement rates. These are the first audiology codes to include time designations. The coding victory for audiologists represents almost two years of work by the HCEC. The codes were developed in collaboration with other organizations representing audiology. For 2005, the conversion factor, the multiplier that converts relative value units to payment amounts, was increased by 1.5% from the 2004 level to equal $37.8975, compared to $37.3374 last year. On average, audiology services increased by approximately 1.5%.

The Centers for Medicare and Medicaid Services (CMS) also accepted comments submitted by ASHA to create a new Ambulatory Payment Classification (APC) for cochlear implant follow-up and programming. As part of its comments to CMS on the Hospital Outpatient Prospective Payment System (OPPS) for 2005, ASHA argued that reimbursement for these procedures were unreasonably low given the time, complexity, and resources involved; and were not clinically homogeneous with other procedures within the APC 0365 (Level II Audiometry). As a result, CMS established a new APC 0366 (Level III Audiometry) which will include services specific to diagnostic analysis and programming after cochlear implantation (CPT codes 92601-92604). Level III Audiometry codes will be reimbursed at $104.92, while Level II Audiometry codes will be reimbursed at $72.61.

CMS has also increased reimbursement rates for cochlear implantation by almost 15% for a median payment rate of $26,000. ASHA urged the increased reimbursement rate for this procedure.

ASHAs 2005 Medicare Fee Schedule & Hospital OPPS for Audiologists is available on our Web site at http://www.asha.org/members/issues/reimbursement/medicare/analysis-2005mfs.htm and at the upcoming ASHA Annual Convention in Philadelphia, November 18-20. An expanded article on how these new codes were obtained is scheduled to appear in the November 16 edition of the ASHA Leader. For further information, please contact Mark Kander, ASHAs Director of Health Care Regulatory Analysis, by phone at 800-498-2071, ext. 4139, or via e-mail at mkander@asha.org; or Ingrida Lusis, ASHAs Director of Health Care Regulatory Advocacy, via e-mail at ilusis@asha.org or at ext. 4482.

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