On July 13, 2021, CMS issued the Notice of Proposed Rule Making for the CY 2022 Medicare Physician Fee Schedule (MPFS). The Academy payment policy team has organized a chart of the proposed payment rates for audiology service (see “Current Resources”) based on initial calculations. Staff will continue analysis and post additional guidance.

Access Schedule Here
 
7.13.21 CY 2022 Proposed Medicare Physician Fee Schedule – Initial Calculations of Proposed Payment Rates for Audiology Services 
CPT Code Descriptor MPFS Final 2021 MIPS Proposed 2022 Difference Final 2021 vs Proposed 2022
92537 Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations) $39.86 $39.29 ($0.57)
TC $10.37 $8.73 ($1.64)
PC $29.49 $30.56 $1.07
92538 Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations) $21.71 $21.49 ($0.22)
TC $6.80 $5.71 ($1.09)
PC $14.91 $15.78 $0.87
92540 Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording $105.33 $103.78 ($1.55)
TC $31.76 $27.88 ($3.88)
PC $73.57 $75.90 $2.33
92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording $24.31 $24.52 $0.21
TC $4.54 $4.03 ($0.51)
PC $19.77 $20.49 $0.72
92542 Positional nystagmus test, minimum of 4 positions, with recording $28.20 $28.21 $0.01
TC $4.54 $3.69 ($0.85)
PC $23.66 $24.52 $0.86
92544 Optokinetic nystagmus test, bidirectional, foveal or
peripheral stimulation, with recording		 $17.18 $17.46 $0.28
TC $3.57 $3.36 ($0.21)
PC $13.61 $14.10 $0.49
92545 Oscillating tracking test, with recording $16.21 $16.12 ($0.09)
TC $3.57 $3.02 ($0.55)
PC $12.64 $13.10 $0.46
92546 Sinusoidal vertical axis rotational testing $117.32 $134.34 $17.02
TC $103.06 $119..90 $16.84
PC $14.26 $14.44 $0.18
92547 Use of vertical electrodes (List separately in addition to
code for primary procedure)		 $9.72 $9.40 ($0.32)
92548  Computerized dynamic posturography sensory organization test (CDPSOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report $47.97 $47.02 ($0.95)
TC $15.56 $13.77 ($1.79)
PC $32.41 $33.25 $0.84
92549  Computerized dynamic posturography sensory organization test (CDPSOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report with motor control test (MCT) and adaptation test (ADT) $60.93 $61.79 $0.86
TC $18.47 $18.47 $0.00
PC $42.46 $43.32 $0.86
92550 Tympanometry and reflex threshold measurements $21.39 $21.83 $0.44
92551 Pure tone hearing test air – non covered  $11.34 $13.10 $1.26
92552 Pure tone audiometry (threshold); air only $31.76 $40.64 $8.88
92553 Pure tone audiometry (threshold); air and bone $38.57 $50.04 $11.47
92555 Speech audiometry threshold; $23.98 $30.56 $6.58
92650 Aep scr auditory potential – non covered $27.55 $25.86 ($1.69)
92651 Aep broadband with i&r  $85.56 $82.62 ($2.94)
92652 Aep thrshld est mlt freq i&r $119.39 $109.15 ($10.24)
92653 Aep neurodiagnostic i&r  $83.29 $80.27 ($3.02)
92517 Vemp test i&r cervical  $81.35 $78.59 ($2.76)
92518 Vemp test i&r ocular $75.51 $73.55 ($1.96)
92519 Vemp tst i&r cervical&ocular  $126.72 $122.92 ($3.80)
92556 Speech audiometry threshold; with speech recognition $37.92 $49.03 $11.11
92557 Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) $35.98 $36.27 $0.29
92560 Bekesy audiometry; screening $0.00 deleted code  
92561 Bekesy audiometry; diagnostic $39.22 deleted code  
92562 Loudness balance test, alternate binaural or monaural $44.72 $52.39 $7.67
92563 Tone decay test $30.79 $35.93 $5.14
92564 Short increment sensitivity index (SISI) $23.66 deleted code  
92565 Stenger test, pure tone $16.85 $23.51 $6.66
92567 Tympanometry (impedance testing) $15.88 $15.45 ($0.43)
92568 Acoustic reflex testing, threshold $14.90 $15.45 $0.55
92570 Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing $31.11 $31.90 $0.79
92571 Filtered speech test $26.58 $35.26 $8.68
92572 Staggered spondaic word test $35.97 $51.05 $15.08
92575 Sensorineural acuity level test $66.44 $81.27 $14.83
92576 Synthetic sentence identification test $35.97 $47.02 $11.05
92577 Stenger test, speech $15.23 $23.17 $7.94
92579 Visual reinforcement audiometry (VRA) $44.08 $44.33 $0.25
92582 Conditioning play audiometry $72.60 $95.04 $22.44
92583 Select picture audiometry $48.94 $62.13 $13.19
92584 Electrocochleography $115.38 $105.12 ($10.26)
92587 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report $21.07 $21.16 $0.09
TC $3.89 $3.36 ($0.53)
PC $17.18 $17.80 $0.62
92588 Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report $32.41 $32.91 $0.51
TC $5.19 $4.70 ($0.49)
PC $27.22 $28.21 $0.99
92601 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming $157.51 $155.83 ($1.68)
92602 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming $100.47 $98.07 ($2.40)
92603 Diagnostic analysis of cochlear implant, age 7 years or older; with programming $147.14 $146.76 ($0.38)
92604 Diagnostic analysis of cochlear implant, age 7 years or older; subsequent programming $89.45 $87.99 ($1.46)
92620 Evaluation of central auditory function, with report; initial 60 minutes $88.48 $88.33 ($0.15)
92621 Evaluation of central auditory function, with report; each additional 15 minutes (List separately in addition to code for primary procedure) $21.07 $21.49 $0.42
92625 Assessment of tinnitus (includes pitch, loudness matching, and masking) $65.79 $66.83 $1.04
92626 Evaluation of auditory rehabilitation status; first hour $85.24 $85.64 $0.40
92627 Evaluation of auditory rehabilitation status; each additional 15 minutes (List separately in addition to code for primary procedure) $20.09 $20.15 $0.06
92640 Diagnostic analysis with programming of auditory brainstem implant, per hour $107.60 $108.14 $0.54

Additional Resources:

Fact Sheet on the CY 2022 Physician Fee Schedule Notice of Proposed Rule Making

CMS Press Release on the CY 2022 Physician Fee Schedule Proposed Rule

Federal Register Announcement 7.13.21 of the CY2022 Proposed Medicare Physician Fee Schedule

 

Share this

Related Posts

CY2023 Proposed Medicare Physician Fee Schedule (MPFS): Proposal for Audiology Direct Access (one photo/shutterstock.com)

CY2023 Proposed Medicare Physician Fee Schedule (MPFS): Proposal for Audiology Direct Access

The MPFS is released annually and updates payment policies, payment rates, and other provisions for services in Medicare. The most recent proposal was issued July 6, 2022, and includes a proposal for limited direct access to audiology services in Medicare. Under this proposal, “non-acute,” non-vestibular services (36 codes) may be provided without a physician order…

Read More

Hospital Outpatient Prospective Payment System

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…

Read More

Proposed 2023 Ambulatory Payment Classification Groups for Audiology Codes

2023 Propose Rule on the Hospital Outpatient Prospective Payment System (OPPS) Tables 1-7 see below for Ambulatory Payment Classification (APC) assignments, status indicators (SI), 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…

Read More