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 and creates new GAUDX code for these 36 codes. Under this approach, a “blended” reimbursement rate would apply for all of these services. Beneficiaries could receive one GAUDX coded services every 12 months.
The Academy submitted comments to CMS and provided the following recommendations:
- Utilize existing CPT codes with existing fee schedule reimbursement rate + a new modifier to identify services provided without physician order (rather than GAUDX).
- Make time-limited patient eligibility to these services available in existing on-line tools (MAC portals) to assist audiologists.
- Remove “acute” criterion from the proposal. Audiologists are skilled at care coordination and necessary referrals.
- Remove commentary in proposal that references presumptive safety concerns with direct access to audiology services. These claims lack documentation or citations supporting patient “safety.”
Updated Guidance November 9, 2022 Late November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule on the 2023 Medicare Physician Fee Schedule (MPFS). The Academy has compiled a chart of 2023 reimbursement values for audiology codes, available here. This Final Rule contains significant provisions for the delivery of audiology services….
On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a pre-release notice of final rule-making for the CY 2023 Medicare Physician Fee Schedule Rule (MPFS). The notice will be final upon publication in the Federal Register. CMS also has provided a Fact Sheet that references significant changes for the provision of…
Late November 1, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the 2023 Hospital Outpatient Prospective Payment System (OPPS). Under this rule, CMS finalizes a 3.8 percent increase in the OPPS payment rate for 2023, for those hospitals that meet quality reporting requirements. The OPPS provides technical component (TC) reimbursement…