On January 11, Health and Human Services (HHS) Secretary Alex Azar extended the COVID-19 Public Health Emergency (PHE) declaration effective January 21, 2021, for an additional 90 days. This means that all of the telehealth and other waivers and flexibilities that have been implemented during the PHE will remain in effect until at least April 21, 2021.
In addition, the Consolidated Appropriations Act that was signed into law on December 27, 2020, included provisions that offset most of the 10.2 percent budget neutrality adjustment that had been slated to take effect for Medicare-covered services provided as of January 1, 2021. This changes the CY2021 conversion factor from $32.36 to $34.89 and is accomplished by:
- An increase in the payment schedule of 3.75 percent. This is applied across the board and without distinction to all payments under the Medicare physician payment schedule.
- Extending the two percent Medicare sequester moratorium through March 2021.
- Suspending payments for HCPCS code G2211 for three years (through the end of December 2023). G2211 is the complexity add on code for E/M services.
The Center for Medicare and Medicaid Services (CMS) has now confirmed that it is implementing the above provisions of this legislation and that there will be no delay in claims processing for 2021 services; that is, claims will be paid on time at the correct 2021 rates that reflect this legislation. A projected impact table by specialty and updated CY2021 audiology services fee schedule can be located here.
The Academy remains committed to fighting any cuts to Medicare reimbursement. We are pleased that based on the provisions in the legislation, the revised impact calculations show Audiologists potentially with a three percent increase in CY2021 Medicare reimbursement. This is based on the individual mix of services provided at each practice, but a much-welcomed improvement from the projected 6 percent decrease cuts to CY2021 Medicare reimbursement. If you should have any questions, please contact the Academy’s advocacy team.
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…
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…
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…