The Centers for Medicare and Medicaid Services (CMS) has released the final 2007 Medicare Physician Fee Schedule (MPFS) rule, including 5.05% reduction in payments. The fees are for Part B outpatients, but also apply to inpatients who have exhausted their Part A benefit. The audiology fees apply to the same patient categories, but do not include outpatient hospital services that are governed by a different Medicare payment system. For 2007, there is a new Current Procedural Terminology (CPT) code for auditory brainstem implant programming (92640), as a result of ASHA's advocacy efforts.
Although the midterm elections are set to usher in a new Congress, hope remains that a "lame duck" session of Congress will address the fee schedule payment cut as well as other Medicare priorities. The 5 % cut, that has been the subject of ongoing debate in Congress for more than six years, is the result of a statutory formula known as the Sustainable Growth Rate (SGR). The SGR was originally created to provide stable, long-term growth in Medicare fee schedule expenditures by tying payment increases to a target growth rate based on overall annual expenditures. Congress overturned scheduled cuts in every year except one. As a result of the repeated increases over the target rate, CMS projects a 5% cut for next year's fee schedule.
The percentage reduction affects the conversion factor (reduced by $1.9127 to $35.9848) that is the multiplier for each CPT procedure's relative value units (RVUs). Every CPT code incurs a 5.05% reduction unless there is a change in RVUs. Many audiology and speech-language pathology CPT procedures increased in RVUs, but not enough to eliminate the overall five percent reduction. New payment amounts for selected high incidence codes are:
Sample Changes in Audiology Services
One of the most commonly reported audiology procedures, CPT 92557, comprehensive audiometry, has an increase in the total RVU to 1.33 from 1.31, but the payment will decrease to $47.86 from $49.65 due to the conversion factor rate cut. Other audiology procedures of note are 92585, comprehensive auditory evoked potentials, where the total RVU will decrease to 2.69 from 2.72 and the rate will decrease to $96.80; comprehensive otoacoustic emission RVUs will see a 7% decrease to 1.98; and the 2007 fee will only be $71.25. Among the newer procedures, 92603 will have an 11.3% increase in total RVUs, but the payment will decrease to $84.13 from $88.88 and the new procedure, 92640, auditory brainstem implant programming, will have a total RVU of 1.41 and a payment level of $50.74.
Sample Changes in Speech-Language Pathology Services
The total RVUs for speech-language pathology services will have changes as well. Speech and language evaluation will have an increase to 3.65 from 3.49. Speech-language treatment will see a modest increase to 1.67 from 1.65 and dysphagia treatment increases to only 2.22 from 2.21. There will be problematic reductions in dysphagia clinical evaluation (to 3.06 from 3.52) and in the modified barium swallow evaluation (to 3.12 from 3.52). These artificial fluctuations should stop if ASHA efforts are successful and a truly relative value approach based on professional work as instituted by Medicare.
Like the SGR, without congressional intervention, the therapy cap would return without the exceptions process that, by statute, applied only to therapy services rendered in 2006. The new cap amount is $1,780 for combined services, provided by speech-language pathologists and physical therapists, does not impact services provided in hospitals.
CMS also announced that fees for telehealth services for speech-language pathologists and audiologists cannot be fully considered until Medicare law is amended to permit payment for our professions' services at a distant site. ASHA intends to make congressional action on Medicare coverage of telepractice services a priority in 2007.
The complete fee schedule for audiologists and speech-language pathologists will be posted soon on the ASHA Web site. ASHA will be working with CMS, Congress, and the entire audiology and speech-language pathology community so that Medicare recognizes our services appropriately. For questions about the 2007 MPFS, please contact either Neela Swanson by phone at 800-498-2071, ext. 4387, or by e-mail at nswanson@asha.org; or Mark Kander at 800-498-2071, ext. 4139, or at mkander@asha.org.
Reprinted by permission of the American Speech-Language-Hearing Association
