Centers for Medicare and Medicaid Services (CMS) Release Revision to 2004 Medicare Physician Fee Schedule for Part B Services

The Centers for Medicare and Medicaid Services (CMS) released a revision to its 2004 Medicare Physician Fee Schedule for Part B services to include policy changes from the recently passed Medicare legislation. As published in the Federal Register on January 7, it can be found at: https://www.federalregister.gov/articles/2004/01/07/03-32323/medicare-program-changes-to-medicare-payment-for-drugs-and-physician-fee-schedule-payments-for.

CMS announced that the conversion factor will be $37.3374, which represents a 1.5% increase in overall reimbursement rates. The Medicare Prescription Drug, Improvement and Modernization Act (MPDIMA) of 2003 (P.L. 108-173) saved providers from a 4.5% across-the-board rate reduction. The 2004 payment rates apply to all audiology Medicare Part B services, except for those audiology services provided in a hospital.

ASHA's 2004 Medicare Fee Schedule for Audiologists is available to ASHA members on the Web site at:
https://asha.org/members/issues/reimbursement/analysis-2004mfs. This ASHA document provides a listing of all the procedures used by audiologists, cites the actual national average payment amounts, and describes 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 the over 1000 pages of CPT codes and payment policies from the Federal Register and AMA CPT Manual.

For the most part, the audiology rates received modest increases because of the new conversion factor. For example, the comprehensive hearing test rate rose by 4% to $48.91 from $47.09, tympanometry is increased to $21.66 from $20.97 and electrocochleography rose to $100.81 from $99.32. There will be a new temporary procedure code (G0268 - Removal of Impacted Cerumen, one or both ears) to be used by a physician on the same date of service as audiologic function testing. According to CMS, the new code is to be used only in those unusual circumstances when an employed audiologist who bills under a physician uniform provider identifier number (UPIN) performs audiologic function testing on the same day as removal of impacted cerumen requiring physician expertise for the removal.

The complete final rule with addendums also can be found on the CMS Web site at: https://cms.hhs.gov/. For more information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or at 800-498-2071, ext. 4139; or Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, via e-mail at ilusis@asha.org or at 800-498-2071, ext. 4482.