2023 Medicare Part B Proposed Rule Includes New Provision for Access to Audiology Services, Payment Cuts, and Some Telehealth Expansion

UPDATE: Additional Details on 2023 Medicare Proposed Rule, Including Payment Cuts, Access to Audiology Services, Coding Updates (July 15, 2022)

The Centers for Medicare & Medicaid Services (CMS) has released the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule, which establishes payment policies and rates for Part B (outpatient) audiology and speech-language pathology services. Significant policies addressed in this rule include—but are not limited to—a new provision for access to audiology services; payment cuts for audiology, speech-language pathology, and other services; changes to coding for remote therapeutic monitoring; telehealth services; quality reporting; and alternative payment models.

ASHA will submit comprehensive comments on the proposed rule by early September. The final rule will apply to services provided in calendar year 2023.

The following information highlights key provisions impacting audiologists and speech-language pathologists. ASHA will provide a more detailed summary of these and other proposed changes through ASHA Headlines and ASHA Leader Live next week.

Payment Rates and Coding Updates

Conversion Factor

CMS uses an annual conversion factor (CF) to calculate MPFS payment rates. For 2023, CMS estimates that the CF will be $33.08, representing a nearly 4.5% decrease from the $34.61 CF for 2022. The proposed decrease in the CF is due in large part to expiration of the 3% positive adjustment that Congress implemented to mitigate significant payment cuts in 2022. Congress must act again to stop the return of the cuts in 2023. ASHA is engaged in ongoing advocacy with Congress and key stakeholders to find short and long-term solutions to address Medicare payment issues.

Coding Updates

CMS is proposing two new G-codes for remote therapeutic monitoring (RTM) services for use under the MPFS. Under the proposed rule, speech-language pathologists (SLPs) would be required to report these new G-codes instead of existing Current Procedural Terminology (CPT®) codes for RTM treatment management services (CPT codes 98980 and 98981).

New Provision for Access to Audiology Services

CMS proposes allowing Medicare beneficiaries access to covered audiology services without a physician referral once per calendar year through use of a new G-code reported by audiologists. While supportive of the movement toward removing the unnecessary physician order requirement, ASHA notes elements of this specific proposal are problematic for both audiologists and beneficiaries. ASHA will address these issues directly with CMS during the comment period.

Telehealth

CMS proposes covering several additional CPT codes typically used by audiologists and SLPs through the end of 2023. Coverage of audiology and speech-language pathology services provided via telehealth is currently tied to the federal Public Health Emergency (PHE), which remains in effect and is renewed every 90 days. If the PHE ends prior to the end of 2023, these codes will only be reimbursed when utilized by a physician or practitioner. ASHA will provide a full listing of these codes in our next update. A listing is also available in Table 8 of the proposed rule.

ASHA remains committed to securing permanent authority for audiologists and SLPs to receive reimbursement for services provided via telehealth at parity with reimbursement for in-person services.

Merit-Based Incentive Payment System (MIPS)

The audiology specialty measure set for the 2023 performance/2025 payment year would include two new measures and remove one measure:

• Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling (Added)
• Screening for Social Drivers of Health (Added)
• Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness (Removed)

The Speech-Language Pathology specialty measure set for 2023 would add one measure for the 2023 performance/2025 payment year: Screening for Social Drivers of Health (Added).

Clinicians continue to be excluded from mandatory MIPS participation if they have allowed charges for covered professional services less than or equal to $90,000, furnish covered professional services to 200 or fewer Medicare Part B-enrolled individuals, or furnish 200 or fewer covered professional services to Medicare Part B-enrolled individuals. As a result, ASHA estimates that less than 1% of its members are subject to MIPS.

ASHA Resources

Additional details on the proposed rule will be published on ASHA Headlines and ASHA Leader Live next week. The current 2022 Medicare outpatient payment rates and related information for audiologists and SLPs are available on ASHA’s website.

Questions?

Please contact reimbursement@asha.org.