Medicare Part B Payment Cuts to Audiology and Speech-Language Pathology Services

Updated December 6, 2022

Audiologists and speech-language pathologists (SLPs) have faced significant payment cuts to Medicare Part B (outpatient) services beginning in 2021. Although extensive advocacy by ASHA and other stakeholders resulted in legislation that mitigated the 2021 and 2022 cuts, the cuts are set to return in 2023 if Congress doesn't act again by the end of the year.

ASHA has engaged in ongoing advocacy and collaboration with CMS, key decision makers—including members of Congress—and other provider groups to find short- and long-term solutions. These activities are a part of our overall efforts to ensure adequate Medicare payment for audiology and speech-language pathology services.

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Impact on Audiologists and SLPs

In its release of the 2023 final rule for the Medicare Physician Fee Schedule (MPFS) for Part B services, CMS finalized an almost 4.5% decrease to the conversion factor (CF), which will disproportionately impact Medicare Part B payment for audiologists, speech-language pathologists (SLPs), and over 30 other Medicare provider groups. This cut is primarily due to the expiration of the 3.00% payment adjustment to mitigate the impact of the 2022 cuts.

Audiologists and SLPs also face other Medicare cuts unrelated to the cut to the CF. These cuts, known as sequestration (2% reduction), and statutory "Pay-As-You-Go", or PAYGO, (4% reduction), could result in over 10% in total cuts to overall Medicare payments when added to the CF reduction. Congress acted to address some—but not all—of these cuts in 2021 and 2022 by passing legislation that significantly reduced the cuts and phased in the remaining cuts over the course of 2022.

Summary of Estimated Payment Changes

For 2023, CMS estimates an overall 2% decrease in payment for audiology services and a 1% decrease for speech-language pathology services in addition to the adjustments outlined above, which means audiologists are facing at least a 12% decrease in payments and SLPs an 11% decrease. Keep in mind that the direct, cumulative impact of payment adjustments on individual clinicians or practices will vary depending on several factors, including locality-specific rates and the specific procedure codes billed. For additional information, please see ASHA's detailed analysis of the final rule.

ASHA’s advocacy efforts have focused on reversing these cuts in their entirety and working toward a long-term solution to stabilize Medicare payment policy. While far from ideal, Congressional action reduced the near-term Medicare payment cuts in 2021 and 2022—which could have been as high as 10% or more—allowing additional time for ASHA to work with allied stakeholders to convince Congress to more fully address the cuts in 2023 and to work toward a long-term policy solution. However, clinicians should be prepared for some cuts to go into effect on Jan. 1 if Congress does not pass a full legislative fix before the end of the year.

Why This is Happening

The Medicare Part B payment cuts are the result of three separate statutory provisions designed to control federal spending. They are 1) budget neutrality, 2) statutory "Pay-As-You-Go" (PAYGO), and 3) sequestration. Advocacy by ASHA and other stakeholders helped lead to legislation postponing or mitigating these cuts for 2021 and 2022. However, they are slated to return in 2023 without further Congressional action.

Budget Neutrality

A significant portion of the payment cuts came about because CMS finalized changes to office-based outpatient evaluation and management (E/M) procedure codes, resulting in payment increases for primary care services beginning in 2021. Every year, CMS must ensure that rate changes for all procedure codes paid under the MPFS remain budget neutral, as mandated by law. As a result, Medicare Part B providers may see incremental decreases in payments annually when CMS shifts funding to accommodate increases in payments for other services. The negative impact to across the board Medicare payments is higher than usual because of the significant increase in value for the updated E/M codes. Although legislation significantly reduced the E/M-related cuts in 2021 by 3.75% and by 3% in 2022, it didn't stop the E/M code changes, so the payment reductions will continue to return each year to meet the budget neutrality mandate, unless Congress and CMS find short- and long-term policy solutions.

Statutory PAYGO

This policy requires new legislation increasing the federal deficit to be offset by reduced spending elsewhere. Medicare payments are subject to this policy, but can't be reduced by more than 4%.

Sequestration

This policy stems from a 2011 law requiring automatic reductions in programs, such as Medicare, to impose fiscal restraint on federal spending. 

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ASHA’s Advocacy Highlights

Congressional Advocacy

ASHA engages in ongoing advocacy with House and Senate members and staff directly and as part of a broad coalition of physician and nonphysician groups urging Congress to prevent resumption of the sequestration cuts and to seek short- and long-term solutions to Medicare payment cuts to audiology and speech-language pathology services.

Regulatory Advocacy

ASHA engages in ongoing advocacy with CMS and the Department of Health and Human Services (HHS) directly and as part of a broad coalition of physician and nonphysician groups to find regulatory solutions to find strategies within CMS's authority to mitigate the negative impact of the cuts to providers, including audiologists and SLPs.

  • ASHA member sign-on letter [PDF] asking CMS to find ways to reduce the impact of the cuts and to work with Congress on long-term Medicare payment reform (9/6/2022)
  • Comment letter to CMS [PDF] regarding the proposed 2023 Medicare Physician Fee Schedule (9/6/2022)
  • Comment letter to CMS [PDF] regarding the proposed 2022 Medicare Physician Fee Schedule (9/9/2021)
  • Request for a meeting [PDF] with CMS Administrator Chiquita Brooks LaSure to discuss the payment cuts (7/2/2021)

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The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.

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