On August 8th, the Centers for Medicare and Medicaid Services (CMS) published their proposed reimbursement schedule for audiologists that will reduce payments by 21.3% over a four year period. Next year it is proposed that our reimbursement be reduced by 5.8%. These figures represent a reduction that is four times greater than any other health care provider. Chiropractors were second to audiologists with a reduction of 5.3% over the next four years.

The pertinent section of the proposed fee schedule can be reviewed here. The complete document can be found on the CMS website.

Why did CMS propose such a drastic reduction in our reimbursement rates? Audiology codes over the decades existed in a special category called “non-physician work pool.” CMS has decided to remove all non-physician work pool codes and place them in a category called “individual specialty pool.” This action results in a severe reduction in audiologists’ reimbursement. CMS’ proposed fees do not presently include practice expenses nor do they recognize that hearing and balance services include “physician work.” Physician work means that CMS views our services as not requiring any patient management. CMS assumes that audiologists only perform a test and then blindly turn over the results to a physician for interpretation and patient counseling. As we know, this is not truly the case. The CMS perception that audiologists do not manage patient care is perpetuated by their strong physician bias. CMS lags far behind all other insurance carriers in their utilization of non-physician providers.

The audiology membership organizations have opened a dialogue with CMS to voice concern over this proposed fee structure and, more importantly, to point out issues that are not presently being considered. The ADA Board would like to assure you that we are working on your behalf to reverse CMS’s drastic reduction in your reimbursement rates. We realize that resolving this issue to benefit patients is your top priority. If CMS’ proposed reductions are not changed, then our profession will also be adversely affected by other insurance carriers who use Medicare payment rates to decide payment rates. Thus, the proposed Medicare reductions could easily impact our entire portfolio of diagnostic reimbursement with other insurance carriers.

Call to Action
You have the right to voice your opinion on this proposed fee reduction for our profession. Log on to this CMS website to send your comments via the Internet. When you enter your comments you will note that Medicare does not list audiologists as a category. Please list yourself as "other practitioner."

We have placed a recommended letter on our Web site that you can cut and paste into the comments section. [Note: This document is in PDF format which requires Adobe Reader. After opening the document, choose the "Select Text" tool and highlight the text you wish to copy. Copy and Paste as you would normally.

CMS must receive public comments by Friday, September 30th. So, act now on behalf of your patients and your profession!

Please feel free to contact me with any questions  at 410-944-3100. Thank you for your help.

Craig Johnson, Au.D. President

DISCLAIMER: The ADA is dedicated to leadership in advancing practitioner excellence, high ethical standards, professional autonomy, hearing technology, and sound business practices in the provision of quality audiological care.