Patients will benefit from increased device and service accessibility, while providers may experience payment pressure

Audiologists and patients who depend on hearing aids for quality of life are affected by two recent judgements. The 2023 Medicare Physician Fee Schedule Proposed Rule, which was announced on July 7 and the Medical Devices; Ear, Nose, and Throat Devices; Establishing Over-the-Counter Hearing Aids Final Rule, respectively, are the first and second


More OTC Options for People with Hearing Loss

Millions of Americans now have easier access to and lower costs for over-the-counter (OTC) hearing aids thanks to the FDA's news release from August 17. The less expensive hearing aids might be seen as early as mid-October and won't require a medical checkup, prescription, or fitting modification by an audiologist. According to a news statement, the new FDA regulation "is intended to ensure the safety and effectiveness of OTC hearing aids, while supporting innovation and competition in the hearing aid technology sector." Patients with mild to moderate hearing loss can benefit from the greater access to hearing aids

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"Establishing this new regulatory category will allow patients with perceived mild to moderate hearing loss to have convenient access to an assortment of safe, effective, and reasonably priced hearing aids from their neighbourhood store or online," stated FDA Commissioner Robert M. Califf, MD



Audiologists Experience Financial Pain

The MPFS proposed rule would provide Medicare patients access to some audiology services without a doctor's prescription, but it would also reduce reimbursement for audiologists and speech-language pathologists starting in 2023



The American Academy of Audiology states that the following ways the proposed MPFS amendment impacts audiology payment:



The suggested conversion factor (CF) for CY 2023 is $33.0775. Absent congressional intervention, this means a drop of -4.42 percent from the CF of $34.6062 in 2022. This is mainly because the conversion factor will no longer be increased by 3 percent at the end of 2022 as required by law


The American Academy of Audiology also points out that "the 3 percent drop in the conversion factor" is NOT included in the Audiology Services Payment Values table in the proposed regulation. As a result, the impact that has been mentioned for audiology as a whole does not match what is shown in Table 138: CY 2023 PFS Estimated Impact on Total Allowed Charges by Specialty (page. 1439)



Visit the American Academy of Audiology website for a detailed list of the 2023 MPFS Proposed Rule Payment Chart for Audiology Services



Coding Adjustments Comply with the No Physician Referral Rule

In 2023, patients will only be able to visit an audiologist directly (without a physician referral) once every 12 months for a non-acute hearing assessment, according to a proposal from the Centers for Medicare & Medicaid Services (CMS). To record this, a fresh HCPCS G-code is being developed



GAUDX Audiology service(s) personally provided by an audiologist without a doctor's or NPP's order for non-acute hearing assessment, but not audiology services linked to disequilibrium, hearing aids, or exams for the purpose of prescribing, fitting, or altering hearing aids



Instead of invoicing for the 34 CPT® codes for audiology services that audiologists presently offer, they are required to use the GAUDX code. When performed every 12 months, the following 34 codes for tests that audiologists can perform without a doctor's or non-physician practitioner's (NPP) referral are proposed to be replaced by GAUDX: 92550, 92552, 92553, 92555-92557, 92562, 92563, 92565, 92567, 92568, 92570, 92571, 92572, 92575-92577, 92579, 92582



Audiologists need an order/referral and the appropriate CPT® code to record if the patient returns for therapy before the 12-month mark (s). Since the proposed GAUDX code is generic, both tests that are divided into PC/TC (professional component/technical component) and those that are not are possible, according to the American Academy of Audiology. Make sure every test is recorded in the medical record before invoicing. Only one unit of code GAUDX may be invoiced under the CMS proposed rule, and "1" should be included in the "days or units" box 24G on the CMS-1500 Claim Form


To offer value to GAUDX, CMS suggests combining the values of the most frequently used CPT® audiology codes. For instance:



92557 Complete audiometry, speech recognition, and threshold assessment (92553 and 92556 combined)



Tympanometry) 92567 (impedance testing)



According to CMS, the two codes 92557 (which combines 92553 and 92556) and 92567 are the most typical services rendered by audiologists



Medical organisations with reservations about the enhanced access to audiology services include the American Speech-Language-Hearing Association (ASHA). Although ASHA supports Medicare beneficiaries' right to access audiology services without a doctor or other healthcare professional's order, this specific provision is constrained, problematic, and, as proposed, could result in significant administrative burdens for audiologists and access challenges for Medicare beneficiaries

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