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CMS Creates New Payment Level for Cochlear Implant Follow-up Services

The Centers for Medicare and Medicaid Services (CMS) accepted comments submitted by ASHA to create a new Ambulatory Payment Classification (APC) for cochlear implant follow-up and programming. As part of its comments to CMS on the Hospital Outpatient Prospective Payment System (OPPS) for 2005, ASHA argued that reimbursement for these procedures were unreasonably low given the time, complexity, and resources involved; and were not clinically homogeneous with other procedures within the APC 0365 (Level II Audiometry). As a result, CMS has established a new APC 0366 (Level III Audiometry) which will include services specific to diagnostic analysis and programming after cochlear implantation (CPT codes 92601-92604). Level III Audiometry codes will be reimbursed at $104.92, while Level II Audiometry codes will be reimbursed at $72.61.

CMS has also increased reimbursement rates for cochlear implantation by almost 15% for a median payment rate of $26,000. ASHA urged the increased reimbursement rate for this procedure. For additional information, please contact Mark Kander, ASHA’s Director of Health Care Regulatory Analysis, at mkander@asha.org or via telephone at 800-489-2071, ext. 4139.