Medicare: Medicare Updates: CPT Rate Increases Happy 2004! The new year brings us some good news from the Centers for Medicare and Medicaid Services (CMS) concerning Medicare rate adjustments for many services. As you may already know, the reimbursement rates were increased from $ 42.30 (2003 rate) to $131.43 (2004 rate) for a clinical dysphagia ... Article
Article  |   March 01, 2004
Medicare: Medicare Updates: CPT Rate Increases
Author Notes
  • Rosemary GriffinColumn Editor
Article Information
Swallowing, Dysphagia & Feeding Disorders / Practice Management / Professional Issues & Training / Medicare
Article   |   March 01, 2004
Medicare: Medicare Updates: CPT Rate Increases
SIG 11 Perspectives on Administration and Supervision, March 2004, Vol. 14, 9-10. doi:10.1044/aas14.1.9
SIG 11 Perspectives on Administration and Supervision, March 2004, Vol. 14, 9-10. doi:10.1044/aas14.1.9
Happy 2004! The new year brings us some good news from the Centers for Medicare and Medicaid Services (CMS) concerning Medicare rate adjustments for many services.
As you may already know, the reimbursement rates were increased from $ 42.30 (2003 rate) to $131.43 (2004 rate) for a clinical dysphagia evaluation and from $45.98 (2003 rate) to $131.43 (2004 rate) for the videofluoroscopic or modified barium swallow study. The reimbursement rate for a speech-language evaluation is also increased from approximately $93 (in 2003) to $131 (in 2004).
At the New York State Speech-Language-Hearing Association Convention last year, Steven White from ASHA presented the rather complex mechanism by which CMS determines rates for particular services. Each CPT procedure is evaluated according to a resource-based relative value system. This takes into account the amount of work (time, technical skill, physical effort, stress, and judgment) required of physicians and other practitioners, as well as overhead costs and professional liability costs. Apparently, the significant decrease in reimbursement for dysphagia services throughout 2003 was due to a RVU (relative value unit) calculation that omitted the physician work component. Many thanks are extended to Steve White and other members of ASHA’s Health Care Economics Committee (HCEC) for successfully advocating for an adjustment in many rates. Unfortunately, the reimbursement for a speech-language treatment session was reduced in 2004 by 19% from the 2003 rate. ASHA’s explanation is that CMS was reviewing the work factors typically involved when working with a child and that the 2003 rate is, therefore, an inappropriate reimbursement amount when applied to adult treatment. ASHA’s HCEC will be presenting this concern to the Practice Expense Advisory Committee (PEAC) for further review.
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