MEDICAID REIMBURSEMENT OF HEARING SERVICES

1
MEDICAID REIMBURSEMENTOF HEARING SERVICES

• Peggy McManus, Ruti Levtov Karl White, Irene
  Forsman, Terry Foust
• July 2005

2
Methodology

• 15 state email survey, conducted by MCH Policy
  Research Center, January March 2005
• Examined FFS policies for a comprehensive set of
  hearing services
• Obtained 2005 fees and compared them to 2000 fees
  collected by MCHPRC in previous study

3
Research Questions

• Do states have reimbursable codes for a
  comprehensive set of hearing services?
• What are average payment amounts, range of
  payments, fee distribution in 2005?
• What changes in reimbursement have states made
  since 2000?
• How do state Medicaid fees compare to Medicare
  fees?

4
Overall Findings

• State Medicaid agencies have billable codes for a
  broad array of hearing services
• Wide variation exists in FFS payments for each of
  the hearing services examined
• Since 2000, Medicaid fees for more than half of
  the hearing services examined declined
• Medicaid fees are low, well below Medicare fees

5
Fees for Selected Hearing Services (Tables 1,2,
3)

• Diagnostic evaluation services (92506)
• In 2005, 13 of 15 states had a billable code for
  this service (MD ME had no code)
• Average rate 59.98 low of 12.10 (VT) to high
  of 127.42 in (WY vast majority paid in low to
  middle fee distribution
• Since 2000, fees for this service are on average
  32 higher than in same states in 2000

6
More Medicaid Fees

• Audiologic treatment services (92507)
• Same 2 states had no billable code for this
  service
• Lower fees than for 92506 39.16 on average, low
  of 10.38 and high of 69.03
• Fees increased, on average, by 21
• Variation in fees may be due to length of visit,
  which is not distinguished in CPT codes

7
Medicaid Fees for Audiologic Function Tests

• Almost all states had billable costs for each of
  the 15 tests
• Fees vary significantly by test (Table 1)
• Fee distribution shows no consistent pattern
• Since 2000, almost all of the fees declined

8
Medicaid Fees for Hearing Aid Services

• Billable codes for hearing aids are much more
  variable than for tests evaluation treatment
  services, esp. for digitally programmable hearing
  aids
• States more likely to use manual pricing or
  bundled payments for hearing aid services
• Range of payments is dramatic
• Fees for half of the hearing aid codes that
  existed in 2000 actually declined since 2000

9
Medicaid Fees for Cochlear Implant Services

• Most of these codes new since 2000 states often
  manually price these services or fold them into
  hospital payments
• Several states limit their billable codes for
  cochlear implant services
• In the 4 states with a billable code for cochlear
  devices, fees average 15,248, but ranged from
  14,074 to 17,127
• Initial cochlear implant fees increased by 8
  since 2000, but replacements decreased by almost
  7

10
Medicaid Fees for Assistive Communication Services

• 3 of 15 states have reimbursable codes for
  adaptive hearing devices
• State covering this service have manual pricing
  policies

11
Comparing Medicaid Medicare Fees (Table 4)

• Overall, Medicaid fees are 69 of Medicare fees
• Medicaid fees as a percent of Medicare fees vary
  by service, with a low of 40 for pure tone
  audiometry (air bone) and a high of 89 for
  auditory evoked potentials for evoked response
  audiometry

12
Policy Implications

• Although most states have billable codes for a
  broad array of hearing services, it is unclear
  whether states without billable codes for
  specific hearing services are using EPSDT
• Variation is state Medicaid fees are not
  accounted for by urban/rural state or per capita
  income

13
Policy Implications

• To arrive at more consistent payment policies,
  states may want to adopt fees that are some
  proportion of Medicare fees
• Low Medicaid payment levels are likely to
  adversely affect access to audiology services and
  also participation of audiologists

14
Policy Implications (cont.)

• Despite difficult financial times, it is
  important for State Medicaid agencies,
  audiologists, and EHDI officials to work together
  to phase-in improvements in reimbursement to
  assure that low income children have access to
  needed hearing services