Monday, 04 January 2021

Medical Reimbursement, Consolidated Appropriations Act 2021

Posted in ADA News

On December 27, 2020, President Donald Trump signed the Consolidated Appropriations Act 2021 (HR 133) into law. The following provisions were included in this Act, which went into effect on January 1, 2021. These audiology related provisions include:

  • A three month moratorium (until March 31, 2021) on the 2% sequestration that has been applied to all Medicare allowable payments since April 2013.
  • A one year moratorium (until January 1, 2022) on the approximate 7% payment reduction that was scheduled to be applied to all covered audiology services in 2021. Medicare payments will now only be reduced by 2.25 to 3.25% (or .25 to 1.25%, for the first quarter, if you also consider the sequestration moratorium).
  • Creation of regulations governing surprise medical billing. If you are out of network with a Medicare Advantage plan, providers should never be collecting more than the Medicare limiting charge for Medicare covered services. If a provider is out of network with a specific insurer, providers should be having the patients complete a notice of non-coverage before charging them your usual and customary rate for out of network services.
  • Given that this bill was just signed one week ago, the Centers for Medicare and Medicaid Services (CMS) has yet to update their Medicare Physician Fee Schedule Lookup Tool. None of the Medicare Administrative Contractors have updated their fee schedules as of yet. As a result, there is no way to know yet exactly what the Medicare allowable rates will be for your area. Please routinely check the websites for these updates.

If you have any questions or concerns, please do not hesitate to contact This email address is being protected from spambots. You need JavaScript enabled to view it. or call 773-960-6625.