2006 proposed fee schedule - American Society of Clinical Oncology

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180 CBSA Code Urban Area Wage (Constituent Counties) Index 12100 Walton County, GA Atlantic City, NJ Atlantic County, NJ 1.1901 12220 Auburn-Opelika, AL Lee County, AL 0.8696 12260 Augusta-Richmond County, GA-SC Burke County, GA Columbia County, GA McDuffie County, GA Richmond County, GA Aiken County, SC 0.9785 12420 12540 12580 12620 12700 12940 Edgefield County, SC Austin-Round Rock, TX 0.9668 Bastrop County, TX Caldwell County, TX Hays County, TX Travis County, TX Williamson County, TX Bakersfield, CA 1.0582 Kern County, CA Baltimore-Towson, MD 1.0135 Anne Arundel County, MD Baltimore County, MD Carroll County, MD Harford County, MD Howard County, MD Queen Anne's County, MD Baltimore City, MD Bangor, ME 1.0233 Penobscot County, ME Barnstable Town, MA 1.2815 Barnstable County, MA Baton Rouge, LA 0.8799 Ascension Parish, LA East Baton Rouge Parish, LA East Feliciana Parish, LA Iberville Parish, LA Livingston Parish, LA Pointe Coupee Parish, LA St. Helena Parish, LA
181 CBSA Code Urban Area Wage (Constituent Counties) West Baton Rouge Parish, LA West Feliciana Parish, LA Index 12980 Battle Creek, MI Calhoun County, MI 0.9729 13020 Bay City, MI Bay County, MI 0.9567 13140 Beaumont-Port Arthur, TX Hardin County, TX Jefferson County, TX 0.8696 13380 13460 13644 13740 13780 13820 13900 13980 Orange County, TX Bellingham, WA 1.2013 Whatcom County, WA Bend, OR 1.1045 Deschutes County, OR Bethesda-Frederick-Gaithersburg, MD 1.1760 Frederick County, MD Montgomery County, MD Billings, MT 0.9047 Carbon County, MT Yellowstone County, MT Binghamton, NY 0.8768 Broome County, NY Tioga County, NY Birmingham-Hoover, AL 0.9186 Bibb County, AL Blount County, AL Chilton County, AL Jefferson County, AL St. Clair County, AL Shelby County, AL Walker County, AL Bismarck, ND 0.8696 Burleigh County, ND Morton County, ND Blacksburg-Christiansburg-Radford, VA 0.8696 Giles County, VA Montgomery County, VA Pulaski County, VA Radford City, VA 14020 Bloomington, IN 0.8696
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DEPARTMENT OF HEALTH AND HUMAN SERV
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2. By mail. You may mail written co
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Rick Ensor (410) 786-5617 (for issu
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service of the U.S. Government Prin
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4. Proposed Revisions to §413.170
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AGA American Gastroenterological As
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GAO General Accounting Office GPCI
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PLI Professional liability insuranc
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Initially, only the physician work
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This resource-based system was base
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effect in 1997, published on Novemb
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● Revised requirements for superv
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efinement of work RVUs; and solicit
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historical allowed charges. This le
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November 1, 2001 (66 FR 55246).) Th
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The CPEPs identified specific input
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codes that the RUC has not yet revi
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procedure: $27,305,408. In this exa
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as a whole. Indirect costs include
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● The unscaled indirect expense a
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BNF is applied to (multiplied by) t
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NPWP Step 2--Calculation of Charge-
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In Table 11, the scaled total direc
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TABLE 13--Budget Neutrality and Fin
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The following discussion outlines t
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exist, and suggests that the need f
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TABLE 14--Practice Expense Per Hour
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We believe that we have consistentl
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Due to the ongoing refinement by th
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indirect PE methodology is inaccura
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multi-specialty PEAC that were base
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the needed survey or other data or
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PERC/RUC recommendations for these
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eflect the typical number of cast c
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on comments received and additional
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We have reviewed the PE database an
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the ACR. We have accepted the follo
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● Clinical Labor for G-codes Rela
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proposed associated prices that we
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Supply Code Supply Description Unit
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● Supply and Equipment Items Need
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Code 2005 Description Unit Unit Pri
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Code 2005 Description Price EQ212 p
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Effective January 1, 2006, this pro
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challenge the validity of a new loc
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ones reconfigured). Yet we also rec
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The issue of payment locality desig
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specialties listed infrequently as
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for premium rating purposes. ISO co
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psychology to the nonsurgical risk
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to anesthesiology which is 2.84 rat
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103 However, as noted previously in
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● Category #1: Services that are
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G0270, G0271 and 97802 through 9780
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Group Medical Nutritional Therapy (
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111 furnished in the group setting
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CMS Review 113 As noted previously,
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system that permits the physician a
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117 associated with the provided se
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119 overlapping surgeries, the teac
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anesthesia programs that have arran
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123 Section 623 of the MMA also req
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125 hospital-based facilities; whil
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127 The next step would be to devel
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Page 131 and 132: 131 independent facilities, to acco
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Page 135 and 136: distributed this over a total proje
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Page 141 and 142: 141 than 0.9000 are paid more than
Page 143 and 144: adoption of the new hospital wage i
Page 145 and 146: of geographic designations for purp
Page 147 and 148: and they may or may not be suitable
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Page 151 and 152: (2) Metropolitan Divisions Under OM
Page 153 and 154: 153 applying revised composite paym
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Page 159 and 160: 159 ESRD facilities is 53.711, as s
Page 161 and 162: from the cost reports. To avoid dou
Page 163 and 164: from Worksheet A. The resulting mar
Page 165 and 166: (1) Hospital Data Used In this prop
Page 167 and 168: wage data ended. However, since the
Page 169 and 170: approach to phasing-in the proposed
Page 171 and 172: facilities that would receive lower
Page 173 and 174: 173 wage index values and then simu
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Page 217 and 218: TABLE 28--Proposed ESRD Wage Index
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Page 221 and 222: effect as long as the rate exceeds
Page 223 and 224: ● Adding a definition of a “ped
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Page 227 and 228: their intermediaries. Current parag
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231 revised paragraph, a facility w
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H. Payment for Covered Outpatient D
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calculation. We also discuss the su
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customers (for example, physicians)
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239 We believe the weighted average
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number of 11-digit NDCs sold for ea
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243 included in the template, it is
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current reporting format is an appr
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247 section 1847A of the Act for th
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each quarter at the following web s
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251 We also note MedPAC’s recomme
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costs and units. We seek comments a
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255 pays for DME and associated sup
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pharmacy activities required to get
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259 representing 42 percent of the
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261 basic pharmacy services such as
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seek comment on the potential impac
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265 overpaying for the costs associ
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267 and information about how pharm
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269 takes good faith efforts to res
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271 Specifically, we consider that
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supplies. Using billing data, we id
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70481 CT orbit/ear/fossa w/ dye 704
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K. Therapy Cap 73223 MRI joint uppe
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provided for an active subluxation
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is less than 2 percent of spending
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(2) entities determined by the Secr
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285 We are proposing a supplemental
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FQHC claim form to effectuate the b
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289 can issue a final determination
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291 conclude that Hispanic persons
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293 nuclear medicine services in ei
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adiopharmaceuticals. In the final r
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297 (including Nuclear Medicine and
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we would resolve any doubt on the m
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facility payment rather than a TC c
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ventures and leases, pose a risk of
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305 Underlying the projected rate r
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decisions are central to the health
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however. We are particularly intere
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The collection requirement in this
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eporting requirements are discussed
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IV. Response to Comments Because of
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achieve the objectives with less si
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319 The analysis and discussion pro
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321 for a new code may change becau
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323 TABLE 30--Impact of Practice Ex
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hour for these specialties. As note
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Both physical/occupational therapy
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329 proposing to add cardiology cat
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Speciality Impact of Removing Aberr
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Family TABLE 32--Impact of Multiple
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335 column includes the current est
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Specialty Medicare Allowed Charges
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339 Non-Facility Facility % % HCPCS
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341 have undertaken a similar analy
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of the updated GPCI data. For the R
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C. Medicare Telehealth Services In
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347 TABLE 37--Impact of Proposed Ch
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349 of the increase to the drug add
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plus current AAP priced drug paymen
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353 the center up to what it would
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satisfies the requirements of the i
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357 certainty the extent of these s
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delivery arrangements and would hel
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List of Subjects 42 CFR Part 405 Ad
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(including by refunding amounts in
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(2) Any financial incentives provid
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7. The authority citation for part
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* * * * * PART 413--PRINCIPLES OF R
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371 D. Redesignating paragraphs (l)
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373 (3) The additional nursing hour
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cost components relating to trainin
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CAPD and CCPD) when the facility ac
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Indirect Sales means from the manuf
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amount for the quarter to the neare
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383 25. The heading for Part 426 is
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385 (Catalog of Federal Domestic As
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1. CPT/HCPCS code. This is the CPT
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grace period. This indicator is no
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5. Physician work RVUs. These are t
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ADDENDUM B: RELATIVE VALUE UNITS (R
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CPT Code Short Descriptors 21480 Re
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CPT Code Short Descriptors 92284 Da
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Addendum D 2006 GEOGRAPHIC PRACTICE
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Carrier Locality Locality name Work
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Carrier Locality Locality Name 2006
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Addendum F ESRD FACILITIES- METROPO
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715 SSA State/County Code County an
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