2006 proposed fee schedule - American Society of Clinical Oncology

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212 CBSA Code Urban Area Wage (Constituent Counties) Index 45780 Miller County, AR Bowie County, TX Toledo, OH Fulton County, OH Lucas County, OH Ottawa County, OH 0.9805 45820 45940 46060 46140 46220 46340 46540 46660 Wood County, OH Topeka, KS 0.9135 Jackson County, KS Jefferson County, KS Osage County, KS Shawnee County, KS Wabaunsee County, KS Trenton-Ewing, NJ 1.1095 Mercer County, NJ Tucson, AZ 0.9194 Pima County, AZ Tulsa, OK 0.8696 Creek County, OK Okmulgee County, OK Osage County, OK Pawnee County, OK Rogers County, OK Tulsa County, OK Wagoner County, OK Tuscaloosa, AL 0.8922 Greene County, AL Hale County, AL Tuscaloosa County, AL Tyler, TX 0.9521 Smith County, TX Utica-Rome, NY 0.8696 Herkimer County, NY Oneida County, NY Valdosta, GA 0.9079 Brooks County, GA Echols County, GA Lanier County, GA Lowndes County, GA 46700 Vallejo-Fairfield, CA 1.5242
213 CBSA Code Urban Area Wage (Constituent Counties) Index 46940 Solano County, CA Vero Beach, FL Indian River County, FL 0.9661 47020 Victoria, TX Calhoun County, TX Goliad County, TX 0.8696 47220 47260 47300 47380 47580 47644 47894 Victoria County, TX Vineland-Millville-Bridgeton, NJ 1.0063 Cumberland County, NJ Virginia Beach-Norfolk-Newport News, VA-NC 0.9011 Currituck County, NC Gloucester County, VA Isle <strong>of</strong> Wight County, VA James City County, VA Mathews County, VA Surry County, VA York County, VA Chesapeake City, VA Hampton City, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City, VA Williamsburg City, VA Visalia-Porterville, CA 1.0306 Tulare County, CA Waco, TX 0.8723 McLennan County, TX Warner Robins, GA 0.8853 Houston County, GA Warren-Farmington Hills-Troy, MI 1.0088 Lapeer County, MI Livingston County, MI Macomb County, MI Oakland County, MI St. Clair County, MI Washington-Arlington-Alexandria, DC-VA-MD-WV 1.1184 District <strong>of</strong> Columbia, DC
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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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Drugs Second Quarter ASP +6 Percent
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131 independent facilities, to acco
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133
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distributed this over a total proje
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137 additional 0.7 percent addition
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139 billed drugs regardless of sett
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141 than 0.9000 are paid more than
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adoption of the new hospital wage i
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of geographic designations for purp
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and they may or may not be suitable
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the Medicare Geographic Classificat
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(2) Metropolitan Divisions Under OM
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153 applying revised composite paym
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ased on the labor components establ
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157 actual cost structure faced by
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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
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Page 173 and 174: 173 wage index values and then simu
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Page 211: 211 CBSA Code Urban Area Wage (Cons
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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Page 233 and 234: H. Payment for Covered Outpatient D
Page 235 and 236: calculation. We also discuss the su
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Page 245 and 246: current reporting format is an appr
Page 247 and 248: 247 section 1847A of the Act for th
Page 249 and 250: each quarter at the following web s
Page 251 and 252: 251 We also note MedPAC’s recomme
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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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