2006 proposed fee schedule - American Society of Clinical Oncology

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● Incentive payment improvements for physicians in physician shortage areas. ● Changes to payment for covered outpatient drugs and biologicals and drug administration services. ● Changes to payment for renal dialysis services. ● Coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration. ● Coverage of hospice consultation service. ● Indexing the Part B deductible to inflation. ● Extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases. ● Revisions to reassignment provisions. ● Payment for diagnostic mammograms. ● Coverage of religious nonmedical health care institution items and services to the beneficiary’s home. In addition, the November 15, 2004 PFS final rule finalized the calendar year (CY) 2004 interim RVUs for new and revised codes in effect during CY 2004 and issued interim RVUs for new and revised procedure codes for CY 2005; updated the codes subject to the physician self-referral prohibition; discussed payment for set-up of portable x-ray equipment; discussed the third 5-year 24
efinement of work RVUs; and solicited comments on potentially misvalued work RVUs. In accordance with section 1848(d)(1)(E) of the Act, we also announced that the PFS update for CY 2005 would be 1.5 percent; the initial estimate for the sustainable growth rate for CY 2005 is 4.3; and the CF for CY 2005 is $37.8975. 25
Page 1 and 2: DEPARTMENT OF HEALTH AND HUMAN SERV
Page 3 and 4: 2. By mail. You may mail written co
Page 5 and 6: Rick Ensor (410) 786-5617 (for issu
Page 7 and 8: service of the U.S. Government Prin
Page 9 and 10: 4. Proposed Revisions to §413.170
Page 11 and 12: AGA American Gastroenterological As
Page 13 and 14: GAO General Accounting Office GPCI
Page 15 and 16: PLI Professional liability insuranc
Page 17 and 18: Initially, only the physician work
Page 19 and 20: This resource-based system was base
Page 21 and 22: effect in 1997, published on Novemb
Page 23: ● Revised requirements for superv
Page 27 and 28: historical allowed charges. This le
Page 29 and 30: November 1, 2001 (66 FR 55246).) Th
Page 31 and 32: The CPEPs identified specific input
Page 33 and 34: codes that the RUC has not yet revi
Page 35 and 36: procedure: $27,305,408. In this exa
Page 37 and 38: as a whole. Indirect costs include
Page 39 and 40: ● The unscaled indirect expense a
Page 41 and 42: BNF is applied to (multiplied by) t
Page 43 and 44: NPWP Step 2--Calculation of Charge-
Page 45 and 46: In Table 11, the scaled total direc
Page 47 and 48: TABLE 13--Budget Neutrality and Fin
Page 49 and 50: The following discussion outlines t
Page 51 and 52: exist, and suggests that the need f
Page 53 and 54: TABLE 14--Practice Expense Per Hour
Page 55 and 56: We believe that we have consistentl
Page 57 and 58: Due to the ongoing refinement by th
Page 59 and 60: indirect PE methodology is inaccura
Page 61 and 62: multi-specialty PEAC that were base
Page 63 and 64: the needed survey or other data or
Page 65 and 66: PERC/RUC recommendations for these
Page 67 and 68: eflect the typical number of cast c
Page 69 and 70: on comments received and additional
Page 71 and 72: We have reviewed the PE database an
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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
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from the cost reports. To avoid dou
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from Worksheet A. The resulting mar
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(1) Hospital Data Used In this prop
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wage data ended. However, since the
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approach to phasing-in the proposed
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facilities that would receive lower
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173 wage index values and then simu
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175 Because Neighborhood Dialysis C
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177 detected through our receipt of
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179 CBSA Code Urban Area Wage (Cons
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TABLE 28--Proposed ESRD Wage Index
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● Extraordinary circumstances (§
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effect as long as the rate exceeds
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● Adding a definition of a “ped
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exception rate. The facility would
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their intermediaries. Current parag
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229 costs are reasonable and allowa
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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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2006 proposed fee schedule - American Society of Clinical Oncology

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