2006 proposed fee schedule - American Society of Clinical Oncology

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Global $1,095.00 $620.00 $1,714.00 $1,450 Table 29 Diagnostic Imaging Services Family 1 Ultrasound (Chest/Abdomen/Pelvis - Non- Obstetrical 76604 Ultrasound exam, chest, b-scan 76645 Ultrasound exam, breast(s) 76700 Ultrasound exam, abdom, complete 76705 Echo exam of abdomen 76770 Ultrasound exam abdo back wall, comp 76775 Ultrasound exam abdo back wall, lim 76778 Ultrasound exam kidney transplant 76830 Transvaginal Ultrasound, non-ob 76831 Echo exam, uterus 76856 Ultrasound exam, pelvic, complete 76857 Ultrasound exam, pelvic, limited Family 2 CT and CTA (Chest/Thorax/Abd/Pelvis) 71250 CT thorax w/o dye 71260 CT thorax w/ dye 71270 CT thorax w/o & w/ dye 71275 CTA, chest 72191 CTA, pelv w/o & w/ dye 72192 CT pelvis w/o dye 72193 CT pelvis w/ dye 72194 CT pelvis w/o & w/ dye 74150 CT abdomen w/o dye 74160 CT abdomen w/ dye 74170 CT abdomen w/o & w/ dye 74175 CTA, abdom w/o & w/ dye 75635 CTA abdominal arteries 0067T CT colonography; dx Family 3 CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck) 70450 CT head/brain w/o dye 70460 CT head/brain w/ dye 70470 CT head/brain w/o & w/ dye 70480 CT orbit/ear/fossa w/o dye 274 $207 + $978 + (.5 x $530)
70481 CT orbit/ear/fossa w/ dye 70482 CT orbit/ear/fossa w/o & w/ dye 70486 CT maxillofacial w/o dye 70487 CT maxillofacial w/ dye 70488 CT maxillofacial w/o & w/ dye 70490 CT soft tissue neck w/o dye 70491 CT soft tissue neck w/ dye 70492 CT soft tissue neck w/o & w/ dye 70496 CTA, head 70498 CTA, neck Family 4 MRI and MRA (Chest/Abd/Pelvis) 71550 MRI chest w/o dye 71551 MRI chest w/ dye 71552 MRI chest w/o & w/ dye 71555 MRI angio chest w/ or w/o dye 72195 MRI pelvis w/o dye 72196 MRI pelvis w/ dye 72197 MRI pelvis w/o &w/ dye 72198 MRI angio pelvis w/ or w/o dye 74181 MRI abdomen w/o dye 74182 MRI abdomen w/ dye 74183 MRI abdomen w/o and w/ dye 74185 MRI angio, abdom w/ or w/o dye Family 5 MRI and MRA (Head/Brain/Neck) 70540 MRI orbit/face/neck w/o dye 70542 MRI orbit/face/neck w/ dye 70543 MRI orbit/face/neck w/o & w/dye 70544 MRA head w/o dye 70545 MRA head w/dye 70546 MRA head w/o & w/dye 70547 MRA neck w/o dye 70548 MRA neck w/dye 70549 MRA neck w/o & w/dye 70551 MRI brain w/o dye 70552 MRI brain w/dye 70553 MRI brain w/o & w/dye Family 6 MRI and MRA (spine) 72141 MRI neck spine w/o dye 275
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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
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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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Page 227 and 228: their intermediaries. Current parag
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Page 231 and 232: 231 revised paragraph, a facility w
Page 233 and 234: H. Payment for Covered Outpatient D
Page 235 and 236: calculation. We also discuss the su
Page 237 and 238: customers (for example, physicians)
Page 239 and 240: 239 We believe the weighted average
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Page 243 and 244: 243 included in the template, it is
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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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Page 261 and 262: 261 basic pharmacy services such as
Page 263 and 264: seek comment on the potential impac
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Page 269 and 270: 269 takes good faith efforts to res
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Page 273: supplies. Using billing data, we id
Page 277 and 278: K. Therapy Cap 73223 MRI joint uppe
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Page 283 and 284: (2) entities determined by the Secr
Page 285 and 286: 285 We are proposing a supplemental
Page 287 and 288: FQHC claim form to effectuate the b
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Page 291 and 292: 291 conclude that Hispanic persons
Page 293 and 294: 293 nuclear medicine services in ei
Page 295 and 296: adiopharmaceuticals. In the final r
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Page 299 and 300: we would resolve any doubt on the m
Page 301 and 302: facility payment rather than a TC c
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Page 305 and 306: 305 Underlying the projected rate r
Page 307 and 308: decisions are central to the health
Page 309 and 310: however. We are particularly intere
Page 311 and 312: The collection requirement in this
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Page 315 and 316: IV. Response to Comments Because of
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Page 319 and 320: 319 The analysis and discussion pro
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Page 323 and 324: 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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