2006 proposed fee schedule - American Society of Clinical Oncology

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72142 MRI neck spine w/dye 72146 MRI chest spine w/o dye 72147 MRI chest spine w/dye 72148 MRI lumbar spine w/o dye 72149 MRI lumbar spine w/dye 72156 MRI neck spine w/o & w/dye 72157 MRI chest spine w/o & w/dye 72158 MRI lumbar spine w/o & w/dye Family 7 CT (spine) 72125 CT neck spine w/o dye 72126 CT neck spine w/dye 72127 CT neck spine w/o & w/dye 72128 CT chest spine w/o dye 72129 CT chest spine w/dye 72130 CT chest spine w/o & w/dye 72131 CT lumbar spine w/o dye 72132 CT lumbar spine w/dye 72133 CT lumbar spine w/o & w/dye Family 8 MRI and MRA (lower extremities) 73718 MRI lower extremity w/o dye 73719 MRI lower extremity w/dye 73720 MRI lower ext w/ & w/o dye 73721 MRI joint of lwr extre w/o dye 73722 MRI joint of lwr extr w/dye 73723 MRI joint of lwr extr w/o & w/dye 73725 MRA lower ext w or w/o dye Family 9 CT and CTA (lower extremities) 73700 CT lower extremity w/o dye 73701 CT lower extremity w/dye 73702 CT lower extremity w/o & w/dye 73706 CTA lower ext w/o & w/dye Family 10 Mr and MRI (upper extremities and joints) 73218 MRI upper extr w/o dye 73219 MRI upper extr w/dye 73220 MRI upper extremity w/o & w/dye 73221 MRI joint upper extr w/o dye 73222 MRI joint upper extr w/dye 276
K. Therapy Cap 73223 MRI joint upper extr w/o & w/dye Family 11 CT and CTA (upper extremities) 73200 CT upper extremity w/o dye 73201 CT upper extremity w/dye 73202 CT upper extremity w/o & w/dye 73206 CTA upper extr w/o & w/dye 277 [If you choose to comment on issues in this section, please include the caption “THERAPY CAP” at the beginning of your comments.] Section 1833(g)(1) of the Act applies an annual, per beneficiary combined cap on outpatient physical therapy (PT) and speech-language pathology services, and a similar separate cap on outpatient occupational therapy services under Medicare Part B. This cap was added by section 4541 of the BBA 1997, Pub. L. 105-33. However, the application of the caps was suspended from CY 2000 through CY 2002 under section 1833(g)(4) of the Act by section 221 of the of BBRA 1999, Pub. L. 106-113, and extended by section 421 of BIPA 2000, Pub. L. 105-551. The caps were implemented from September 1, 2003 through December 7, 2003. Section 624 of the MMA reinstated the moratorium on the application of these caps from December 8, 2003 through December 31, 2005.
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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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● Adding a definition of a “ped
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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 247 and 248: 247 section 1847A of the Act for th
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Page 251 and 252: 251 We also note MedPAC’s recomme
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Page 263 and 264: seek comment on the potential impac
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Page 267 and 268: 267 and information about how pharm
Page 269 and 270: 269 takes good faith efforts to res
Page 271 and 272: 271 Specifically, we consider that
Page 273 and 274: supplies. Using billing data, we id
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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
Page 297 and 298: 297 (including Nuclear Medicine and
Page 299 and 300: we would resolve any doubt on the m
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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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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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