2006 proposed fee schedule - American Society of Clinical Oncology

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TABLE 31--Specialty Impact of Malpractice RVU Changes Speciality Impact of Removing Aberrant Malpractice Data Impact of Crosswalk Changes Combined Impacts* Physicians: Allergy/Immunology 0.0% 0.0% 0.0% Anesthesiology 0.0% 0.0% -0.1% Cardiac Surgery 0.2% 0.1% 0.2% Cardiology 0.0% 0.1% 0.1% Colon and Rectal Surgery 0.0% 0.0% 0.0% Critical Care 0.0% 0.0% 0.0% Dermatology -0.1% 0.0% -0.1% Emergency Medicine 0.0% 0.0% 0.0% Endocrinology 0.0% 0.0% 0.0% Family Practice 0.0% 0.0% 0.0% Gastroenterology 0.0% 0.0% 0.0% General Practice 0.0% 0.0% 0.0% General Surgery 0.0% 0.0% 0.1% Geriatrics 0.0% 0.0% 0.0% Hand Surgery 0.1% 0.0% 0.1% Hematology/Oncology 0.0% 0.0% 0.0% Infectious Disease 0.0% 0.0% 0.0% Internal Medicine 0.0% 0.0% 0.0% Interventional Radiology -0.1% 0.0% -0.1% Nephrology 0.0% 0.0% 0.0% Neurology 0.0% 0.0% 0.0% Neurosurgery 0.2% 0.1% 0.2% Nuclear Medicine -0.1% 0.0% -0.1% Obstetrics/Gynecology 0.0% 0.0% 0.0% Ophthalmology 0.0% 0.0% 0.0% Orthopedic Surgery 0.1% 0.0% 0.1% Otolaryngology 0.0% 0.0% 0.0% Pathology 0.0% 0.0% 0.0% Pediatrics 0.0% 0.0% 0.0% Physical Medicine 0.0% 0.0% -0.1% Plastic Surgery 0.0% 0.0% 0.0% Psychiatry 0.0% -0.1% -0.1% Pulmonary Disease 0.0% 0.0% 0.0% Radiation Oncology 0.0% 0.0% 0.0% Radiology 0.0% 0.0% 0.0% Rheumatology 0.0% 0.0% 0.0% Thoracic Surgery 0.2% 0.0% 0.2% Urology 0.0% 0.0% 0.0% Vascular Surgery 0.0% 0.0% 0.0% Practitioners: Audiologist 0.0% 0.0% 0.0% 330
Speciality Impact of Removing Aberrant Malpractice Data Impact of Crosswalk Changes Combined Impacts* Chiropractor 0.0% -0.5% -0.6% Clinical Psychologist 0.0% 0.0% -0.3% Clinical Social Worker 0.0% 0.0% -0.4% Nurse Anesthetist 0.0% -0.2% 0.0% Nurse Practitioner 0.0% 0.0% 0.0% Optometry 0.0% -0.1% 0.0% Oral/Maxillofacial Surgery 0.0% 0.0% 0.0% Physical/Occupational Therapy 0.0% 0.0% -0.5% Physician Assistants 0.0% 0.0% 0.0% Podiatry 0.2% 0.0% 0.0% Suppliers: Diagnostic Testing Facility 0.0% 0.0% 0.0% Independent Laboratory 0.0% 0.0% 0.0% Portable X-Ray Supplier 0.0% 0.0% 0.0% *Sum of the columns may be different due to rounding. 331 As discussed in section II.J. of this proposed rule, we are proposing to reduce payments for technical components of certain multiple imaging procedures performed in the same session within the same imaging families. In order to calculate the impact of this proposed change, we examined 2004 PFS carrier claims processed through March 31, 2005. We extracted all claims that were billed on the same day, for the same beneficiary, at the same provider, for multiple diagnostic imaging procedures within the same family of codes. For each subset of claims, the procedures were arrayed based on the pricing of the technical component of these services. We simulated the effect of the multiple procedure payment reduction by accounting for 100 percent of the highest priced technical component, and 50 percent of all other technical components. Note that if the procedure
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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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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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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
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Page 309 and 310: however. We are particularly intere
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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 369 and 370: * * * * * PART 413--PRINCIPLES OF R
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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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