2006 proposed fee schedule - American Society of Clinical Oncology
2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology
340 Non-Facility Facility % % HCPCS MOD DESCRIPTION Follow-up Old New Change Old New Change 99262 inpatient consult Follow-up N/A N/A N/A $45.48 $43.50 -4% 99263 inpatient consult Emergency dept N/A N/A N/A $67.46 $64.57 -4% 99283 visit Emergency dept N/A N/A N/A $62.15 $59.30 -5% 99284 visit Critical care, first N/A N/A N/A $97.02 $92.54 -5% 99291 hour Critical care, $256.57 $243.87 -5% $207.68 $198.33 -4% 99292 addÏl 30 min Nursing facility $113.69 $108.60 -4% $103.84 $99.17 -4% 99302 care Nursing facility $87.92 $84.00 -4% $87.92 $84.00 -4% 99303 care Nursing fac care, $108.39 $103.43 -5% $108.39 $103.43 -5% 99312 subseq Nursing fac care, $56.47 $54.03 -4% $56.47 $54.03 -4% 99313 subseq Home visit, est $79.58 $76.18 -4% $79.58 $76.18 -4% 99348 patient Home visit, est $72.01 $68.65 -5% N/A N/A N/A 99350 patient Immunization $164.48 $156.46 -5% N/A N/A N/A G0008 admin ESRD related $18.57 $17.88 -4% N/A N/A N/A G0317 svs 4+mo 20+yrs Initial preventive $307.73 $294.91 -4% $307.73 $294.91 -4% G0344 exam EKG for initial $97.40 $93.69 -4% $72.76 $69.47 -5% G0366 prevent exam EKG tracing for $26.91 $24.23 -10% N/A N/A N/A G0367 initial prev EKG interpret & $17.81 $15.42 -13% N/A N/A N/A G0368 report preve $9.10 $8.81 -3% $9.10 $8.81 -3% In the November 15, 2004 PFS final rule, we showed the combined impact of PFS and drug payment changes on the total revenues for specialties that perform a significant volume of drug administration services. (69 FR 66406) Although we have not performed a similar combined impact analysis this year for all of the specialties considered last year, we
341 have undertaken a similar analysis of hematology/oncology. In last year’s final rule, we announced a one-year demonstration to collect information about symptoms for cancer patients receiving chemotherapy (69 FR 66308). Although this demonstration was implemented through the Secretary’s authority under sections 402(a)(1)(B) and 402(a)(2) of the Social Security Act Amendments of 1967 (Pub. L. 90-248) and not through administrative rulemaking, we discussed the impacts of the additional payments from this demonstration in last year’s final rule impact analysis. Therefore, we are also including an analysis of the impact on payments to hematology/oncology as this demonstration project ends. As indicated in Table 35 below, PFS services account for approximately 28 percent of Medicare revenues for hematology/oncology. Medicare payments for all PFS services provided by the specialties of hematology/oncology are projected to decrease by 5.2 percent for 2006. We estimate the impact of the one-year demonstration was 15 percent higher payments relative to PFS payments during 2005. We estimate that approximately 69 percent of total Medicare revenues for hematology/oncology are attributed to drugs, and, for purposes of this analysis, we are assuming no change in the payment levels for Part B drugs during 2006. Assuming no changes in utilization for
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340<br />
Non-Facility Facility<br />
%<br />
%<br />
HCPCS MOD DESCRIPTION<br />
Follow-up<br />
Old New Change Old New Change<br />
99262<br />
inpatient consult<br />
Follow-up<br />
N/A N/A N/A $45.48 $43.50 -4%<br />
99263<br />
inpatient consult<br />
Emergency dept<br />
N/A N/A N/A $67.46 $64.57 -4%<br />
99283<br />
visit<br />
Emergency dept<br />
N/A N/A N/A $62.15 $59.30 -5%<br />
99284<br />
visit<br />
Critical care, first<br />
N/A N/A N/A $97.02 $92.54 -5%<br />
99291<br />
hour<br />
Critical care,<br />
$256.57 $243.87 -5% $207.68 $198.33 -4%<br />
99292<br />
addÏl 30 min<br />
Nursing facility<br />
$113.69 $108.60 -4% $103.84 $99.17 -4%<br />
99302<br />
care<br />
Nursing facility<br />
$87.92 $84.00 -4% $87.92 $84.00 -4%<br />
99303<br />
care<br />
Nursing fac care,<br />
$108.39 $103.43 -5% $108.39 $103.43 -5%<br />
99312<br />
subseq<br />
Nursing fac care,<br />
$56.47 $54.03 -4% $56.47 $54.03 -4%<br />
99313<br />
subseq<br />
Home visit, est<br />
$79.58 $76.18 -4% $79.58 $76.18 -4%<br />
99348<br />
patient<br />
Home visit, est<br />
$72.01 $68.65 -5% N/A N/A N/A<br />
99350<br />
patient<br />
Immunization<br />
$164.48 $156.46 -5% N/A N/A N/A<br />
G0008<br />
admin<br />
ESRD related<br />
$18.57 $17.88 -4% N/A N/A N/A<br />
G0317<br />
svs 4+mo 20+yrs<br />
Initial preventive<br />
$307.73 $294.91 -4% $307.73 $294.91 -4%<br />
G0344<br />
exam<br />
EKG for initial<br />
$97.40 $93.69 -4% $72.76 $69.47 -5%<br />
G0366<br />
prevent exam<br />
EKG tracing for<br />
$26.91 $24.23 -10% N/A N/A N/A<br />
G0367<br />
initial prev<br />
EKG interpret &<br />
$17.81 $15.42 -13% N/A N/A N/A<br />
G0368<br />
report preve $9.10 $8.81 -3% $9.10 $8.81 -3%<br />
In the November 15, 2004 PFS final rule, we showed the<br />
combined impact <strong>of</strong> PFS and drug payment changes on the total<br />
revenues for specialties that perform a significant volume<br />
<strong>of</strong> drug administration services. (69 FR 66406) Although we<br />
have not performed a similar combined impact analysis this<br />
year for all <strong>of</strong> the specialties considered last year, we
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