2006 proposed fee schedule - American Society of Clinical Oncology

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ADDENDUM B: RELATIVE VALUE UNITS (RVUs) AND RELATED INFORMATION Physician work Facility PE RVUs 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 3 +Indicates RVUs are not used for Medicare payment. Malpractice RVUs Nonfacility Total CPT 1 / HCPCS 2 Mod Status Description RVUs 3 Non-facility Facility PE RVUs Total Global 11446 A Exc face-mm b9+marg > 4 cm 4.49 4.17 2.71 0.43 9.09 7.63 010 11450 A Removal, sweat gland lesion 2.74 4.91 2.02 0.34 7.99 5.10 090 11451 A Removal, sweat gland lesion 3.95 6.43 2.52 0.53 10.90 7.00 090 11462 A Removal, sweat gland lesion 2.52 5.04 2.03 0.32 7.88 4.86 090 11463 A Removal, sweat gland lesion 3.95 6.59 2.67 0.54 11.08 7.16 090 11470 A Removal, sweat gland lesion 3.26 4.98 2.28 0.40 8.64 5.93 090 11471 A Removal, sweat gland lesion 4.41 6.48 2.76 0.58 11.47 7.75 090 11600 A Exc tr-ext mlg+marg 0.5 < cm 1.31 2.68 0.96 0.10 4.09 2.38 010 11601 A Exc tr-ext mlg+marg 0.6-1 cm 1.80 2.86 1.21 0.12 4.78 3.14 010 11602 A Exc tr-ext mlg+marg 1.1-2 cm 1.95 3.00 1.25 0.12 5.07 3.32 010 11603 A Exc tr-ext mlg+marg 2.1-3 cm 2.19 3.22 1.31 0.16 5.58 3.66 010 11604 A Exc tr-ext mlg+marg 3.1-4 cm 2.40 3.52 1.37 0.20 6.13 3.98 010 11606 A Exc tr-ext mlg+marg > 4 cm 3.43 4.22 1.70 0.36 8.01 5.49 010 11620 A Exc h-f-nk-sp mlg+marg 0.5 < 1.19 2.65 0.94 0.09 3.93 2.22 010 11621 A Exc h-f-nk-sp mlg+marg 0.6-1 1.76 2.86 1.22 0.12 4.74 3.11 010 11622 A Exc h-f-nk-sp mlg+marg 1.1-2 2.09 3.14 1.37 0.14 5.38 3.60 010 11623 A Exc h-f-nk-sp mlg+marg 2.1-3 2.62 3.49 1.55 0.20 6.30 4.36 010 11624 A Exc h-f-nk-sp mlg+marg 3.1-4 3.07 3.90 1.74 0.27 7.23 5.07 010 11626 A Exc h-f-nk-sp mlg+mar > 4 cm 4.30 4.79 2.34 0.45 9.54 7.09 010 11640 A Exc face-mm malig+marg 0.5 < 1.35 2.74 1.09 0.11 4.20 2.55 010 11641 A Exc face-mm malig+marg 0.6-1 2.16 3.19 1.50 0.16 5.52 3.82 010 11642 A Exc face-mm malig+marg 1.1-2 2.60 3.59 1.67 0.19 6.38 4.45 010 11643 A Exc face-mm malig+marg 2.1-3 3.11 3.98 1.91 0.26 7.34 5.28 010 11644 A Exc face-mm malig+marg 3.1-4 4.03 4.87 2.39 0.37 9.27 6.79 010 11646 A Exc face-mm mlg+marg > 4 cm 5.95 5.96 3.38 0.61 12.53 9.94 010 11719 R Trim nail(s) 0.17 0.27 0.07 0.02 0.46 0.26 000 11720 A Debride nail, 1-5 0.32 0.36 0.12 0.04 0.72 0.48 000 11721 A Debride nail, 6 or more 0.54 0.46 0.21 0.07 1.07 0.82 000 11730 A Removal of nail plate 1.13 1.08 0.42 0.14 2.36 1.69 000 11732 A Remove nail plate, add-on 0.57 0.46 0.22 0.07 1.10 0.86 ZZZ
ADDENDUM B: RELATIVE VALUE UNITS (RVUs) AND RELATED INFORMATION Physician work Facility PE RVUs 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 3 +Indicates RVUs are not used for Medicare payment. Malpractice RVUs Nonfacility Total CPT 1 / HCPCS 2 Mod Status Description RVUs 3 Non-facility Facility PE RVUs Total Global 11740 A Drain blood from under nail 0.37 0.59 0.36 0.04 1.00 0.77 000 11750 A Removal of nail bed 1.86 2.27 1.76 0.22 4.35 3.85 010 11752 A Remove nail bed/finger tip 2.68 3.09 2.95 0.35 6.12 5.98 010 11755 A Biopsy, nail unit 1.31 1.70 0.78 0.14 3.15 2.23 000 11760 A Repair of nail bed 1.58 2.68 1.71 0.21 4.47 3.50 010 11762 A Reconstruction of nail bed 2.90 3.00 2.27 0.36 6.26 5.53 010 11765 A Excision of nail fold, toe 0.69 1.91 0.80 0.08 2.68 1.57 010 11770 A Removal of pilonidal lesion 2.62 3.43 1.49 0.33 6.37 4.44 010 11771 A Removal of pilonidal lesion 5.74 5.69 3.32 0.74 12.18 9.80 090 11772 A Removal of pilonidal lesion 6.98 7.42 5.05 0.89 15.29 12.92 090 11900 A Injection into skin lesions 0.52 0.72 0.22 0.02 1.26 0.76 000 11901 A Added skin lesions injection 0.80 0.76 0.38 0.03 1.59 1.21 000 11920 R Correct skin color defects 1.61 3.44 1.08 0.24 5.30 2.93 000 11921 R Correct skin color defects 1.93 3.70 1.24 0.29 5.92 3.47 000 11922 R Correct skin color defects 0.49 1.08 0.24 0.07 1.65 0.80 ZZZ 11950 R Therapy for contour defects 0.84 1.13 0.41 0.06 2.03 1.31 000 11951 R Therapy for contour defects 1.19 1.47 0.51 0.11 2.77 1.82 000 11952 R Therapy for contour defects 1.69 1.81 0.67 0.16 3.66 2.52 000 11954 R Therapy for contour defects 1.85 2.32 0.89 0.25 4.42 3.00 000 11960 A Insert tissue expander(s) 9.09 NA 10.12 1.31 NA 20.51 090 11970 A Replace tissue expander 7.06 NA 5.95 1.05 NA 14.07 090 11971 A Remove tissue expander(s) 2.13 8.65 3.67 0.32 11.10 6.12 090 11975 N Insert contraceptive cap 1.48 1.50 0.57 0.17 3.15 2.22 XXX 11976 R Removal of contraceptive cap 1.78 1.75 0.66 0.21 3.74 2.66 000 11977 N Removal/reinsert contra cap 3.31 2.31 1.25 0.37 5.99 4.93 XXX 11980 A Implant hormone pellet(s) 1.48 1.12 0.58 0.13 2.73 2.19 000 11981 A Insert drug implant device 1.48 1.82 0.67 0.12 3.43 2.28 XXX 11982 A Remove drug implant device 1.78 2.03 0.82 0.17 3.98 2.78 XXX 11983 A Remove/insert drug implant 3.31 2.51 1.51 0.23 6.05 5.04 XXX 12001 A Repair superficial wound(s) 1.70 1.91 0.75 0.15 3.76 2.60 010
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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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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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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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