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 12002 A Repair superficial wound(s) 1.86 1.97 0.87 0.17 4.00 2.90 010 12004 A Repair superficial wound(s) 2.24 2.24 0.98 0.21 4.70 3.43 010 12005 A Repair superficial wound(s) 2.87 2.73 1.16 0.27 5.87 4.30 010 12006 A Repair superficial wound(s) 3.67 3.28 1.47 0.35 7.29 5.49 010 12007 A Repair superficial wound(s) 4.12 3.69 1.76 0.45 8.26 6.33 010 12011 A Repair superficial wound(s) 1.76 2.06 0.76 0.16 3.99 2.68 010 12013 A Repair superficial wound(s) 1.99 2.20 0.90 0.18 4.37 3.07 010 12014 A Repair superficial wound(s) 2.46 2.49 1.02 0.23 5.19 3.72 010 12015 A Repair superficial wound(s) 3.20 3.03 1.21 0.29 6.52 4.70 010 12016 A Repair superficial wound(s) 3.93 3.45 1.48 0.37 7.74 5.78 010 12017 A Repair superficial wound(s) 4.71 NA 1.84 0.47 NA 7.02 010 12018 A Repair superficial wound(s) 5.53 NA 2.19 0.64 NA 8.37 010 12020 A Closure of split wound 2.63 3.78 1.88 0.30 6.71 4.80 010 12021 A Closure of split wound 1.84 1.82 1.40 0.24 3.90 3.48 010 12031 A Layer closure of wound(s) 2.15 2.69 1.06 0.17 5.01 3.39 010 12032 A Layer closure of wound(s) 2.47 4.16 1.76 0.16 6.80 4.39 010 12034 A Layer closure of wound(s) 2.93 3.55 1.47 0.25 6.73 4.64 010 12035 A Layer closure of wound(s) 3.43 5.25 2.09 0.39 9.07 5.91 010 12036 A Layer closure of wound(s) 4.05 5.50 2.47 0.55 10.10 7.07 010 12037 A Layer closure of wound(s) 4.67 6.07 2.88 0.66 11.40 8.21 010 12041 A Layer closure of wound(s) 2.37 2.89 1.20 0.19 5.46 3.77 010 12042 A Layer closure of wound(s) 2.75 3.58 1.49 0.17 6.50 4.41 010 12044 A Layer closure of wound(s) 3.15 3.70 1.61 0.27 7.12 5.03 010 12045 A Layer closure of wound(s) 3.64 5.20 2.22 0.41 9.25 6.27 010 12046 A Layer closure of wound(s) 4.25 6.30 2.68 0.54 11.09 7.47 010 12047 A Layer closure of wound(s) 4.65 6.42 2.99 0.58 11.64 8.22 010 12051 A Layer closure of wound(s) 2.47 3.52 1.47 0.20 6.19 4.15 010 12052 A Layer closure of wound(s) 2.78 3.56 1.46 0.17 6.50 4.40 010 12053 A Layer closure of wound(s) 3.13 3.83 1.55 0.23 7.18 4.91 010 12054 A Layer closure of wound(s) 3.46 4.13 1.64 0.30 7.89 5.40 010
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 12055 A Layer closure of wound(s) 4.43 5.03 2.12 0.45 9.91 7.00 010 12056 A Layer closure of wound(s) 5.24 6.86 2.95 0.59 12.69 8.78 010 12057 A Layer closure of wound(s) 5.96 6.58 3.62 0.56 13.11 10.15 010 13100 A Repair of wound or lesion 3.13 4.22 2.26 0.26 7.60 5.64 010 13101 A Repair of wound or lesion 3.92 5.05 2.65 0.26 9.23 6.82 010 13102 A Repair wound/lesion add-on 1.24 1.27 0.56 0.13 2.64 1.93 ZZZ 13120 A Repair of wound or lesion 3.31 4.29 2.29 0.26 7.85 5.86 010 13121 A Repair of wound or lesion 4.33 5.26 2.75 0.25 9.84 7.32 010 13122 A Repair wound/lesion add-on 1.44 1.54 0.62 0.15 3.13 2.21 ZZZ 13131 A Repair of wound or lesion 3.79 4.58 2.63 0.26 8.63 6.68 010 13132 A Repair of wound or lesion 5.95 6.47 4.16 0.32 12.74 10.43 010 13133 A Repair wound/lesion add-on 2.19 1.80 1.02 0.18 4.18 3.39 ZZZ 13150 A Repair of wound or lesion 3.81 4.92 2.70 0.34 9.06 6.85 010 13151 A Repair of wound or lesion 4.45 5.08 3.10 0.31 9.83 7.86 010 13152 A Repair of wound or lesion 6.33 6.56 3.96 0.40 13.30 10.69 010 13153 A Repair wound/lesion add-on 2.38 2.07 1.11 0.24 4.69 3.74 ZZZ 13160 A Late closure of wound 10.48 NA 7.03 1.54 NA 19.05 090 14000 A Skin tissue rearrangement 5.89 8.20 5.35 0.59 14.68 11.83 090 14001 A Skin tissue rearrangement 8.48 10.09 6.90 0.82 19.39 16.20 090 14020 A Skin tissue rearrangement 6.59 9.07 6.37 0.64 16.30 13.61 090 14021 A Skin tissue rearrangement 10.06 10.93 8.08 0.81 21.80 18.95 090 14040 A Skin tissue rearrangement 7.88 9.46 7.06 0.62 17.95 15.55 090 14041 A Skin tissue rearrangement 11.49 11.70 8.59 0.73 23.92 20.81 090 14060 A Skin tissue rearrangement 8.51 9.39 7.32 0.68 18.58 16.51 090 14061 A Skin tissue rearrangement 12.29 12.73 9.39 0.76 25.78 22.44 090 14300 A Skin tissue rearrangement 11.76 12.16 8.95 1.16 25.09 21.87 090 14350 A Skin tissue rearrangement 9.62 NA 7.01 1.34 NA 17.97 090 15000 A Skin graft 4.00 3.98 2.14 0.54 8.52 6.68 000 15001 A Skin graft add-on 1.00 1.32 0.40 0.14 2.46 1.54 ZZZ 15050 A Skin pinch graft 4.30 6.91 4.97 0.57 11.78 9.84 090
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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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347 TABLE 37--Impact of Proposed Ch
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Page 369 and 370: * * * * * PART 413--PRINCIPLES OF R
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Page 385 and 386: 385 (Catalog of Federal Domestic As
Page 387 and 388: 1. CPT/HCPCS code. This is the CPT
Page 389 and 390: grace period. This indicator is no
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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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