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 17260 A Destruction of skin lesions 0.91 1.33 0.69 0.04 2.28 1.64 010 17261 A Destruction of skin lesions 1.17 1.83 0.91 0.05 3.05 2.13 010 17262 A Destruction of skin lesions 1.58 2.13 1.11 0.06 3.78 2.76 010 17263 A Destruction of skin lesions 1.79 2.32 1.18 0.07 4.19 3.04 010 17264 A Destruction of skin lesions 1.94 2.51 1.19 0.08 4.53 3.22 010 17266 A Destruction of skin lesions 2.34 2.79 1.26 0.09 5.23 3.69 010 17270 A Destruction of skin lesions 1.32 1.89 0.94 0.05 3.27 2.31 010 17271 A Destruction of skin lesions 1.49 2.01 1.07 0.06 3.56 2.63 010 17272 A Destruction of skin lesions 1.77 2.25 1.21 0.07 4.10 3.06 010 17273 A Destruction of skin lesions 2.05 2.48 1.31 0.08 4.62 3.44 010 17274 A Destruction of skin lesions 2.60 2.87 1.53 0.10 5.56 4.23 010 17276 A Destruction of skin lesions 3.21 3.26 1.72 0.16 6.63 5.08 010 17280 A Destruction of skin lesions 1.17 1.80 0.87 0.05 3.03 2.09 010 17281 A Destruction of skin lesions 1.72 2.15 1.18 0.07 3.94 2.98 010 17282 A Destruction of skin lesions 2.04 2.43 1.35 0.08 4.55 3.47 010 17283 A Destruction of skin lesions 2.65 2.86 1.58 0.11 5.61 4.34 010 17284 A Destruction of skin lesions 3.22 3.26 1.82 0.13 6.60 5.17 010 17286 A Destruction of skin lesions 4.44 4.01 2.44 0.23 8.68 7.11 010 17304 A 1 stage mohs, up to 5 spec 7.61 9.35 3.85 0.30 17.26 11.76 000 17305 A 2 stage mohs, up to 5 spec 2.86 4.64 1.46 0.11 7.61 4.42 000 17306 A 3 stage mohs, up to 5 spec 2.86 4.79 1.47 0.11 7.76 4.44 000 17307 A Mohs addl stage up to 5 spec 2.86 4.39 1.49 0.11 7.36 4.45 000 17310 A Mohs any stage > 5 spec each 0.95 1.74 0.51 0.03 2.72 1.49 ZZZ 17340 A Cryotherapy of skin 0.76 0.38 0.36 0.05 1.19 1.17 010 17360 A Skin peel therapy 1.43 1.51 0.96 0.06 3.00 2.46 010 17380 R Hair removal by electrolysis 0.00 0.00 0.00 0.00 0.00 0.00 000 17999 C Skin tissue procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 19000 A Drainage of breast lesion 0.84 1.97 0.32 0.08 2.89 1.24 000 19001 A Drain breast lesion add-on 0.42 0.25 0.15 0.04 0.71 0.61 ZZZ 19020 A Incision of breast lesion 3.57 6.18 2.67 0.45 10.20 6.68 090
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 19030 A Injection for breast x-ray 1.53 3.03 0.53 0.09 4.65 2.15 000 19100 A Bx breast percut w/o image 1.27 2.06 0.43 0.16 3.50 1.86 000 19101 A Biopsy of breast, open 3.19 4.65 1.98 0.39 8.23 5.56 010 19102 A Bx breast percut w/image 2.00 3.99 0.68 0.14 6.13 2.83 000 19103 A Bx breast percut w/device 3.70 11.81 1.26 0.30 15.81 5.25 000 19110 A Nipple exploration 4.30 5.75 2.87 0.57 10.62 7.74 090 19112 A Excise breast duct fistula 3.67 5.89 2.69 0.48 10.04 6.84 090 19120 A Removal of breast lesion 5.56 4.56 3.06 0.73 10.85 9.35 090 19125 A Excision, breast lesion 6.06 4.77 3.28 0.80 11.63 10.14 090 19126 A Excision, addl breast lesion 2.94 NA 0.98 0.38 NA 4.29 ZZZ 19140 A Removal of breast tissue 5.14 7.05 3.39 0.69 12.88 9.22 090 19160 A Partial mastectomy 5.99 NA 3.41 0.79 NA 10.19 090 19162 A P-mastectomy w/ln removal 13.54 NA 6.26 1.79 NA 21.59 090 19180 A Removal of breast 8.81 NA 5.00 1.18 NA 14.99 090 19182 A Removal of breast 7.74 NA 4.72 1.04 NA 13.50 090 19200 A Removal of breast 15.50 NA 7.87 1.92 NA 25.29 090 19220 A Removal of breast 15.73 NA 8.17 2.07 NA 25.98 090 19240 A Removal of breast 16.01 NA 8.15 2.12 NA 26.28 090 19260 A Removal of chest wall lesion 15.45 NA 10.76 2.13 NA 28.34 090 19271 A Revision of chest wall 18.91 NA 17.32 2.62 NA 38.84 090 19272 A Extensive chest wall surgery 21.56 NA 18.30 2.99 NA 42.85 090 19290 A Place needle wire, breast 1.27 3.01 0.44 0.07 4.36 1.78 000 19291 A Place needle wire, breast 0.63 1.27 0.22 0.04 1.94 0.89 ZZZ 19295 A Place breast clip, percut 0.00 2.74 NA 0.01 2.75 NA ZZZ 19296 A Place po breast cath for rad 3.64 117.96 1.50 0.36 121.96 5.49 000 19297 A Place breast cath for rad 1.72 NA 0.62 0.17 NA 2.52 ZZZ 19298 A Place breast rad tube/caths 6.01 39.56 2.35 0.43 46.00 8.79 000 19316 A Suspension of breast 10.69 NA 7.30 1.64 NA 19.63 090 19318 A Reduction of large breast 15.63 NA 10.79 2.92 NA 29.34 090 19324 A Enlarge breast 5.85 NA 4.79 0.84 NA 11.48 090
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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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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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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
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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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