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 21080 A Prepare face/oral prosthesis 25.11 23.16 18.23 3.74 52.01 47.08 090 21081 A Prepare face/oral prosthesis 22.90 21.14 16.42 3.20 47.24 42.52 090 21082 A Prepare face/oral prosthesis 20.88 18.48 14.83 3.11 42.47 38.82 090 21083 A Prepare face/oral prosthesis 19.31 17.90 13.57 2.88 40.09 35.76 090 21084 A Prepare face/oral prosthesis 22.52 21.12 16.44 2.18 45.82 41.15 090 21085 A Prepare face/oral prosthesis 9.01 8.28 6.79 1.27 18.56 17.07 010 21086 A Prepare face/oral prosthesis 24.93 22.34 18.15 3.71 50.98 46.79 090 21087 A Prepare face/oral prosthesis 24.93 22.11 18.05 3.44 50.48 46.42 090 21088 C Prepare face/oral prosthesis 0.00 0.00 0.00 0.00 0.00 0.00 090 21089 C Prepare face/oral prosthesis 0.00 0.00 0.00 0.00 0.00 0.00 090 21100 A Maxillofacial fixation 4.22 11.76 4.79 0.34 16.32 9.35 090 21110 A Interdental fixation 5.21 10.08 8.54 0.72 16.01 14.47 090 21116 A Injection, jaw joint x-ray 0.81 4.08 0.34 0.06 4.95 1.21 000 21120 A Reconstruction of chin 4.93 10.42 7.29 0.60 15.95 12.82 090 21121 A Reconstruction of chin 7.65 9.92 7.81 0.90 18.47 16.36 090 21122 A Reconstruction of chin 8.53 NA 8.55 1.07 NA 18.15 090 21123 A Reconstruction of chin 11.16 NA 10.59 1.40 NA 23.15 090 21125 A Augmentation, lower jaw bone 10.62 55.80 8.18 0.79 67.21 19.59 090 21127 A Augmentation, lower jaw bone 11.12 48.12 9.27 1.52 60.76 21.91 090 21137 A Reduction of forehead 9.83 NA 7.48 1.32 NA 18.63 090 21138 A Reduction of forehead 12.19 NA 9.25 1.74 NA 23.18 090 21139 A Reduction of forehead 14.62 NA 11.13 1.18 NA 26.93 090 21141 A Reconstruct midface, lefort 18.11 NA 13.41 2.35 NA 33.87 090 21142 A Reconstruct midface, lefort 18.82 NA 12.75 2.38 NA 33.95 090 21143 A Reconstruct midface, lefort 19.59 NA 14.37 1.66 NA 35.62 090 21145 A Reconstruct midface, lefort 19.95 NA 13.66 2.84 NA 36.45 090 21146 A Reconstruct midface, lefort 20.72 NA 15.04 3.09 NA 38.85 090 21147 A Reconstruct midface, lefort 21.78 NA 14.88 1.84 NA 38.51 090 21150 A Reconstruct midface, lefort 25.25 NA 16.60 2.55 NA 44.40 090 21151 A Reconstruct midface, lefort 28.32 NA 21.89 2.30 NA 52.51 090
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 21154 A Reconstruct midface, lefort 30.53 NA 22.45 2.48 NA 55.46 090 21155 A Reconstruct midface, lefort 34.47 NA 23.33 6.64 NA 64.44 090 21159 A Reconstruct midface, lefort 42.40 NA 27.95 8.18 NA 78.53 090 21160 A Reconstruct midface, lefort 46.46 NA 27.92 4.13 NA 78.51 090 21172 A Reconstruct orbit/forehead 27.82 NA 13.53 3.55 NA 44.90 090 21175 A Reconstruct orbit/forehead 33.19 NA 17.38 4.83 NA 55.40 090 21179 A Reconstruct entire forehead 22.26 NA 13.72 2.80 NA 38.78 090 21180 A Reconstruct entire forehead 25.20 NA 14.96 3.48 NA 43.65 090 21181 A Contour cranial bone lesion 9.91 NA 7.23 1.32 NA 18.46 090 21182 A Reconstruct cranial bone 32.20 NA 18.55 2.80 NA 53.56 090 21183 A Reconstruct cranial bone 35.33 NA 20.24 4.47 NA 60.04 090 21184 A Reconstruct cranial bone 38.26 NA 21.33 5.70 NA 65.29 090 21188 A Reconstruction of midface 22.47 NA 18.35 1.69 NA 42.52 090 21193 A Reconst lwr jaw w/o graft 17.15 NA 12.42 2.23 NA 31.81 090 21194 A Reconst lwr jaw w/graft 19.85 NA 13.45 2.02 NA 35.32 090 21195 A Reconst lwr jaw w/o fixation 17.24 NA 14.61 1.64 NA 33.50 090 21196 A Reconst lwr jaw w/fixation 18.92 NA 15.41 2.07 NA 36.40 090 21198 A Reconstr lwr jaw segment 14.17 NA 12.46 1.44 NA 28.07 090 21199 A Reconstr lwr jaw w/advance 16.01 NA 8.90 1.39 NA 26.30 090 21206 A Reconstruct upper jaw bone 14.11 NA 12.46 1.33 NA 27.90 090 21208 A Augmentation of facial bones 10.23 23.47 9.29 1.09 34.79 20.61 090 21209 A Reduction of facial bones 6.72 10.88 7.90 0.90 18.50 15.52 090 21210 A Face bone graft 10.23 27.25 9.15 1.30 38.78 20.68 090 21215 A Lower jaw bone graft 10.77 47.37 9.24 1.53 59.67 21.54 090 21230 A Rib cartilage graft 10.77 NA 7.79 1.29 NA 19.85 090 21235 A Ear cartilage graft 6.72 10.18 6.28 0.61 17.52 13.62 090 21240 A Reconstruction of jaw joint 14.06 NA 11.95 2.24 NA 28.25 090 21242 A Reconstruction of jaw joint 12.96 NA 11.42 1.78 NA 26.15 090 21243 A Reconstruction of jaw joint 20.80 NA 17.27 3.25 NA 41.33 090 21244 A Reconstruction of lower jaw 11.86 NA 11.91 1.25 NA 25.02 090
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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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satisfies the requirements of the i
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357 certainty the extent of these s
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delivery arrangements and would hel
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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
Page 391 and 392: 5. Physician work RVUs. These are t
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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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