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 21245 A Reconstruction of jaw 11.86 14.32 9.62 1.19 27.37 22.67 090 21246 A Reconstruction of jaw 12.47 NA 8.83 1.35 NA 22.65 090 21247 A Reconstruct lower jaw bone 22.65 NA 17.07 2.83 NA 42.54 090 21248 A Reconstruction of jaw 11.48 12.29 9.24 1.55 25.32 22.28 090 21249 A Reconstruction of jaw 17.52 16.75 12.47 2.48 36.76 32.47 090 21255 A Reconstruct lower jaw bone 16.72 NA 15.70 2.38 NA 34.80 090 21256 A Reconstruction of orbit 16.20 NA 11.48 1.50 NA 29.18 090 21260 A Revise eye sockets 16.53 NA 13.26 0.97 NA 30.76 090 21261 A Revise eye sockets 31.50 NA 23.50 3.42 NA 58.42 090 21263 A Revise eye sockets 28.44 NA 19.87 2.62 NA 50.93 090 21267 A Revise eye sockets 18.91 NA 18.95 1.70 NA 39.56 090 21268 A Revise eye sockets 24.49 NA 19.69 3.65 NA 47.83 090 21270 A Augmentation, cheek bone 10.23 11.66 7.09 0.72 22.61 18.04 090 21275 A Revision, orbitofacial bones 11.24 NA 7.91 1.29 NA 20.45 090 21280 A Revision of eyelid 6.03 NA 5.78 0.42 NA 12.23 090 21282 A Revision of eyelid 3.49 NA 4.35 0.26 NA 8.10 090 21295 A Revision of jaw muscle/bone 1.53 NA 2.51 0.16 NA 4.20 090 21296 A Revision of jaw muscle/bone 4.25 NA 4.95 0.34 NA 9.54 090 21299 C Cranio/maxillofacial surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 21300 A Treatment of skull fracture 0.72 2.00 0.26 0.13 2.85 1.11 000 21310 A Treatment of nose fracture 0.58 2.16 0.15 0.05 2.79 0.78 000 21315 A Treatment of nose fracture 1.51 4.19 1.81 0.14 5.84 3.46 010 21320 A Treatment of nose fracture 1.85 3.89 1.58 0.18 5.92 3.61 010 21325 A Treatment of nose fracture 3.77 NA 8.21 0.31 NA 12.29 090 21330 A Treatment of nose fracture 5.38 NA 9.26 0.56 NA 15.20 090 21335 A Treatment of nose fracture 8.62 NA 9.38 0.74 NA 18.74 090 21336 A Treat nasal septal fracture 5.72 NA 9.31 0.55 NA 15.59 090 21337 A Treat nasal septal fracture 2.71 5.96 3.49 0.28 8.95 6.48 090 21338 A Treat nasoethmoid fracture 6.46 NA 13.21 0.82 NA 20.49 090 21339 A Treat nasoethmoid fracture 8.10 NA 13.20 0.96 NA 22.26 090
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 21340 A Treatment of nose fracture 10.77 NA 8.17 1.15 NA 20.09 090 21343 A Treatment of sinus fracture 12.96 NA 14.86 1.47 NA 29.28 090 21344 A Treatment of sinus fracture 19.73 NA 15.85 2.43 NA 38.01 090 21345 A Treat nose/jaw fracture 8.17 9.82 7.04 0.92 18.91 16.13 090 21346 A Treat nose/jaw fracture 10.61 NA 11.91 1.21 NA 23.73 090 21347 A Treat nose/jaw fracture 12.70 NA 15.39 1.47 NA 29.55 090 21348 A Treat nose/jaw fracture 16.69 NA 10.81 2.48 NA 29.98 090 21355 A Treat cheek bone fracture 3.77 6.07 3.42 0.34 10.18 7.52 010 21356 A Treat cheek bone fracture 4.15 6.99 4.41 0.46 11.60 9.02 010 21360 A Treat cheek bone fracture 6.46 NA 5.80 0.74 NA 13.00 090 21365 A Treat cheek bone fracture 14.96 NA 10.51 1.69 NA 27.16 090 21366 A Treat cheek bone fracture 17.78 NA 11.02 2.49 NA 31.29 090 21385 A Treat eye socket fracture 9.17 NA 8.06 0.97 NA 18.20 090 21386 A Treat eye socket fracture 9.17 NA 6.88 0.97 NA 17.01 090 21387 A Treat eye socket fracture 9.71 NA 8.67 1.08 NA 19.46 090 21390 A Treat eye socket fracture 10.13 NA 7.58 0.90 NA 18.61 090 21395 A Treat eye socket fracture 12.69 NA 8.75 1.44 NA 22.88 090 21400 A Treat eye socket fracture 1.40 2.60 1.82 0.15 4.15 3.37 090 21401 A Treat eye socket fracture 3.27 7.77 3.44 0.38 11.41 7.09 090 21406 A Treat eye socket fracture 7.01 NA 5.92 0.73 NA 13.67 090 21407 A Treat eye socket fracture 8.62 NA 6.66 0.94 NA 16.22 090 21408 A Treat eye socket fracture 12.38 NA 8.63 1.44 NA 22.45 090 21421 A Treat mouth roof fracture 5.14 9.62 8.32 0.73 15.49 14.19 090 21422 A Treat mouth roof fracture 8.33 NA 7.89 0.99 NA 17.20 090 21423 A Treat mouth roof fracture 10.40 NA 9.02 1.27 NA 20.69 090 21431 A Treat craniofacial fracture 7.05 NA 9.40 0.70 NA 17.15 090 21432 A Treat craniofacial fracture 8.62 NA 7.96 0.81 NA 17.39 090 21433 A Treat craniofacial fracture 25.36 NA 15.91 2.78 NA 44.05 090 21435 A Treat craniofacial fracture 17.25 NA 12.37 1.98 NA 31.60 090 21436 A Treat craniofacial fracture 28.06 NA 17.82 3.09 NA 48.96 090
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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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List of Subjects 42 CFR Part 405 Ad
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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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