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 21440 A Treat dental ridge fracture 2.71 7.43 6.26 0.38 10.52 9.34 090 21445 A Treat dental ridge fracture 5.38 10.05 8.32 0.78 16.21 14.48 090 21450 A Treat lower jaw fracture 2.98 7.70 6.71 0.33 11.01 10.02 090 21451 A Treat lower jaw fracture 4.87 9.77 8.44 0.63 15.27 13.94 090 21452 A Treat lower jaw fracture 1.98 12.37 4.74 0.27 14.62 7.00 090 21453 A Treat lower jaw fracture 5.54 11.18 10.71 0.74 17.46 16.99 090 21454 A Treat lower jaw fracture 6.46 NA 6.17 0.82 NA 13.46 090 21461 A Treat lower jaw fracture 8.10 26.43 12.53 0.98 35.51 21.60 090 21462 A Treat lower jaw fracture 9.80 29.34 12.71 1.27 40.41 23.78 090 21465 A Treat lower jaw fracture 11.91 NA 9.63 1.50 NA 23.05 090 21470 A Treat lower jaw fracture 15.35 NA 11.78 1.96 NA 29.09 090 21480 A Reset dislocated jaw 0.61 1.72 0.19 0.06 2.39 0.86 000 21485 A Reset dislocated jaw 3.99 8.73 7.76 0.51 13.23 12.25 090 21490 A Repair dislocated jaw 11.86 NA 9.55 1.96 NA 23.37 090 21493 A Treat hyoid bone fracture 1.27 NA 0.53 0.12 NA 1.92 090 21494 A Treat hyoid bone fracture 6.28 NA 3.42 0.57 NA 10.27 090 21495 A Treat hyoid bone fracture 5.69 NA 8.55 0.46 NA 14.70 090 21497 A Interdental wiring 3.86 8.88 7.77 0.50 13.24 12.12 090 21499 C Head surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 21501 A Drain neck/chest lesion 3.81 6.31 3.73 0.43 10.55 7.97 090 21502 A Drain chest lesion 7.12 NA 5.42 0.97 NA 13.52 090 21510 A Drainage of bone lesion 5.74 NA 5.42 0.80 NA 11.96 090 21550 A Biopsy of neck/chest 2.06 3.85 1.74 0.16 6.08 3.96 010 21555 A Remove lesion, neck/chest 4.35 5.54 3.17 0.56 10.45 8.08 090 21556 A Remove lesion, neck/chest 5.57 NA 4.05 0.65 NA 10.27 090 21557 A Remove tumor, neck/chest 8.89 NA 5.23 1.08 NA 15.19 090 21600 A Partial removal of rib 6.89 NA 5.68 0.99 NA 13.57 090 21610 A Partial removal of rib 14.62 NA 8.68 3.07 NA 26.37 090 21615 A Removal of rib 9.88 NA 6.42 1.45 NA 17.75 090 21616 A Removal of rib and nerves 12.04 NA 7.95 1.86 NA 21.85 090
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 21620 A Partial removal of sternum 6.79 NA 5.72 0.98 NA 13.50 090 21627 A Sternal debridement 6.81 NA 6.17 1.02 NA 14.00 090 21630 A Extensive sternum surgery 17.38 NA 11.45 2.58 NA 31.42 090 21632 A Extensive sternum surgery 18.15 NA 10.81 2.65 NA 31.60 090 21685 A Hyoid myotomy & suspension 13.01 NA 9.82 1.06 NA 23.89 090 21700 A Revision of neck muscle 6.19 NA 4.74 0.32 NA 11.26 090 21705 A Revision of neck muscle/rib 9.61 NA 5.43 1.43 NA 16.47 090 21720 A Revision of neck muscle 5.68 NA 2.87 0.91 NA 9.46 090 21725 A Revision of neck muscle 6.99 NA 5.31 1.21 NA 13.51 090 21740 A Reconstruction of sternum 16.51 NA 8.37 2.36 NA 27.24 090 21742 C Repair stern/nuss w/o scope 0.00 0.00 0.00 0.00 0.00 0.00 090 21743 C Repair sternum/nuss w/scope 0.00 0.00 0.00 0.00 0.00 0.00 090 21750 A Repair of sternum separation 10.77 NA 5.94 1.63 NA 18.35 090 21800 A Treatment of rib fracture 0.96 0.00 1.31 0.09 1.05 2.36 090 21805 A Treatment of rib fracture 2.76 NA 3.20 0.38 NA 6.34 090 21810 A Treatment of rib fracture(s) 6.86 NA 4.93 0.94 NA 12.74 090 21820 A Treat sternum fracture 1.28 1.78 1.70 0.16 3.22 3.15 090 21825 A Treat sternum fracture 7.41 NA 6.25 1.11 NA 14.78 090 21899 C Neck/chest surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 21920 A Biopsy soft tissue of back 2.06 3.54 1.48 0.14 5.74 3.68 010 21925 A Biopsy soft tissue of back 4.49 5.12 3.24 0.60 10.20 8.33 090 21930 A Remove lesion, back or flank 5.00 5.82 3.39 0.66 11.48 9.05 090 21935 A Remove tumor, back 17.97 NA 9.46 2.47 NA 29.90 090 22100 A Remove part of neck vertebra 9.74 NA 7.39 2.13 NA 19.26 090 22101 A Remove part, thorax vertebra 9.82 NA 7.57 1.90 NA 19.28 090 22102 A Remove part, lumbar vertebra 9.82 NA 7.89 1.87 NA 19.58 090 22103 A Remove extra spine segment 2.34 NA 1.17 0.44 NA 3.96 ZZZ 22110 A Remove part of neck vertebra 12.75 NA 8.96 2.76 NA 24.47 090 22112 A Remove part, thorax vertebra 12.82 NA 9.03 2.52 NA 24.36 090 22114 A Remove part, lumbar vertebra 12.82 NA 9.02 2.63 NA 24.46 090
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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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(including by refunding amounts in
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Page 387 and 388: 1. CPT/HCPCS code. This is the CPT
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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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