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 23460 A Repair shoulder capsule 15.38 NA 11.01 2.66 NA 29.05 090 23462 A Repair shoulder capsule 15.31 NA 10.42 2.59 NA 28.32 090 23465 A Repair shoulder capsule 15.86 NA 10.83 2.76 NA 29.46 090 23466 A Repair shoulder capsule 14.23 NA 11.02 2.46 NA 27.71 090 23470 A Reconstruct shoulder joint 17.15 NA 11.86 2.98 NA 32.00 090 23472 A Reconstruct shoulder joint 21.11 NA 13.97 3.66 NA 38.74 090 23480 A Revision of collar bone 11.18 NA 8.49 1.94 NA 21.61 090 23485 A Revision of collar bone 13.44 NA 9.57 2.33 NA 25.34 090 23490 A Reinforce clavicle 11.86 NA 8.43 1.47 NA 21.76 090 23491 A Reinforce shoulder bones 14.22 NA 10.37 2.46 NA 27.05 090 23500 A Treat clavicle fracture 2.08 2.79 2.44 0.30 5.17 4.82 090 23505 A Treat clavicle fracture 3.69 4.29 3.74 0.61 8.59 8.04 090 23515 A Treat clavicle fracture 7.41 NA 6.34 1.28 NA 15.03 090 23520 A Treat clavicle dislocation 2.16 2.77 2.67 0.34 5.28 5.17 090 23525 A Treat clavicle dislocation 3.60 4.40 3.83 0.46 8.46 7.88 090 23530 A Treat clavicle dislocation 7.31 NA 5.75 1.20 NA 14.27 090 23532 A Treat clavicle dislocation 8.02 NA 6.76 1.38 NA 16.15 090 23540 A Treat clavicle dislocation 2.23 2.79 2.28 0.29 5.31 4.81 090 23545 A Treat clavicle dislocation 3.26 4.10 3.29 0.35 7.71 6.90 090 23550 A Treat clavicle dislocation 7.24 NA 6.18 1.25 NA 14.67 090 23552 A Treat clavicle dislocation 8.46 NA 7.08 1.46 NA 17.00 090 23570 A Treat shoulder blade fx 2.23 2.92 2.81 0.36 5.52 5.40 090 23575 A Treat shoulder blade fx 4.06 4.75 4.19 0.59 9.40 8.84 090 23585 A Treat scapula fracture 8.97 NA 7.39 1.54 NA 17.90 090 23600 A Treat humerus fracture 2.94 4.40 3.44 0.48 7.81 6.86 090 23605 A Treat humerus fracture 4.87 5.95 4.97 0.84 11.66 10.68 090 23615 A Treat humerus fracture 9.36 NA 8.56 1.62 NA 19.54 090 23616 A Treat humerus fracture 21.28 NA 13.70 3.69 NA 38.67 090 23620 A Treat humerus fracture 2.40 3.51 2.89 0.40 6.31 5.69 090 23625 A Treat humerus fracture 3.93 4.80 4.16 0.67 9.40 8.76 090
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 23630 A Treat humerus fracture 7.35 NA 6.41 1.27 NA 15.04 090 23650 A Treat shoulder dislocation 3.39 3.68 2.67 0.30 7.36 6.35 090 23655 A Treat shoulder dislocation 4.57 NA 4.04 0.69 NA 9.30 090 23660 A Treat shoulder dislocation 7.49 NA 6.18 1.29 NA 14.96 090 23665 A Treat dislocation/fracture 4.47 5.18 4.59 0.71 10.36 9.77 090 23670 A Treat dislocation/fracture 7.91 NA 6.61 1.36 NA 15.88 090 23675 A Treat dislocation/fracture 6.05 6.63 5.66 1.01 13.70 12.73 090 23680 A Treat dislocation/fracture 10.06 NA 7.86 1.75 NA 19.67 090 23700 A Fixation of shoulder 2.53 NA 2.11 0.44 NA 5.08 010 23800 A Fusion of shoulder joint 14.17 NA 10.10 2.35 NA 26.62 090 23802 A Fusion of shoulder joint 16.61 NA 9.87 2.70 NA 29.19 090 23900 A Amputation of arm & girdle 19.73 NA 11.40 3.18 NA 34.31 090 23920 A Amputation at shoulder joint 14.62 NA 9.65 2.46 NA 26.73 090 23921 A Amputation follow-up surgery 5.49 NA 4.93 0.78 NA 11.20 090 23929 C Shoulder surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 23930 A Drainage of arm lesion 2.95 5.96 2.24 0.43 9.34 5.62 010 23931 A Drainage of arm bursa 1.79 5.52 2.09 0.28 7.60 4.16 010 23935 A Drain arm/elbow bone lesion 6.09 NA 5.72 1.05 NA 12.86 090 24000 A Exploratory elbow surgery 5.82 NA 5.24 0.97 NA 12.03 090 24006 A Release elbow joint 9.32 NA 7.51 1.50 NA 18.33 090 24065 A Biopsy arm/elbow soft tissue 2.08 3.47 1.72 0.17 5.73 3.97 010 24066 A Biopsy arm/elbow soft tissue 5.21 8.65 4.03 0.80 14.66 10.04 090 24075 A Remove arm/elbow lesion 3.92 7.23 3.34 0.56 11.71 7.81 090 24076 A Remove arm/elbow lesion 6.30 NA 4.75 0.95 NA 12.01 090 24077 A Remove tumor of arm/elbow 11.76 NA 7.55 1.72 NA 21.04 090 24100 A Biopsy elbow joint lining 4.93 NA 4.39 0.85 NA 10.17 090 24101 A Explore/treat elbow joint 6.13 NA 5.73 1.03 NA 12.90 090 24102 A Remove elbow joint lining 8.04 NA 6.64 1.33 NA 16.01 090 24105 A Removal of elbow bursa 3.61 NA 4.25 0.61 NA 8.47 090 24110 A Remove humerus lesion 7.39 NA 6.46 1.28 NA 15.13 090
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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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(2) Any financial incentives provid
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7. The authority citation for part
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* * * * * PART 413--PRINCIPLES OF R
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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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