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 24516 A Treat humerus fracture 11.65 NA 8.82 2.02 NA 22.49 090 24530 A Treat humerus fracture 3.50 5.33 3.92 0.57 9.40 7.99 090 24535 A Treat humerus fracture 6.87 7.89 6.43 1.18 15.94 14.48 090 24538 A Treat humerus fracture 9.44 NA 8.42 1.64 NA 19.50 090 24545 A Treat humerus fracture 10.46 NA 8.18 1.82 NA 20.46 090 24546 A Treat humerus fracture 15.70 NA 10.96 2.73 NA 29.39 090 24560 A Treat humerus fracture 2.81 4.64 3.09 0.44 7.88 6.33 090 24565 A Treat humerus fracture 5.56 6.71 5.37 0.93 13.20 11.86 090 24566 A Treat humerus fracture 7.80 NA 7.86 1.30 NA 16.96 090 24575 A Treat humerus fracture 10.66 NA 8.14 1.86 NA 20.66 090 24576 A Treat humerus fracture 2.87 4.90 3.60 0.46 8.23 6.93 090 24577 A Treat humerus fracture 5.79 7.01 5.67 0.95 13.75 12.41 090 24579 A Treat humerus fracture 11.60 NA 8.55 2.02 NA 22.17 090 24582 A Treat humerus fracture 8.56 NA 8.78 1.48 NA 18.82 090 24586 A Treat elbow fracture 15.22 NA 10.87 2.64 NA 28.73 090 24587 A Treat elbow fracture 15.17 NA 10.68 2.52 NA 28.37 090 24600 A Treat elbow dislocation 4.23 4.99 3.39 0.50 9.72 8.12 090 24605 A Treat elbow dislocation 5.42 NA 5.20 0.89 NA 11.51 090 24615 A Treat elbow dislocation 9.43 NA 7.57 1.60 NA 18.59 090 24620 A Treat elbow fracture 6.98 NA 6.08 1.07 NA 14.13 090 24635 A Treat elbow fracture 13.20 NA 13.92 2.28 NA 29.40 090 24640 A Treat elbow dislocation 1.20 2.03 0.77 0.12 3.35 2.10 010 24650 A Treat radius fracture 2.16 4.11 2.66 0.35 6.62 5.18 090 24655 A Treat radius fracture 4.40 6.05 4.65 0.70 11.15 9.75 090 24665 A Treat radius fracture 8.15 NA 7.26 1.41 NA 16.81 090 24666 A Treat radius fracture 9.50 NA 7.80 1.62 NA 18.92 090 24670 A Treat ulnar fracture 2.55 4.27 2.98 0.41 7.23 5.93 090 24675 A Treat ulnar fracture 4.72 6.10 4.83 0.81 11.63 10.36 090 24685 A Treat ulnar fracture 8.81 NA 7.27 1.52 NA 17.60 090 24800 A Fusion of elbow joint 11.20 NA 8.49 1.63 NA 21.33 090
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 24802 A Fusion/graft of elbow joint 13.70 NA 10.04 2.37 NA 26.11 090 24900 A Amputation of upper arm 9.61 NA 6.91 1.53 NA 18.05 090 24920 A Amputation of upper arm 9.55 NA 6.77 1.61 NA 17.93 090 24925 A Amputation follow-up surgery 7.07 NA 5.91 1.14 NA 14.12 090 24930 A Amputation follow-up surgery 10.25 NA 7.05 1.67 NA 18.97 090 24931 A Amputate upper arm & implant 12.73 NA 5.68 1.89 NA 20.30 090 24935 A Revision of amputation 15.57 NA 7.92 2.13 NA 25.62 090 24940 C Revision of upper arm 0.00 0.00 0.00 0.00 0.00 0.00 090 24999 C Upper arm/elbow surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 25000 A Incision of tendon sheath 3.38 NA 6.49 0.55 NA 10.41 090 25001 A Incise flexor carpi radialis 3.38 NA 4.10 0.55 NA 8.03 090 25020 A Decompress forearm 1 space 5.92 NA 9.00 0.93 NA 15.85 090 25023 A Decompress forearm 1 space 12.97 NA 14.21 2.03 NA 29.21 090 25024 A Decompress forearm 2 spaces 9.51 NA 7.28 1.36 NA 18.15 090 25025 A Decompress forearm 2 spaces 16.55 NA 9.75 1.82 NA 28.13 090 25028 A Drainage of forearm lesion 5.25 NA 7.73 0.81 NA 13.79 090 25031 A Drainage of forearm bursa 4.14 NA 7.45 0.63 NA 12.22 090 25035 A Treat forearm bone lesion 7.36 NA 12.69 1.24 NA 21.29 090 25040 A Explore/treat wrist joint 7.18 NA 7.00 1.15 NA 15.34 090 25065 A Biopsy forearm soft tissues 1.99 3.49 1.85 0.15 5.64 4.00 010 25066 A Biopsy forearm soft tissues 4.13 NA 6.69 0.64 NA 11.46 090 25075 A Removal forearm lesion subcu 3.74 NA 5.66 0.55 NA 9.95 090 25076 A Removal forearm lesion deep 4.92 NA 8.98 0.74 NA 14.64 090 25077 A Remove tumor, forearm/wrist 9.77 NA 11.47 1.42 NA 22.66 090 25085 A Incision of wrist capsule 5.50 NA 6.78 0.85 NA 13.13 090 25100 A Biopsy of wrist joint 3.90 NA 5.04 0.59 NA 9.53 090 25101 A Explore/treat wrist joint 4.69 NA 5.64 0.75 NA 11.08 090 25105 A Remove wrist joint lining 5.85 NA 6.97 0.92 NA 13.74 090 25107 A Remove wrist joint cartilage 6.43 NA 7.98 0.99 NA 15.41 090 25110 A Remove wrist tendon lesion 3.92 NA 6.65 0.62 NA 11.19 090
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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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371 D. Redesignating paragraphs (l)
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373 (3) The additional nursing hour
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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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