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 25111 A Remove wrist tendon lesion 3.39 NA 4.51 0.53 NA 8.43 090 25112 A Reremove wrist tendon lesion 4.53 NA 5.05 0.70 NA 10.28 090 25115 A Remove wrist/forearm lesion 8.83 NA 13.21 1.31 NA 23.35 090 25116 A Remove wrist/forearm lesion 7.11 NA 12.34 1.11 NA 20.56 090 25118 A Excise wrist tendon sheath 4.37 NA 5.49 0.68 NA 10.54 090 25119 A Partial removal of ulna 6.04 NA 7.25 0.96 NA 14.25 090 25120 A Removal of forearm lesion 6.10 NA 11.29 1.00 NA 18.39 090 25125 A Remove/graft forearm lesion 7.48 NA 12.05 1.06 NA 20.60 090 25126 A Remove/graft forearm lesion 7.56 NA 12.20 1.27 NA 21.02 090 25130 A Removal of wrist lesion 5.26 NA 6.15 0.80 NA 12.21 090 25135 A Remove & graft wrist lesion 6.89 NA 7.22 1.02 NA 15.13 090 25136 A Remove & graft wrist lesion 5.97 NA 6.35 1.03 NA 13.35 090 25145 A Remove forearm bone lesion 6.37 NA 11.29 1.01 NA 18.67 090 25150 A Partial removal of ulna 7.09 NA 7.83 1.14 NA 16.06 090 25151 A Partial removal of radius 7.39 NA 11.93 1.18 NA 20.50 090 25170 A Extensive forearm surgery 11.09 NA 14.28 1.77 NA 27.15 090 25210 A Removal of wrist bone 5.95 NA 6.52 0.88 NA 13.35 090 25215 A Removal of wrist bones 7.90 NA 8.37 1.19 NA 17.46 090 25230 A Partial removal of radius 5.23 NA 5.89 0.79 NA 11.91 090 25240 A Partial removal of ulna 5.17 NA 6.61 0.81 NA 12.59 090 25246 A Injection for wrist x-ray 1.45 3.36 0.50 0.09 4.90 2.05 000 25248 A Remove forearm foreign body 5.14 NA 8.08 0.72 NA 13.94 090 25250 A Removal of wrist prosthesis 6.60 NA 5.92 1.01 NA 13.53 090 25251 A Removal of wrist prosthesis 9.58 NA 7.68 1.26 NA 18.52 090 25259 A Manipulate wrist w/anesthes 3.75 NA 5.53 0.62 NA 9.90 090 25260 A Repair forearm tendon/muscle 7.81 NA 12.49 1.19 NA 21.49 090 25263 A Repair forearm tendon/muscle 7.83 NA 12.46 1.18 NA 21.47 090 25265 A Repair forearm tendon/muscle 9.89 NA 13.46 1.47 NA 24.82 090 25270 A Repair forearm tendon/muscle 6.00 NA 11.23 0.95 NA 18.18 090 25272 A Repair forearm tendon/muscle 7.04 NA 11.96 1.11 NA 20.11 090
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 25274 A Repair forearm tendon/muscle 8.76 NA 12.81 1.36 NA 22.92 090 25275 A Repair forearm tendon sheath 8.51 NA 7.34 1.31 NA 17.15 090 25280 A Revise wrist/forearm tendon 7.22 NA 11.85 1.08 NA 20.15 090 25290 A Incise wrist/forearm tendon 5.29 NA 13.90 0.82 NA 20.01 090 25295 A Release wrist/forearm tendon 6.55 NA 11.39 1.00 NA 18.94 090 25300 A Fusion of tendons at wrist 8.81 NA 8.15 1.26 NA 18.22 090 25301 A Fusion of tendons at wrist 8.41 NA 7.76 1.29 NA 17.46 090 25310 A Transplant forearm tendon 8.15 NA 12.25 1.21 NA 21.61 090 25312 A Transplant forearm tendon 9.58 NA 13.12 1.41 NA 24.11 090 25315 A Revise palsy hand tendon(s) 10.20 NA 13.54 1.58 NA 25.32 090 25316 A Revise palsy hand tendon(s) 12.33 NA 15.27 1.74 NA 29.35 090 25320 A Repair/revise wrist joint 10.77 NA 11.02 1.61 NA 23.40 090 25332 A Revise wrist joint 11.41 NA 8.89 1.83 NA 22.13 090 25335 A Realignment of hand 12.89 NA 11.18 1.92 NA 25.99 090 25337 A Reconstruct ulna/radioulnar 10.17 NA 10.64 1.61 NA 22.42 090 25350 A Revision of radius 8.79 NA 13.10 1.46 NA 23.35 090 25355 A Revision of radius 10.17 NA 13.71 1.73 NA 25.61 090 25360 A Revision of ulna 8.44 NA 12.99 1.41 NA 22.84 090 25365 A Revise radius & ulna 12.40 NA 14.72 2.15 NA 29.28 090 25370 A Revise radius or ulna 13.37 NA 15.25 2.28 NA 30.89 090 25375 A Revise radius & ulna 13.05 NA 15.43 2.26 NA 30.73 090 25390 A Shorten radius or ulna 10.40 NA 13.71 1.65 NA 25.76 090 25391 A Lengthen radius or ulna 13.66 NA 15.64 2.21 NA 31.51 090 25392 A Shorten radius & ulna 13.96 NA 15.22 2.10 NA 31.28 090 25393 A Lengthen radius & ulna 15.88 NA 16.66 2.76 NA 35.30 090 25394 A Repair carpal bone, shorten 10.40 NA 7.82 1.59 NA 19.81 090 25400 A Repair radius or ulna 10.92 NA 14.27 1.82 NA 27.01 090 25405 A Repair/graft radius or ulna 14.39 NA 16.29 2.32 NA 33.00 090 25415 A Repair radius & ulna 13.36 NA 15.55 2.17 NA 31.07 090 25420 A Repair/graft radius & ulna 16.34 NA 17.27 2.61 NA 36.23 090
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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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cost components relating to trainin
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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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2006 proposed fee schedule - American Society of Clinical Oncology

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