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 25905 A Amputation of forearm 9.13 NA 11.58 1.40 NA 22.11 090 25907 A Amputation follow-up surgery 7.81 NA 11.06 1.10 NA 19.96 090 25909 A Amputation follow-up surgery 8.97 NA 11.60 1.44 NA 22.01 090 25915 A Amputation of forearm 17.08 NA 17.81 2.93 NA 37.83 090 25920 A Amputate hand at wrist 8.69 NA 7.56 1.35 NA 17.59 090 25922 A Amputate hand at wrist 7.42 NA 6.76 1.12 NA 15.31 090 25924 A Amputation follow-up surgery 8.47 NA 7.77 1.32 NA 17.56 090 25927 A Amputation of hand 8.81 NA 11.04 1.27 NA 21.11 090 25929 A Amputation follow-up surgery 7.60 NA 5.70 1.14 NA 14.43 090 25931 A Amputation follow-up surgery 7.82 NA 10.79 1.15 NA 19.75 090 25999 C Forearm or wrist surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 26010 A Drainage of finger abscess 1.54 5.21 1.56 0.18 6.93 3.29 010 26011 A Drainage of finger abscess 2.19 8.22 2.23 0.33 10.74 4.75 010 26020 A Drain hand tendon sheath 4.67 NA 5.17 0.73 NA 10.56 090 26025 A Drainage of palm bursa 4.82 NA 4.94 0.76 NA 10.52 090 26030 A Drainage of palm bursa(s) 5.93 NA 5.53 0.92 NA 12.38 090 26034 A Treat hand bone lesion 6.23 NA 6.14 1.01 NA 13.38 090 26035 A Decompress fingers/hand 9.52 NA 7.64 1.47 NA 18.62 090 26037 A Decompress fingers/hand 7.25 NA 6.11 1.13 NA 14.50 090 26040 A Release palm contracture 3.34 NA 3.91 0.53 NA 7.77 090 26045 A Release palm contracture 5.56 NA 5.45 0.93 NA 11.94 090 26055 A Incise finger tendon sheath 2.70 13.25 3.79 0.43 16.38 6.92 090 26060 A Incision of finger tendon 2.82 NA 3.39 0.45 NA 6.65 090 26070 A Explore/treat hand joint 3.69 NA 3.29 0.48 NA 7.45 090 26075 A Explore/treat finger joint 3.79 NA 3.68 0.53 NA 7.99 090 26080 A Explore/treat finger joint 4.24 NA 4.69 0.66 NA 9.59 090 26100 A Biopsy hand joint lining 3.67 NA 3.99 0.54 NA 8.19 090 26105 A Biopsy finger joint lining 3.71 NA 4.08 0.59 NA 8.38 090 26110 A Biopsy finger joint lining 3.53 NA 3.91 0.53 NA 7.97 090 26115 A Removal hand lesion subcut 3.86 12.36 4.61 0.59 16.81 9.06 090
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 26116 A Removal hand lesion, deep 5.53 NA 5.81 0.84 NA 12.18 090 26117 A Remove tumor, hand/finger 8.56 NA 6.86 1.26 NA 16.67 090 26121 A Release palm contracture 7.55 NA 6.73 1.17 NA 15.44 090 26123 A Release palm contracture 9.30 NA 8.57 1.43 NA 19.30 090 26125 A Release palm contracture 4.61 NA 2.37 0.70 NA 7.68 ZZZ 26130 A Remove wrist joint lining 5.42 NA 5.17 0.94 NA 11.53 090 26135 A Revise finger joint, each 6.96 NA 6.25 1.07 NA 14.28 090 26140 A Revise finger joint, each 6.17 NA 5.85 0.92 NA 12.94 090 26145 A Tendon excision, palm/finger 6.32 NA 5.85 0.97 NA 13.15 090 26160 A Remove tendon sheath lesion 3.16 11.58 3.98 0.49 15.23 7.63 090 26170 A Removal of palm tendon, each 4.77 NA 4.78 0.69 NA 10.24 090 26180 A Removal of finger tendon 5.18 NA 5.23 0.78 NA 11.19 090 26185 A Remove finger bone 5.25 NA 5.85 0.81 NA 11.91 090 26200 A Remove hand bone lesion 5.51 NA 5.19 0.88 NA 11.58 090 26205 A Remove/graft bone lesion 7.71 NA 6.67 1.20 NA 15.57 090 26210 A Removal of finger lesion 5.15 NA 5.24 0.79 NA 11.18 090 26215 A Remove/graft finger lesion 7.10 NA 6.17 0.98 NA 14.25 090 26230 A Partial removal of hand bone 6.33 NA 5.71 1.01 NA 13.05 090 26235 A Partial removal, finger bone 6.19 NA 5.62 0.95 NA 12.76 090 26236 A Partial removal, finger bone 5.32 NA 5.14 0.81 NA 11.27 090 26250 A Extensive hand surgery 7.56 NA 6.23 1.07 NA 14.85 090 26255 A Extensive hand surgery 12.43 NA 9.06 1.68 NA 23.18 090 26260 A Extensive finger surgery 7.03 NA 5.99 1.01 NA 14.03 090 26261 A Extensive finger surgery 9.10 NA 5.99 1.14 NA 16.23 090 26262 A Partial removal of finger 5.67 NA 5.16 0.88 NA 11.71 090 26320 A Removal of implant from hand 3.98 NA 4.17 0.59 NA 8.74 090 26340 A Manipulate finger w/anesth 2.51 NA 4.73 0.39 NA 7.62 090 26350 A Repair finger/hand tendon 5.99 NA 13.59 0.93 NA 20.51 090 26352 A Repair/graft hand tendon 7.69 NA 14.33 1.13 NA 23.15 090 26356 A Repair finger/hand tendon 8.08 NA 17.23 1.21 NA 26.52 090
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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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CAPD and CCPD) when the facility ac
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Indirect Sales means from the manuf
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Page 393 and 394: ADDENDUM B: RELATIVE VALUE UNITS (R
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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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