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 26545 A Reconstruct finger joint 6.92 NA 11.40 1.05 NA 19.37 090 26546 A Repair nonunion hand 8.93 NA 14.18 1.44 NA 24.54 090 26548 A Reconstruct finger joint 8.04 NA 12.05 1.20 NA 21.29 090 26550 A Construct thumb replacement 21.25 NA 16.68 2.45 NA 40.38 090 26551 A Great toe-hand transfer 46.60 NA 30.93 7.96 NA 85.49 090 26553 A Single transfer, toe-hand 46.29 NA 24.09 2.41 NA 72.79 090 26554 A Double transfer, toe-hand 54.98 NA 35.75 9.41 NA 100.14 090 26555 A Positional change of finger 16.64 NA 17.43 2.48 NA 36.56 090 26556 A Toe joint transfer 47.28 NA 33.97 2.57 NA 83.82 090 26560 A Repair of web finger 5.38 NA 9.22 0.85 NA 15.45 090 26561 A Repair of web finger 10.92 NA 11.75 1.45 NA 24.12 090 26562 A Repair of web finger 15.01 NA 16.25 2.23 NA 33.49 090 26565 A Correct metacarpal flaw 6.74 NA 11.26 1.00 NA 19.01 090 26567 A Correct finger deformity 6.82 NA 11.21 1.04 NA 19.08 090 26568 A Lengthen metacarpal/finger 9.09 NA 14.50 1.49 NA 25.08 090 26580 A Repair hand deformity 18.19 NA 13.16 2.28 NA 33.63 090 26587 A Reconstruct extra finger 14.06 NA 8.99 1.53 NA 24.58 090 26590 A Repair finger deformity 17.97 NA 13.46 2.77 NA 34.20 090 26591 A Repair muscles of hand 3.26 NA 8.94 0.48 NA 12.68 090 26593 A Release muscles of hand 5.31 NA 10.45 0.78 NA 16.54 090 26596 A Excision constricting tissue 8.96 NA 8.42 1.43 NA 18.81 090 26600 A Treat metacarpal fracture 1.96 3.79 2.57 0.30 6.05 4.83 090 26605 A Treat metacarpal fracture 2.86 4.70 3.55 0.49 8.05 6.90 090 26607 A Treat metacarpal fracture 5.36 NA 5.98 0.87 NA 12.21 090 26608 A Treat metacarpal fracture 5.36 NA 6.00 0.88 NA 12.25 090 26615 A Treat metacarpal fracture 5.33 NA 5.12 0.86 NA 11.31 090 26641 A Treat thumb dislocation 3.94 4.72 3.42 0.39 9.05 7.75 090 26645 A Treat thumb fracture 4.41 5.31 4.08 0.67 10.39 9.16 090 26650 A Treat thumb fracture 5.72 NA 6.43 0.94 NA 13.09 090 26665 A Treat thumb fracture 7.61 NA 6.39 0.90 NA 14.90 090
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 26670 A Treat hand dislocation 3.69 4.41 2.85 0.39 8.49 6.92 090 26675 A Treat hand dislocation 4.64 5.57 4.34 0.77 10.98 9.75 090 26676 A Pin hand dislocation 5.52 NA 6.43 0.91 NA 12.86 090 26685 A Treat hand dislocation 6.98 NA 5.94 1.09 NA 14.02 090 26686 A Treat hand dislocation 7.95 NA 6.67 1.24 NA 15.86 090 26700 A Treat knuckle dislocation 3.69 3.68 2.76 0.35 7.71 6.80 090 26705 A Treat knuckle dislocation 4.19 5.43 4.18 0.66 10.28 9.03 090 26706 A Pin knuckle dislocation 5.12 NA 4.95 0.81 NA 10.88 090 26715 A Treat knuckle dislocation 5.74 NA 5.33 0.91 NA 11.98 090 26720 A Treat finger fracture, each 1.66 2.70 1.98 0.24 4.60 3.89 090 26725 A Treat finger fracture, each 3.34 4.60 3.40 0.53 8.47 7.26 090 26727 A Treat finger fracture, each 5.23 NA 5.98 0.84 NA 12.05 090 26735 A Treat finger fracture, each 5.98 NA 5.37 0.95 NA 12.30 090 26740 A Treat finger fracture, each 1.94 3.04 2.63 0.31 5.30 4.88 090 26742 A Treat finger fracture, each 3.85 5.11 3.78 0.58 9.54 8.21 090 26746 A Treat finger fracture, each 5.81 NA 5.37 0.91 NA 12.09 090 26750 A Treat finger fracture, each 1.70 2.41 1.94 0.22 4.33 3.86 090 26755 A Treat finger fracture, each 3.11 4.27 2.91 0.42 7.80 6.44 090 26756 A Pin finger fracture, each 4.39 NA 5.49 0.71 NA 10.59 090 26765 A Treat finger fracture, each 4.17 NA 4.24 0.66 NA 9.07 090 26770 A Treat finger dislocation 3.03 3.34 2.32 0.27 6.64 5.62 090 26775 A Treat finger dislocation 3.71 5.29 3.69 0.54 9.54 7.94 090 26776 A Pin finger dislocation 4.80 NA 5.76 0.77 NA 11.33 090 26785 A Treat finger dislocation 4.21 NA 4.37 0.68 NA 9.26 090 26820 A Thumb fusion with graft 8.27 NA 12.42 1.30 NA 21.99 090 26841 A Fusion of thumb 7.13 NA 12.37 1.18 NA 20.69 090 26842 A Thumb fusion with graft 8.25 NA 12.54 1.32 NA 22.11 090 26843 A Fusion of hand joint 7.62 NA 11.60 1.15 NA 20.37 090 26844 A Fusion/graft of hand joint 8.74 NA 12.56 1.33 NA 22.63 090 26850 A Fusion of knuckle 6.97 NA 11.44 1.06 NA 19.48 090
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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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amount for the quarter to the neare
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383 25. The heading for Part 426 is
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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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