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 26852 A Fusion of knuckle with graft 8.47 NA 12.16 1.22 NA 21.85 090 26860 A Fusion of finger joint 4.69 NA 10.46 0.73 NA 15.88 090 26861 A Fusion of finger jnt, add-on 1.74 NA 0.90 0.27 NA 2.92 ZZZ 26862 A Fusion/graft of finger joint 7.37 NA 11.62 1.10 NA 20.09 090 26863 A Fuse/graft added joint 3.90 NA 2.05 0.56 NA 6.50 ZZZ 26910 A Amputate metacarpal bone 7.61 NA 10.59 1.16 NA 19.36 090 26951 A Amputation of finger/thumb 4.59 NA 9.50 0.71 NA 14.80 090 26952 A Amputation of finger/thumb 6.31 NA 10.91 0.95 NA 18.17 090 26989 C Hand/finger surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 26990 A Drainage of pelvis lesion 7.48 NA 6.97 1.22 NA 15.67 090 26991 A Drainage of pelvis bursa 6.68 10.53 5.30 1.11 18.32 13.09 090 26992 A Drainage of bone lesion 13.03 NA 9.96 2.16 NA 25.15 090 27000 A Incision of hip tendon 5.62 NA 5.11 0.98 NA 11.71 090 27001 A Incision of hip tendon 6.94 NA 5.89 1.24 NA 14.08 090 27003 A Incision of hip tendon 7.34 NA 6.33 1.12 NA 14.79 090 27005 A Incision of hip tendon 9.67 NA 7.57 1.72 NA 18.95 090 27006 A Incision of hip tendons 9.69 NA 7.73 1.69 NA 19.11 090 27025 A Incision of hip/thigh fascia 11.16 NA 8.32 1.84 NA 21.33 090 27030 A Drainage of hip joint 13.02 NA 9.33 2.26 NA 24.61 090 27033 A Exploration of hip joint 13.40 NA 9.61 2.32 NA 25.33 090 27035 A Denervation of hip joint 16.69 NA 10.89 2.15 NA 29.73 090 27036 A Excision of hip joint/muscle 12.89 NA 9.70 2.26 NA 24.85 090 27040 A Biopsy of soft tissues 2.88 5.38 2.05 0.27 8.53 5.20 010 27041 A Biopsy of soft tissues 9.90 NA 6.60 1.35 NA 17.85 090 27047 A Remove hip/pelvis lesion 7.45 7.18 4.71 1.03 15.67 13.19 090 27048 A Remove hip/pelvis lesion 6.25 NA 4.72 0.92 NA 11.89 090 27049 A Remove tumor, hip/pelvis 13.67 NA 8.24 2.06 NA 23.97 090 27050 A Biopsy of sacroiliac joint 4.36 NA 4.30 0.60 NA 9.26 090 27052 A Biopsy of hip joint 6.23 NA 5.71 1.08 NA 13.02 090 27054 A Removal of hip joint lining 8.55 NA 7.11 1.47 NA 17.13 090
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 27060 A Removal of ischial bursa 5.43 NA 4.27 0.80 NA 10.50 090 27062 A Remove femur lesion/bursa 5.37 NA 5.02 0.93 NA 11.32 090 27065 A Removal of hip bone lesion 5.90 NA 5.29 1.01 NA 12.20 090 27066 A Removal of hip bone lesion 10.33 NA 8.19 1.79 NA 20.31 090 27067 A Remove/graft hip bone lesion 13.84 NA 10.34 1.84 NA 26.02 090 27070 A Partial removal of hip bone 10.72 NA 8.80 1.74 NA 21.26 090 27071 A Partial removal of hip bone 11.46 NA 9.74 1.92 NA 23.12 090 27075 A Extensive hip surgery 35.02 NA 18.71 5.64 NA 59.37 090 27076 A Extensive hip surgery 22.13 NA 14.10 3.70 NA 39.94 090 27077 A Extensive hip surgery 40.02 NA 22.00 6.12 NA 68.14 090 27078 A Extensive hip surgery 13.45 NA 9.64 2.22 NA 25.31 090 27079 A Extensive hip surgery 13.76 NA 9.29 1.94 NA 24.99 090 27080 A Removal of tail bone 6.39 NA 4.72 0.93 NA 12.05 090 27086 A Remove hip foreign body 1.87 4.44 1.80 0.25 6.56 3.92 010 27087 A Remove hip foreign body 8.55 NA 6.51 1.35 NA 16.41 090 27090 A Removal of hip prosthesis 11.15 NA 8.50 1.94 NA 21.59 090 27091 A Removal of hip prosthesis 22.15 NA 13.56 3.84 NA 39.56 090 27093 A Injection for hip x-ray 1.30 4.24 0.49 0.13 5.67 1.92 000 27095 A Injection for hip x-ray 1.50 5.37 0.52 0.14 7.01 2.17 000 27096 A Inject sacroiliac joint 1.40 4.02 0.32 0.08 5.50 1.81 000 27097 A Revision of hip tendon 8.81 NA 6.21 1.57 NA 16.58 090 27098 A Transfer tendon to pelvis 8.84 NA 6.82 0.95 NA 16.61 090 27100 A Transfer of abdominal muscle 11.08 NA 8.39 1.85 NA 21.33 090 27105 A Transfer of spinal muscle 11.77 NA 8.87 1.72 NA 22.37 090 27110 A Transfer of iliopsoas muscle 13.27 NA 8.88 2.18 NA 24.32 090 27111 A Transfer of iliopsoas muscle 12.15 NA 8.85 1.94 NA 22.95 090 27120 A Reconstruction of hip socket 18.02 NA 11.51 3.08 NA 32.60 090 27122 A Reconstruction of hip socket 14.99 NA 10.69 2.61 NA 28.29 090 27125 A Partial hip replacement 14.70 NA 10.30 2.54 NA 27.54 090 27130 A Total hip arthroplasty 20.13 NA 12.88 3.50 NA 36.51 090
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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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385 (Catalog of Federal Domestic As
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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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