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 27132 A Total hip arthroplasty 23.32 NA 15.15 4.04 NA 42.51 090 27134 A Revise hip joint replacement 28.54 NA 17.24 4.94 NA 50.72 090 27137 A Revise hip joint replacement 21.18 NA 13.50 3.67 NA 38.35 090 27138 A Revise hip joint replacement 22.18 NA 13.95 3.84 NA 39.97 090 27140 A Transplant femur ridge 12.24 NA 9.11 2.11 NA 23.47 090 27146 A Incision of hip bone 17.43 NA 11.77 2.96 NA 32.17 090 27147 A Revision of hip bone 20.59 NA 12.90 3.57 NA 37.06 090 27151 A Incision of hip bones 22.52 NA 7.72 3.91 NA 34.16 090 27156 A Revision of hip bones 24.64 NA 15.58 4.21 NA 44.43 090 27158 A Revision of pelvis 19.75 NA 10.86 3.16 NA 33.77 090 27161 A Incision of neck of femur 16.71 NA 11.73 2.94 NA 31.38 090 27165 A Incision/fixation of femur 17.92 NA 12.51 3.10 NA 33.53 090 27170 A Repair/graft femur head/neck 16.08 NA 10.95 2.81 NA 29.85 090 27175 A Treat slipped epiphysis 8.47 NA 6.48 1.46 NA 16.41 090 27176 A Treat slipped epiphysis 12.05 NA 8.73 2.22 NA 23.01 090 27177 A Treat slipped epiphysis 15.09 NA 10.56 2.61 NA 28.26 090 27178 A Treat slipped epiphysis 11.99 NA 8.16 2.08 NA 22.24 090 27179 A Revise head/neck of femur 12.99 NA 9.67 2.25 NA 24.91 090 27181 A Treat slipped epiphysis 14.69 NA 9.92 1.57 NA 26.18 090 27185 A Revision of femur epiphysis 9.19 NA 7.28 2.39 NA 18.86 090 27187 A Reinforce hip bones 13.55 NA 9.99 2.37 NA 25.90 090 27193 A Treat pelvic ring fracture 5.56 4.94 4.94 0.96 11.47 11.47 090 27194 A Treat pelvic ring fracture 9.66 NA 7.43 1.65 NA 18.74 090 27200 A Treat tail bone fracture 1.84 2.16 2.09 0.28 4.29 4.21 090 27202 A Treat tail bone fracture 7.04 NA 15.72 1.06 NA 23.83 090 27215 A Treat pelvic fracture(s) 10.05 NA 6.86 1.97 NA 18.88 090 27216 A Treat pelvic ring fracture 15.20 NA 9.29 2.63 NA 27.12 090 27217 A Treat pelvic ring fracture 14.12 NA 9.83 2.41 NA 26.36 090 27218 A Treat pelvic ring fracture 20.16 NA 11.08 3.48 NA 34.72 090 27220 A Treat hip socket fracture 6.18 5.56 5.47 1.07 12.81 12.72 090
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 27222 A Treat hip socket fracture 12.71 NA 9.65 2.19 NA 24.54 090 27226 A Treat hip wall fracture 14.92 NA 7.58 2.48 NA 24.97 090 27227 A Treat hip fracture(s) 23.46 NA 14.93 4.05 NA 42.44 090 27228 A Treat hip fracture(s) 27.17 NA 17.08 4.66 NA 48.92 090 27230 A Treat thigh fracture 5.50 5.35 4.95 0.95 11.80 11.41 090 27232 A Treat thigh fracture 10.68 NA 6.97 1.85 NA 19.50 090 27235 A Treat thigh fracture 12.16 NA 9.14 2.11 NA 23.42 090 27236 A Treat thigh fracture 15.61 NA 10.71 2.71 NA 29.03 090 27238 A Treat thigh fracture 5.52 NA 4.99 0.89 NA 11.40 090 27240 A Treat thigh fracture 12.50 NA 9.20 2.16 NA 23.87 090 27244 A Treat thigh fracture 15.95 NA 10.94 2.77 NA 29.67 090 27245 A Treat thigh fracture 20.32 NA 13.31 3.52 NA 37.15 090 27246 A Treat thigh fracture 4.71 4.33 4.30 0.81 9.85 9.82 090 27248 A Treat thigh fracture 10.45 NA 7.95 1.81 NA 20.21 090 27250 A Treat hip dislocation 6.95 NA 4.46 0.62 NA 12.03 090 27252 A Treat hip dislocation 10.39 NA 7.21 1.66 NA 19.26 090 27253 A Treat hip dislocation 12.93 NA 9.47 2.24 NA 24.63 090 27254 A Treat hip dislocation 18.27 NA 11.66 3.17 NA 33.10 090 27256 A Treat hip dislocation 4.12 3.43 2.02 0.46 8.01 6.60 010 27257 A Treat hip dislocation 5.22 NA 2.73 0.69 NA 8.64 010 27258 A Treat hip dislocation 15.44 NA 10.55 2.64 NA 28.63 090 27259 A Treat hip dislocation 21.56 NA 13.80 3.74 NA 39.11 090 27265 A Treat hip dislocation 5.05 NA 4.64 0.63 NA 10.32 090 27266 A Treat hip dislocation 7.49 NA 6.15 1.29 NA 14.94 090 27275 A Manipulation of hip joint 2.27 NA 2.04 0.39 NA 4.71 010 27280 A Fusion of sacroiliac joint 13.40 NA 9.96 2.53 NA 25.89 090 27282 A Fusion of pubic bones 11.34 NA 8.03 1.86 NA 21.24 090 27284 A Fusion of hip joint 23.46 NA 14.32 3.92 NA 41.69 090 27286 A Fusion of hip joint 23.46 NA 15.30 3.12 NA 41.88 090 27290 A Amputation of leg at hip 23.30 NA 13.67 3.43 NA 40.40 090
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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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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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