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 27295 A Amputation of leg at hip 18.66 NA 10.98 2.95 NA 32.59 090 27299 C Pelvis/hip joint surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 27301 A Drain thigh/knee lesion 6.49 9.54 5.00 1.04 17.08 12.54 090 27303 A Drainage of bone lesion 8.29 NA 6.75 1.43 NA 16.47 090 27305 A Incise thigh tendon & fascia 5.92 NA 5.02 1.01 NA 11.95 090 27306 A Incision of thigh tendon 4.62 NA 4.56 0.85 NA 10.03 090 27307 A Incision of thigh tendons 5.80 NA 5.21 1.04 NA 12.05 090 27310 A Exploration of knee joint 9.28 NA 7.35 1.61 NA 18.24 090 27315 A Partial removal, thigh nerve 6.97 NA 4.85 1.09 NA 12.91 090 27320 A Partial removal, thigh nerve 6.30 NA 5.10 1.06 NA 12.46 090 27323 A Biopsy, thigh soft tissues 2.28 3.74 1.85 0.24 6.26 4.37 010 27324 A Biopsy, thigh soft tissues 4.90 NA 4.09 0.75 NA 9.74 090 27327 A Removal of thigh lesion 4.47 5.95 3.65 0.64 11.06 8.76 090 27328 A Removal of thigh lesion 5.57 NA 4.27 0.84 NA 10.68 090 27329 A Remove tumor, thigh/knee 14.15 NA 8.81 2.14 NA 25.09 090 27330 A Biopsy, knee joint lining 4.97 NA 4.42 0.86 NA 10.25 090 27331 A Explore/treat knee joint 5.88 NA 5.34 1.02 NA 12.24 090 27332 A Removal of knee cartilage 8.28 NA 6.89 1.43 NA 16.60 090 27333 A Removal of knee cartilage 7.30 NA 6.46 1.26 NA 15.02 090 27334 A Remove knee joint lining 8.71 NA 7.18 1.51 NA 17.39 090 27335 A Remove knee joint lining 10.01 NA 7.96 1.74 NA 19.71 090 27340 A Removal of kneecap bursa 4.18 NA 4.41 0.72 NA 9.31 090 27345 A Removal of knee cyst 5.92 NA 5.44 1.00 NA 12.37 090 27347 A Remove knee cyst 5.78 NA 5.27 0.98 NA 12.03 090 27350 A Removal of kneecap 8.18 NA 7.01 1.41 NA 16.60 090 27355 A Remove femur lesion 7.66 NA 6.55 1.32 NA 15.53 090 27356 A Remove femur lesion/graft 9.49 NA 7.61 1.65 NA 18.75 090 27357 A Remove femur lesion/graft 10.53 NA 8.42 1.95 NA 20.90 090 27358 A Remove femur lesion/fixation 4.74 NA 2.44 0.82 NA 8.00 ZZZ 27360 A Partial removal, leg bone(s) 10.50 NA 9.16 1.83 NA 21.49 090
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 27365 A Extensive leg surgery 16.28 NA 11.33 2.79 NA 30.40 090 27370 A Injection for knee x-ray 0.96 3.56 0.33 0.08 4.60 1.38 000 27372 A Removal of foreign body 5.07 9.52 4.54 0.84 15.43 10.45 090 27380 A Repair of kneecap tendon 7.16 NA 6.99 1.24 NA 15.40 090 27381 A Repair/graft kneecap tendon 10.34 NA 8.75 1.79 NA 20.88 090 27385 A Repair of thigh muscle 7.77 NA 7.33 1.36 NA 16.45 090 27386 A Repair/graft of thigh muscle 10.56 NA 9.15 1.85 NA 21.56 090 27390 A Incision of thigh tendon 5.33 NA 4.95 0.92 NA 11.20 090 27391 A Incision of thigh tendons 7.20 NA 6.35 1.23 NA 14.78 090 27392 A Incision of thigh tendons 9.21 NA 7.35 1.57 NA 18.13 090 27393 A Lengthening of thigh tendon 6.39 NA 5.64 1.10 NA 13.13 090 27394 A Lengthening of thigh tendons 8.51 NA 6.98 1.47 NA 16.96 090 27395 A Lengthening of thigh tendons 11.73 NA 9.02 2.04 NA 22.79 090 27396 A Transplant of thigh tendon 7.87 NA 6.77 1.34 NA 15.97 090 27397 A Transplants of thigh tendons 11.28 NA 8.76 1.82 NA 21.87 090 27400 A Revise thigh muscles/tendons 9.03 NA 7.04 1.31 NA 17.37 090 27403 A Repair of knee cartilage 8.34 NA 6.95 1.44 NA 16.72 090 27405 A Repair of knee ligament 8.66 NA 7.25 1.51 NA 17.42 090 27407 A Repair of knee ligament 10.28 NA 8.05 1.78 NA 20.11 090 27409 A Repair of knee ligaments 12.91 NA 9.63 2.24 NA 24.78 090 27412 A Autochondrocyte implant knee 23.28 NA 14.69 4.35 NA 42.32 090 27415 A Osteochondral knee allograft 18.53 NA 12.45 4.35 NA 35.33 090 27418 A Repair degenerated kneecap 10.85 NA 8.61 1.88 NA 21.34 090 27420 A Revision of unstable kneecap 9.84 NA 7.85 1.71 NA 19.40 090 27422 A Revision of unstable kneecap 9.79 NA 7.86 1.70 NA 19.35 090 27424 A Revision/removal of kneecap 9.82 NA 7.83 1.70 NA 19.35 090 27425 A Lat retinacular release open 5.22 NA 5.33 0.90 NA 11.45 090 27427 A Reconstruction, knee 9.37 NA 7.56 1.63 NA 18.55 090 27428 A Reconstruction, knee 14.01 NA 10.90 2.42 NA 27.33 090 27429 A Reconstruction, knee 15.53 NA 12.03 2.70 NA 30.27 090
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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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grace period. This indicator is no
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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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