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 27430 A Revision of thigh muscles 9.68 NA 7.75 1.69 NA 19.12 090 27435 A Incision of knee joint 9.50 NA 8.21 1.69 NA 19.40 090 27437 A Revise kneecap 8.47 NA 7.01 1.49 NA 16.96 090 27438 A Revise kneecap with implant 11.23 NA 8.28 1.95 NA 21.46 090 27440 A Revision of knee joint 10.43 NA 5.82 1.81 NA 18.06 090 27441 A Revision of knee joint 10.82 NA 6.50 1.88 NA 19.20 090 27442 A Revision of knee joint 11.89 NA 8.64 2.09 NA 22.62 090 27443 A Revision of knee joint 10.93 NA 8.44 1.90 NA 21.27 090 27445 A Revision of knee joint 17.69 NA 11.96 3.08 NA 32.73 090 27446 A Revision of knee joint 15.85 NA 10.91 2.80 NA 29.57 090 27447 A Total knee arthroplasty 21.49 NA 14.16 3.79 NA 39.44 090 27448 A Incision of thigh 11.06 NA 8.33 1.94 NA 21.33 090 27450 A Incision of thigh 13.99 NA 10.24 2.42 NA 26.65 090 27454 A Realignment of thigh bone 17.57 NA 12.12 3.12 NA 32.81 090 27455 A Realignment of knee 12.83 NA 9.54 2.24 NA 24.61 090 27457 A Realignment of knee 13.46 NA 9.60 2.34 NA 25.40 090 27465 A Shortening of thigh bone 13.88 NA 9.89 2.47 NA 26.24 090 27466 A Lengthening of thigh bone 16.34 NA 11.46 2.77 NA 30.58 090 27468 A Shorten/lengthen thighs 18.98 NA 12.09 3.30 NA 34.37 090 27470 A Repair of thigh 16.08 NA 11.42 2.79 NA 30.29 090 27472 A Repair/graft of thigh 17.73 NA 12.28 3.07 NA 33.07 090 27475 A Surgery to stop leg growth 8.65 NA 6.97 1.36 NA 16.98 090 27477 A Surgery to stop leg growth 9.86 NA 7.49 1.73 NA 19.08 090 27479 A Surgery to stop leg growth 12.81 NA 9.48 2.78 NA 25.07 090 27485 A Surgery to stop leg growth 8.85 NA 7.16 1.53 NA 17.53 090 27486 A Revise/replace knee joint 19.28 NA 13.08 3.36 NA 35.71 090 27487 A Revise/replace knee joint 25.28 NA 16.04 4.39 NA 45.71 090 27488 A Removal of knee prosthesis 15.75 NA 11.34 2.74 NA 29.83 090 27495 A Reinforce thigh 15.56 NA 11.05 2.71 NA 29.32 090 27496 A Decompression of thigh/knee 6.11 NA 5.42 0.99 NA 12.52 090
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 27497 A Decompression of thigh/knee 7.17 NA 5.28 1.15 NA 13.61 090 27498 A Decompression of thigh/knee 8.00 NA 5.79 1.24 NA 15.03 090 27499 A Decompression of thigh/knee 9.01 NA 6.64 1.47 NA 17.11 090 27500 A Treatment of thigh fracture 5.92 6.67 4.85 1.02 13.61 11.79 090 27501 A Treatment of thigh fracture 5.92 6.35 5.23 1.03 13.30 12.18 090 27502 A Treatment of thigh fracture 10.58 NA 7.88 1.78 NA 20.24 090 27503 A Treatment of thigh fracture 10.58 NA 8.05 1.84 NA 20.47 090 27506 A Treatment of thigh fracture 17.45 NA 12.39 3.03 NA 32.87 090 27507 A Treatment of thigh fracture 14.00 NA 9.53 2.42 NA 25.95 090 27508 A Treatment of thigh fracture 5.83 6.55 5.32 0.97 13.35 12.12 090 27509 A Treatment of thigh fracture 7.72 NA 7.64 1.34 NA 16.69 090 27510 A Treatment of thigh fracture 9.14 NA 7.12 1.53 NA 17.79 090 27511 A Treatment of thigh fracture 13.65 NA 10.77 2.37 NA 26.79 090 27513 A Treatment of thigh fracture 17.93 NA 13.38 3.12 NA 34.43 090 27514 A Treatment of thigh fracture 17.30 NA 12.88 3.00 NA 33.19 090 27516 A Treat thigh fx growth plate 5.37 6.45 5.36 0.81 12.63 11.54 090 27517 A Treat thigh fx growth plate 8.79 NA 7.24 1.22 NA 17.25 090 27519 A Treat thigh fx growth plate 15.03 NA 11.17 2.55 NA 28.75 090 27520 A Treat kneecap fracture 2.87 4.69 3.34 0.47 8.03 6.67 090 27524 A Treat kneecap fracture 10.01 NA 7.97 1.74 NA 19.72 090 27530 A Treat knee fracture 3.78 5.44 4.30 0.65 9.87 8.72 090 27532 A Treat knee fracture 7.30 7.13 6.27 1.26 15.69 14.83 090 27535 A Treat knee fracture 11.50 NA 9.71 2.00 NA 23.21 090 27536 A Treat knee fracture 15.66 NA 11.25 2.73 NA 29.64 090 27538 A Treat knee fracture(s) 4.87 6.23 5.04 0.84 11.94 10.75 090 27540 A Treat knee fracture 13.11 NA 9.21 2.27 NA 24.59 090 27550 A Treat knee dislocation 5.76 6.12 4.78 0.76 12.64 11.30 090 27552 A Treat knee dislocation 7.91 NA 6.75 1.36 NA 16.01 090 27556 A Treat knee dislocation 14.42 NA 11.21 2.50 NA 28.13 090 27557 A Treat knee dislocation 16.77 NA 12.63 2.97 NA 32.38 090
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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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5. Physician work RVUs. These are t
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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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