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 27558 A Treat knee dislocation 17.73 NA 12.57 3.08 NA 33.38 090 27560 A Treat kneecap dislocation 3.82 4.97 3.08 0.40 9.19 7.29 090 27562 A Treat kneecap dislocation 5.79 NA 4.62 0.94 NA 11.36 090 27566 A Treat kneecap dislocation 12.23 NA 9.03 2.12 NA 23.38 090 27570 A Fixation of knee joint 1.74 NA 1.72 0.30 NA 3.77 010 27580 A Fusion of knee 19.38 NA 14.25 3.37 NA 37.00 090 27590 A Amputate leg at thigh 12.03 NA 6.53 1.74 NA 20.30 090 27591 A Amputate leg at thigh 12.69 NA 8.40 2.02 NA 23.11 090 27592 A Amputate leg at thigh 10.02 NA 6.02 1.45 NA 17.49 090 27594 A Amputation follow-up surgery 6.92 NA 5.04 1.02 NA 12.99 090 27596 A Amputation follow-up surgery 10.60 NA 6.65 1.57 NA 18.82 090 27598 A Amputate lower leg at knee 10.53 NA 6.85 1.65 NA 19.03 090 27599 C Leg surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 27600 A Decompression of lower leg 5.65 NA 4.37 0.86 NA 10.88 090 27601 A Decompression of lower leg 5.64 NA 4.68 0.80 NA 11.13 090 27602 A Decompression of lower leg 7.35 NA 4.97 1.10 NA 13.43 090 27603 A Drain lower leg lesion 4.94 7.21 4.07 0.74 12.89 9.75 090 27604 A Drain lower leg bursa 4.47 5.96 3.87 0.69 11.12 9.03 090 27605 A Incision of achilles tendon 2.88 7.29 2.26 0.41 10.58 5.55 010 27606 A Incision of achilles tendon 4.14 NA 3.25 0.69 NA 8.07 010 27607 A Treat lower leg bone lesion 7.98 NA 6.02 1.31 NA 15.30 090 27610 A Explore/treat ankle joint 8.35 NA 6.79 1.40 NA 16.54 090 27612 A Exploration of ankle joint 7.33 NA 5.95 1.13 NA 14.42 090 27613 A Biopsy lower leg soft tissue 2.17 3.43 1.77 0.20 5.81 4.14 010 27614 A Biopsy lower leg soft tissue 5.66 7.24 4.34 0.78 13.69 10.78 090 27615 A Remove tumor, lower leg 12.57 NA 9.08 1.83 NA 23.48 090 27618 A Remove lower leg lesion 5.09 6.11 3.92 0.72 11.92 9.73 090 27619 A Remove lower leg lesion 8.41 9.38 5.82 1.25 19.03 15.48 090 27620 A Explore/treat ankle joint 5.98 NA 5.31 0.97 NA 12.26 090 27625 A Remove ankle joint lining 8.31 NA 6.30 1.28 NA 15.89 090
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 27626 A Remove ankle joint lining 8.92 NA 6.73 1.48 NA 17.12 090 27630 A Removal of tendon lesion 4.80 7.39 4.27 0.74 12.93 9.81 090 27635 A Remove lower leg bone lesion 7.79 NA 6.54 1.31 NA 15.63 090 27637 A Remove/graft leg bone lesion 9.86 NA 8.03 1.66 NA 19.55 090 27638 A Remove/graft leg bone lesion 10.57 NA 8.04 1.84 NA 20.45 090 27640 A Partial removal of tibia 11.37 NA 9.90 1.88 NA 23.15 090 27641 A Partial removal of fibula 9.25 NA 8.03 1.46 NA 18.74 090 27645 A Extensive lower leg surgery 14.18 NA 11.57 2.41 NA 28.16 090 27646 A Extensive lower leg surgery 12.67 NA 10.60 2.05 NA 25.32 090 27647 A Extensive ankle/heel surgery 12.24 NA 7.48 1.75 NA 21.47 090 27648 A Injection for ankle x-ray 0.96 3.39 0.34 0.08 4.43 1.38 000 27650 A Repair achilles tendon 9.70 NA 7.30 1.59 NA 18.59 090 27652 A Repair/graft achilles tendon 10.33 NA 7.81 1.71 NA 19.85 090 27654 A Repair of achilles tendon 10.02 NA 6.97 1.58 NA 18.57 090 27656 A Repair leg fascia defect 4.57 8.20 3.70 0.69 13.46 8.96 090 27658 A Repair of leg tendon, each 4.98 NA 4.45 0.79 NA 10.22 090 27659 A Repair of leg tendon, each 6.81 NA 5.50 1.09 NA 13.40 090 27664 A Repair of leg tendon, each 4.59 NA 4.42 0.76 NA 9.77 090 27665 A Repair of leg tendon, each 5.40 NA 4.84 0.89 NA 11.14 090 27675 A Repair lower leg tendons 7.18 NA 5.59 1.11 NA 13.89 090 27676 A Repair lower leg tendons 8.43 NA 6.57 1.37 NA 16.36 090 27680 A Release of lower leg tendon 5.74 NA 4.96 0.93 NA 11.63 090 27681 A Release of lower leg tendons 6.82 NA 5.74 1.15 NA 13.72 090 27685 A Revision of lower leg tendon 6.50 7.38 5.35 0.97 14.86 12.82 090 27686 A Revise lower leg tendons 7.46 NA 6.30 1.24 NA 15.00 090 27687 A Revision of calf tendon 6.24 NA 5.18 1.00 NA 12.43 090 27690 A Revise lower leg tendon 8.72 NA 6.22 1.33 NA 16.27 090 27691 A Revise lower leg tendon 9.97 NA 7.54 1.64 NA 19.15 090 27692 A Revise additional leg tendon 1.87 NA 0.90 0.32 NA 3.10 ZZZ 27695 A Repair of ankle ligament 6.51 NA 5.71 1.05 NA 13.27 090
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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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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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