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 27881 A Amputation of lower leg 12.34 NA 8.58 1.98 NA 22.90 090 27882 A Amputation of lower leg 8.95 NA 6.29 1.29 NA 16.53 090 27884 A Amputation follow-up surgery 8.22 NA 5.60 1.22 NA 15.04 090 27886 A Amputation follow-up surgery 9.33 NA 6.34 1.40 NA 17.06 090 27888 A Amputation of foot at ankle 9.68 NA 7.28 1.51 NA 18.47 090 27889 A Amputation of foot at ankle 9.99 NA 6.30 1.46 NA 17.75 090 27892 A Decompression of leg 7.39 NA 5.44 1.10 NA 13.93 090 27893 A Decompression of leg 7.35 NA 5.32 1.10 NA 13.78 090 27894 A Decompression of leg 10.49 NA 7.57 1.65 NA 19.71 090 27899 C Leg/ankle surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 28001 A Drainage of bursa of foot 2.74 3.15 1.93 0.33 6.21 5.00 010 28002 A Treatment of foot infection 4.62 5.17 3.71 0.61 10.39 8.94 010 28003 A Treatment of foot infection 8.42 6.42 5.15 1.12 15.96 14.69 090 28005 A Treat foot bone lesion 8.69 NA 5.96 1.16 NA 15.81 090 28008 A Incision of foot fascia 4.45 4.77 3.20 0.57 9.79 8.22 090 28010 A Incision of toe tendon 2.85 2.45 2.42 0.36 5.66 5.62 090 28011 A Incision of toe tendons 4.14 0.00 3.28 0.59 4.73 8.01 090 28020 A Exploration of foot joint 5.01 6.09 4.06 0.72 11.82 9.79 090 28022 A Exploration of foot joint 4.67 5.39 3.80 0.62 10.68 9.09 090 28024 A Exploration of toe joint 4.38 5.38 3.85 0.58 10.34 8.81 090 28030 A Removal of foot nerve 6.15 NA 3.67 0.74 NA 10.56 090 28035 A Decompression of tibia nerve 5.09 6.00 4.03 0.70 11.79 9.82 090 28043 A Excision of foot lesion 3.54 3.94 3.14 0.46 7.94 7.13 090 28045 A Excision of foot lesion 4.72 5.58 3.58 0.63 10.93 8.93 090 28046 A Resection of tumor, foot 10.18 8.90 6.37 1.36 20.44 17.91 090 28050 A Biopsy of foot joint lining 4.25 5.11 3.55 0.60 9.96 8.40 090 28052 A Biopsy of foot joint lining 3.94 5.08 3.38 0.53 9.55 7.85 090 28054 A Biopsy of toe joint lining 3.45 4.89 3.18 0.46 8.80 7.09 090 28060 A Partial removal, foot fascia 5.23 5.69 3.86 0.70 11.62 9.79 090 28062 A Removal of foot fascia 6.52 6.70 4.03 0.83 14.05 11.38 090
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 28070 A Removal of foot joint lining 5.10 5.45 3.78 0.73 11.28 9.61 090 28072 A Removal of foot joint lining 4.58 5.68 4.20 0.68 10.94 9.46 090 28080 A Removal of foot lesion 3.58 5.41 3.72 0.47 9.45 7.77 090 28086 A Excise foot tendon sheath 4.78 7.81 4.55 0.76 13.35 10.09 090 28088 A Excise foot tendon sheath 3.86 5.80 3.79 0.61 10.26 8.26 090 28090 A Removal of foot lesion 4.41 5.34 3.44 0.59 10.34 8.44 090 28092 A Removal of toe lesions 3.64 5.34 3.47 0.49 9.47 7.59 090 28100 A Removal of ankle/heel lesion 5.66 7.86 4.61 0.82 14.34 11.09 090 28102 A Remove/graft foot lesion 7.74 NA 5.81 1.14 NA 14.68 090 28103 A Remove/graft foot lesion 6.50 NA 4.57 0.91 NA 11.98 090 28104 A Removal of foot lesion 5.12 5.69 3.88 0.70 11.51 9.70 090 28106 A Remove/graft foot lesion 7.16 NA 4.44 0.97 NA 12.58 090 28107 A Remove/graft foot lesion 5.56 6.67 4.17 0.74 12.97 10.47 090 28108 A Removal of toe lesions 4.16 4.85 3.25 0.53 9.54 7.94 090 28110 A Part removal of metatarsal 4.08 5.43 3.22 0.54 10.05 7.84 090 28111 A Part removal of metatarsal 5.01 6.36 3.62 0.67 12.04 9.30 090 28112 A Part removal of metatarsal 4.49 5.96 3.54 0.61 11.06 8.64 090 28113 A Part removal of metatarsal 4.79 6.33 4.34 0.63 11.75 9.76 090 28114 A Removal of metatarsal heads 9.80 11.63 8.27 1.42 22.85 19.49 090 28116 A Revision of foot 7.76 7.08 5.17 1.03 15.87 13.96 090 28118 A Removal of heel bone 5.96 6.41 4.30 0.84 13.21 11.11 090 28119 A Removal of heel spur 5.39 5.67 3.73 0.70 11.76 9.83 090 28120 A Part removal of ankle/heel 5.40 7.28 4.34 0.77 13.45 10.51 090 28122 A Partial removal of foot bone 7.29 7.04 5.23 0.98 15.31 13.50 090 28124 A Partial removal of toe 4.81 5.27 3.67 0.60 10.68 9.08 090 28126 A Partial removal of toe 3.52 4.46 2.98 0.45 8.43 6.95 090 28130 A Removal of ankle bone 8.12 NA 6.57 1.26 NA 15.94 090 28140 A Removal of metatarsal 6.91 7.29 4.70 0.92 15.12 12.53 090 28150 A Removal of toe 4.09 5.05 3.27 0.53 9.67 7.89 090 28153 A Partial removal of toe 3.66 4.58 2.73 0.47 8.70 6.86 090
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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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