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 28160 A Partial removal of toe 3.74 4.80 3.31 0.49 9.03 7.53 090 28171 A Extensive foot surgery 9.61 NA 5.43 1.33 NA 16.37 090 28173 A Extensive foot surgery 8.81 7.79 5.16 1.12 17.71 15.08 090 28175 A Extensive foot surgery 6.05 5.93 3.73 0.73 12.71 10.51 090 28190 A Removal of foot foreign body 1.96 3.47 1.44 0.22 5.65 3.62 010 28192 A Removal of foot foreign body 4.64 5.62 3.60 0.61 10.87 8.85 090 28193 A Removal of foot foreign body 5.73 5.84 3.91 0.73 12.30 10.37 090 28200 A Repair of foot tendon 4.60 5.32 3.53 0.61 10.53 8.74 090 28202 A Repair/graft of foot tendon 6.84 7.31 4.47 0.91 15.06 12.23 090 28208 A Repair of foot tendon 4.37 5.05 3.30 0.58 10.00 8.25 090 28210 A Repair/graft of foot tendon 6.35 6.38 4.03 0.81 13.55 11.20 090 28220 A Release of foot tendon 4.53 4.93 3.41 0.57 10.03 8.51 090 28222 A Release of foot tendons 5.62 5.50 4.08 0.69 11.81 10.39 090 28225 A Release of foot tendon 3.66 4.53 2.90 0.46 8.64 7.02 090 28226 A Release of foot tendons 4.53 5.06 3.70 0.58 10.16 8.81 090 28230 A Incision of foot tendon(s) 4.24 4.90 3.61 0.55 9.69 8.40 090 28232 A Incision of toe tendon 3.39 4.71 3.26 0.44 8.54 7.08 090 28234 A Incision of foot tendon 3.37 4.87 3.33 0.44 8.68 7.14 090 28238 A Revision of foot tendon 7.74 7.39 4.89 1.06 16.19 13.69 090 28240 A Release of big toe 4.36 4.87 3.45 0.58 9.81 8.39 090 28250 A Revision of foot fascia 5.92 5.82 4.10 0.82 12.57 10.84 090 28260 A Release of midfoot joint 7.97 6.56 4.95 1.14 15.67 14.06 090 28261 A Revision of foot tendon 11.73 8.87 7.22 1.57 22.17 20.53 090 28262 A Revision of foot and ankle 15.84 13.37 10.63 2.59 31.81 29.06 090 28264 A Release of midfoot joint 10.35 7.94 7.12 1.54 19.83 19.01 090 28270 A Release of foot contracture 4.76 5.16 3.72 0.62 10.54 9.10 090 28272 A Release of toe joint, each 3.80 4.44 2.87 0.46 8.70 7.12 090 28280 A Fusion of toes 5.19 6.34 4.39 0.73 12.26 10.31 090 28285 A Repair of hammertoe 4.59 5.12 3.44 0.59 10.30 8.62 090 28286 A Repair of hammertoe 4.56 5.06 3.27 0.57 10.19 8.40 090
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 28288 A Partial removal of foot bone 4.74 6.20 4.83 0.65 11.59 10.22 090 28289 A Repair hallux rigidus 7.04 8.06 5.68 1.02 16.12 13.74 090 28290 A Correction of bunion 5.66 6.44 4.63 0.82 12.92 11.11 090 28292 A Correction of bunion 7.04 7.80 5.60 0.91 15.75 13.55 090 28293 A Correction of bunion 9.16 11.26 6.22 1.13 21.55 16.51 090 28294 A Correction of bunion 8.57 7.68 4.72 1.09 17.34 14.38 090 28296 A Correction of bunion 9.19 8.36 5.39 1.19 18.74 15.77 090 28297 A Correction of bunion 9.19 9.04 6.14 1.32 19.55 16.65 090 28298 A Correction of bunion 7.95 7.47 4.98 1.05 16.47 13.98 090 28299 A Correction of bunion 10.58 8.99 6.05 1.37 20.94 18.00 090 28300 A Incision of heel bone 9.55 NA 6.86 1.54 NA 17.95 090 28302 A Incision of ankle bone 9.56 NA 6.72 1.42 NA 17.70 090 28304 A Incision of midfoot bones 9.17 8.16 5.67 1.27 18.60 16.11 090 28305 A Incise/graft midfoot bones 10.50 NA 6.72 1.27 NA 18.49 090 28306 A Incision of metatarsal 5.86 6.96 4.14 0.84 13.66 10.84 090 28307 A Incision of metatarsal 6.33 10.64 5.16 0.90 17.87 12.39 090 28308 A Incision of metatarsal 5.29 6.01 3.71 0.70 12.00 9.71 090 28309 A Incision of metatarsals 12.79 NA 7.83 2.04 NA 22.65 090 28310 A Revision of big toe 5.43 5.98 3.56 0.70 12.12 9.70 090 28312 A Revision of toe 4.55 5.67 3.60 0.63 10.85 8.78 090 28313 A Repair deformity of toe 5.01 5.47 4.69 0.73 11.21 10.43 090 28315 A Removal of sesamoid bone 4.86 5.15 3.35 0.63 10.63 8.84 090 28320 A Repair of foot bones 9.19 NA 6.56 1.43 NA 17.18 090 28322 A Repair of metatarsals 8.35 9.10 6.19 1.27 18.72 15.81 090 28340 A Resect enlarged toe tissue 6.98 6.67 4.24 0.84 14.49 12.07 090 28341 A Resect enlarged toe 8.42 7.22 4.82 1.01 16.64 14.25 090 28344 A Repair extra toe(s) 4.26 5.88 3.60 0.51 10.65 8.37 090 28345 A Repair webbed toe(s) 5.92 6.38 4.61 0.80 13.10 11.33 090 28360 A Reconstruct cleft foot 13.35 NA 10.20 2.28 NA 25.83 090 28400 A Treatment of heel fracture 2.16 3.82 2.96 0.35 6.33 5.48 090
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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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