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 28405 A Treatment of heel fracture 4.57 5.00 4.50 0.73 10.30 9.80 090 28406 A Treatment of heel fracture 6.31 NA 6.54 1.11 NA 13.97 090 28415 A Treat heel fracture 15.98 NA 15.56 2.66 NA 34.20 090 28420 A Treat/graft heel fracture 16.65 NA 15.18 2.80 NA 34.63 090 28430 A Treatment of ankle fracture 2.09 3.58 2.48 0.31 5.98 4.88 090 28435 A Treatment of ankle fracture 3.40 4.07 3.64 0.55 8.02 7.59 090 28436 A Treatment of ankle fracture 4.71 NA 5.69 0.81 NA 11.21 090 28445 A Treat ankle fracture 15.63 NA 10.73 2.58 NA 28.94 090 28450 A Treat midfoot fracture, each 1.90 3.31 2.40 0.28 5.50 4.58 090 28455 A Treat midfoot fracture, each 3.10 3.64 3.37 0.44 7.18 6.91 090 28456 A Treat midfoot fracture 2.69 NA 4.03 0.44 NA 7.15 090 28465 A Treat midfoot fracture, each 7.01 NA 7.98 1.10 NA 16.10 090 28470 A Treat metatarsal fracture 1.99 3.31 2.36 0.30 5.60 4.66 090 28475 A Treat metatarsal fracture 2.98 3.53 3.12 0.44 6.94 6.54 090 28476 A Treat metatarsal fracture 3.38 NA 4.82 0.54 NA 8.74 090 28485 A Treat metatarsal fracture 5.71 NA 7.53 0.83 NA 14.07 090 28490 A Treat big toe fracture 1.09 2.00 1.59 0.14 3.23 2.82 090 28495 A Treat big toe fracture 1.58 2.21 2.01 0.20 3.99 3.79 090 28496 A Treat big toe fracture 2.33 7.96 3.12 0.36 10.66 5.82 090 28505 A Treat big toe fracture 3.81 9.34 5.68 0.56 13.71 10.05 090 28510 A Treatment of toe fracture 1.09 1.54 1.49 0.14 2.77 2.72 090 28515 A Treatment of toe fracture 1.46 1.93 1.85 0.18 3.58 3.50 090 28525 A Treat toe fracture 3.33 8.76 5.19 0.49 12.58 9.01 090 28530 A Treat sesamoid bone fracture 1.06 1.67 1.41 0.14 2.87 2.61 090 28531 A Treat sesamoid bone fracture 2.35 7.40 3.45 0.34 10.09 6.14 090 28540 A Treat foot dislocation 2.04 2.65 2.41 0.26 4.95 4.72 090 28545 A Treat foot dislocation 2.45 2.60 2.48 0.37 5.42 5.30 090 28546 A Treat foot dislocation 3.21 6.89 4.25 0.52 10.62 7.97 090 28555 A Repair foot dislocation 6.30 11.09 7.52 1.04 18.43 14.86 090 28570 A Treat foot dislocation 1.66 2.65 2.27 0.23 4.54 4.17 090
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 28575 A Treat foot dislocation 3.32 3.92 3.70 0.56 7.79 7.58 090 28576 A Treat foot dislocation 4.17 NA 4.11 0.69 NA 8.97 090 28585 A Repair foot dislocation 8.00 8.69 7.47 1.25 17.94 16.71 090 28600 A Treat foot dislocation 1.89 3.03 2.61 0.27 5.20 4.77 090 28605 A Treat foot dislocation 2.72 3.35 3.16 0.40 6.46 6.28 090 28606 A Treat foot dislocation 4.90 NA 4.64 0.82 NA 10.36 090 28615 A Repair foot dislocation 7.78 NA 9.80 1.30 NA 18.87 090 28630 A Treat toe dislocation 1.70 1.61 0.96 0.20 3.51 2.87 010 28635 A Treat toe dislocation 1.91 2.21 1.51 0.26 4.38 3.68 010 28636 A Treat toe dislocation 2.78 3.87 2.55 0.43 7.08 5.75 010 28645 A Repair toe dislocation 4.22 5.95 4.24 0.57 10.74 9.03 090 28660 A Treat toe dislocation 1.23 1.48 0.76 0.13 2.84 2.13 010 28665 A Treat toe dislocation 1.92 0.00 1.42 0.26 2.18 3.60 010 28666 A Treat toe dislocation 2.67 NA 2.48 0.43 NA 5.58 010 28675 A Repair of toe dislocation 2.93 7.92 4.53 0.45 11.29 7.91 090 28705 A Fusion of foot bones 18.81 NA 12.10 3.08 NA 33.99 090 28715 A Fusion of foot bones 13.11 NA 9.48 2.16 NA 24.75 090 28725 A Fusion of foot bones 11.61 NA 8.02 1.86 NA 21.49 090 28730 A Fusion of foot bones 10.76 NA 8.29 1.70 NA 20.75 090 28735 A Fusion of foot bones 10.85 NA 7.65 1.68 NA 20.18 090 28737 A Revision of foot bones 9.65 NA 6.70 1.47 NA 17.82 090 28740 A Fusion of foot bones 8.03 10.65 6.34 1.22 19.89 15.58 090 28750 A Fusion of big toe joint 7.30 11.53 6.49 1.13 19.97 14.93 090 28755 A Fusion of big toe joint 4.74 6.22 3.72 0.65 11.61 9.11 090 28760 A Fusion of big toe joint 7.76 8.16 5.48 1.05 16.96 14.28 090 28800 A Amputation of midfoot 8.22 NA 5.67 1.15 NA 15.04 090 28805 A Amputation thru metatarsal 8.40 NA 5.52 1.18 NA 15.10 090 28810 A Amputation toe & metatarsal 6.21 NA 4.39 0.86 NA 11.46 090 28820 A Amputation of toe 4.41 7.47 3.72 0.61 12.49 8.74 090 28825 A Partial amputation of toe 3.59 6.95 3.42 0.50 11.03 7.50 090
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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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