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 29807 A Shoulder arthroscopy/surgery 13.91 NA 10.64 2.41 NA 26.96 090 29819 A Shoulder arthroscopy/surgery 7.63 NA 6.56 1.32 NA 15.51 090 29820 A Shoulder arthroscopy/surgery 7.07 NA 6.01 1.22 NA 14.31 090 29821 A Shoulder arthroscopy/surgery 7.73 NA 6.57 1.33 NA 15.63 090 29822 A Shoulder arthroscopy/surgery 7.43 NA 6.46 1.28 NA 15.18 090 29823 A Shoulder arthroscopy/surgery 8.18 NA 6.98 1.41 NA 16.57 090 29824 A Shoulder arthroscopy/surgery 8.26 NA 7.29 1.42 NA 16.96 090 29825 A Shoulder arthroscopy/surgery 7.63 NA 6.54 1.32 NA 15.48 090 29826 A Shoulder arthroscopy/surgery 9.00 NA 7.28 1.55 NA 17.83 090 29827 A Arthroscop rotator cuff repr 15.37 NA 11.16 2.66 NA 29.19 090 29830 A Elbow arthroscopy 5.76 NA 5.18 0.99 NA 11.93 090 29834 A Elbow arthroscopy/surgery 6.28 NA 5.64 1.08 NA 13.00 090 29835 A Elbow arthroscopy/surgery 6.48 NA 5.69 1.13 NA 13.30 090 29836 A Elbow arthroscopy/surgery 7.56 NA 6.56 1.22 NA 15.33 090 29837 A Elbow arthroscopy/surgery 6.87 NA 5.92 1.19 NA 13.99 090 29838 A Elbow arthroscopy/surgery 7.72 NA 6.66 1.30 NA 15.67 090 29840 A Wrist arthroscopy 5.54 NA 5.15 0.84 NA 11.53 090 29843 A Wrist arthroscopy/surgery 6.01 NA 5.44 0.92 NA 12.37 090 29844 A Wrist arthroscopy/surgery 6.37 NA 5.63 1.04 NA 13.04 090 29845 A Wrist arthroscopy/surgery 7.53 NA 6.29 0.99 NA 14.81 090 29846 A Wrist arthroscopy/surgery 6.75 NA 5.86 1.07 NA 13.68 090 29847 A Wrist arthroscopy/surgery 7.08 NA 5.99 1.08 NA 14.16 090 29848 A Wrist endoscopy/surgery 5.44 NA 5.43 0.86 NA 11.73 090 29850 A Knee arthroscopy/surgery 8.20 NA 5.02 1.25 NA 14.47 090 29851 A Knee arthroscopy/surgery 13.11 NA 9.49 2.34 NA 24.93 090 29855 A Tibial arthroscopy/surgery 10.62 NA 8.48 1.84 NA 20.95 090 29856 A Tibial arthroscopy/surgery 14.15 NA 10.34 2.39 NA 26.87 090 29860 A Hip arthroscopy, dx 8.06 NA 6.73 1.36 NA 16.15 090 29861 A Hip arthroscopy/surgery 9.16 NA 7.11 1.59 NA 17.86 090 29862 A Hip arthroscopy/surgery 9.91 NA 8.29 1.62 NA 19.82 090
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 29863 A Hip arthroscopy/surgery 9.91 NA 8.25 1.42 NA 19.58 090 29866 A Autgrft implnt, knee w/scope 13.91 NA 10.98 2.39 NA 27.28 090 29867 A Allgrft implnt, knee w/scope 17.03 NA 12.80 2.78 NA 32.61 090 29868 A Meniscal trnspl, knee w/scpe 23.64 NA 16.26 4.35 NA 44.25 090 29870 A Knee arthroscopy, dx 5.07 NA 4.72 0.85 NA 10.64 090 29871 A Knee arthroscopy/drainage 6.55 NA 5.68 1.14 NA 13.38 090 29873 A Knee arthroscopy/surgery 6.00 NA 6.35 1.04 NA 13.39 090 29874 A Knee arthroscopy/surgery 7.05 NA 5.88 1.11 NA 14.04 090 29875 A Knee arthroscopy/surgery 6.31 NA 5.65 1.09 NA 13.06 090 29876 A Knee arthroscopy/surgery 7.93 NA 6.80 1.37 NA 16.09 090 29877 A Knee arthroscopy/surgery 7.35 NA 6.52 1.28 NA 15.16 090 29879 A Knee arthroscopy/surgery 8.05 NA 6.89 1.39 NA 16.32 090 29880 A Knee arthroscopy/surgery 8.51 NA 7.12 1.47 NA 17.10 090 29881 A Knee arthroscopy/surgery 7.77 NA 6.73 1.34 NA 15.84 090 29882 A Knee arthroscopy/surgery 8.66 NA 7.01 1.50 NA 17.16 090 29883 A Knee arthroscopy/surgery 11.05 NA 8.77 1.92 NA 21.74 090 29884 A Knee arthroscopy/surgery 7.33 NA 6.48 1.27 NA 15.09 090 29885 A Knee arthroscopy/surgery 9.10 NA 7.71 1.58 NA 18.39 090 29886 A Knee arthroscopy/surgery 7.55 NA 6.63 1.30 NA 15.47 090 29887 A Knee arthroscopy/surgery 9.05 NA 7.67 1.57 NA 18.29 090 29888 A Knee arthroscopy/surgery 13.91 NA 9.87 2.41 NA 26.19 090 29889 A Knee arthroscopy/surgery 16.01 NA 12.04 2.78 NA 30.83 090 29891 A Ankle arthroscopy/surgery 8.41 NA 7.29 1.39 NA 17.09 090 29892 A Ankle arthroscopy/surgery 9.01 NA 7.52 1.41 NA 17.94 090 29893 A Scope, plantar fasciotomy 5.22 6.64 4.09 0.63 12.49 9.94 090 29894 A Ankle arthroscopy/surgery 7.21 NA 5.34 1.15 NA 13.71 090 29895 A Ankle arthroscopy/surgery 6.99 NA 5.34 1.11 NA 13.44 090 29897 A Ankle arthroscopy/surgery 7.18 NA 5.71 1.17 NA 14.06 090 29898 A Ankle arthroscopy/surgery 8.33 NA 6.05 1.28 NA 15.66 090 29899 A Ankle arthroscopy/surgery 13.92 NA 10.23 2.40 NA 26.54 090
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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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Page 407 and 408: 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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