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 29900 A Mcp joint arthroscopy, dx 5.42 NA 5.67 0.94 NA 12.03 090 29901 A Mcp joint arthroscopy, surg 6.13 NA 6.05 1.06 NA 13.25 090 29902 A Mcp joint arthroscopy, surg 6.70 NA 6.33 1.12 NA 14.15 090 29999 C Arthroscopy of joint 0.00 0.00 0.00 0.00 0.00 0.00 YYY 30000 A Drainage of nose lesion 1.43 3.99 1.37 0.12 5.54 2.92 010 30020 A Drainage of nose lesion 1.43 3.41 1.45 0.12 4.97 3.00 010 30100 A Intranasal biopsy 0.94 2.03 0.80 0.07 3.04 1.82 000 30110 A Removal of nose polyp(s) 1.63 3.28 1.54 0.14 5.05 3.31 010 30115 A Removal of nose polyp(s) 4.35 NA 5.73 0.41 NA 10.49 090 30117 A Removal of intranasal lesion 3.17 13.54 4.61 0.26 16.97 8.04 090 30118 A Removal of intranasal lesion 9.70 NA 9.03 0.78 NA 19.50 090 30120 A Revision of nose 5.27 6.80 5.78 0.52 12.59 11.57 090 30124 A Removal of nose lesion 3.11 NA 3.63 0.25 NA 6.98 090 30125 A Removal of nose lesion 7.16 NA 8.11 0.63 NA 15.90 090 30130 A Removal of turbinate bones 3.38 NA 5.52 0.31 NA 9.21 090 30140 A Removal of turbinate bones 3.43 NA 6.22 0.35 NA 10.00 090 30150 A Partial removal of nose 9.15 NA 10.64 0.93 NA 20.72 090 30160 A Removal of nose 9.59 NA 9.92 0.88 NA 20.39 090 30200 A Injection treatment of nose 0.78 1.64 0.73 0.06 2.48 1.57 000 30210 A Nasal sinus therapy 1.08 2.12 1.29 0.09 3.30 2.46 010 30220 A Insert nasal septal button 1.54 4.36 1.51 0.12 6.02 3.18 010 30300 A Remove nasal foreign body 1.04 4.50 1.84 0.08 5.62 2.96 010 30310 A Remove nasal foreign body 1.96 NA 3.04 0.16 NA 5.16 010 30320 A Remove nasal foreign body 4.52 NA 6.84 0.39 NA 11.75 090 30400 R Reconstruction of nose 9.84 NA 15.01 1.04 NA 25.89 090 30410 R Reconstruction of nose 12.99 NA 17.64 1.42 NA 32.05 090 30420 R Reconstruction of nose 15.89 NA 17.44 1.46 NA 34.80 090 30430 R Revision of nose 7.21 NA 15.31 0.77 NA 23.30 090 30435 R Revision of nose 11.71 NA 18.43 1.22 NA 31.36 090 30450 R Revision of nose 18.66 NA 21.03 1.96 NA 41.65 090
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 30460 A Revision of nose 9.97 NA 9.57 1.03 NA 20.57 090 30462 A Revision of nose 19.58 NA 19.21 2.53 NA 41.32 090 30465 A Repair nasal stenosis 11.64 NA 11.57 1.06 NA 24.28 090 30520 A Repair of nasal septum 5.70 NA 6.65 0.46 NA 12.81 090 30540 A Repair nasal defect 7.76 NA 9.00 0.67 NA 17.43 090 30545 A Repair nasal defect 11.38 NA 11.78 1.70 NA 24.86 090 30560 A Release of nasal adhesions 1.26 4.73 2.09 0.10 6.09 3.45 010 30580 A Repair upper jaw fistula 6.69 7.88 5.69 0.89 15.46 13.27 090 30600 A Repair mouth/nose fistula 6.02 7.54 4.90 0.70 14.26 11.63 090 30620 A Intranasal reconstruction 5.97 NA 8.69 0.57 NA 15.23 090 30630 A Repair nasal septum defect 7.12 NA 7.85 0.61 NA 15.58 090 30801 A Cauterization, inner nose 1.09 4.06 1.92 0.09 5.25 3.10 010 30802 A Cauterization, inner nose 2.03 4.58 2.36 0.16 6.78 4.56 010 30901 A Control of nosebleed 1.21 1.34 0.31 0.11 2.67 1.63 000 30903 A Control of nosebleed 1.54 2.74 0.48 0.13 4.42 2.16 000 30905 A Control of nosebleed 1.97 3.51 0.73 0.17 5.65 2.88 000 30906 A Repeat control of nosebleed 2.45 3.89 1.15 0.20 6.55 3.81 000 30915 A Ligation, nasal sinus artery 7.20 NA 6.62 0.58 NA 14.40 090 30920 A Ligation, upper jaw artery 9.84 NA 8.89 0.80 NA 19.52 090 30930 A Therapy, fracture of nose 1.26 NA 1.61 0.12 NA 2.99 010 30999 C Nasal surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 31000 A Irrigation, maxillary sinus 1.15 2.85 1.38 0.09 4.09 2.63 010 31002 A Irrigation, sphenoid sinus 1.91 NA 3.13 0.15 NA 5.19 010 31020 A Exploration, maxillary sinus 2.95 8.41 5.16 0.29 11.65 8.40 090 31030 A Exploration, maxillary sinus 5.92 11.21 6.59 0.60 17.73 13.11 090 31032 A Explore sinus, remove polyps 6.57 NA 7.16 0.59 NA 14.32 090 31040 A Exploration behind upper jaw 9.43 NA 9.43 0.87 NA 19.73 090 31050 A Exploration, sphenoid sinus 5.28 NA 6.29 0.49 NA 12.06 090 31051 A Sphenoid sinus surgery 7.11 NA 8.19 0.62 NA 15.92 090 31070 A Exploration of frontal sinus 4.28 NA 5.90 0.38 NA 10.56 090
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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 409 and 410: 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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