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 31075 A Exploration of frontal sinus 9.17 NA 9.59 0.75 NA 19.51 090 31080 A Removal of frontal sinus 11.42 NA 13.18 1.23 NA 25.83 090 31081 A Removal of frontal sinus 12.76 NA 13.68 2.46 NA 28.90 090 31084 A Removal of frontal sinus 13.52 NA 13.27 1.19 NA 27.98 090 31085 A Removal of frontal sinus 14.21 NA 13.72 1.72 NA 29.65 090 31086 A Removal of frontal sinus 12.87 NA 13.07 1.07 NA 27.00 090 31087 A Removal of frontal sinus 13.11 NA 12.29 1.44 NA 26.83 090 31090 A Exploration of sinuses 9.54 NA 12.48 0.94 NA 22.96 090 31200 A Removal of ethmoid sinus 4.97 NA 8.87 0.29 NA 14.13 090 31201 A Removal of ethmoid sinus 8.38 NA 9.09 0.82 NA 18.28 090 31205 A Removal of ethmoid sinus 10.24 NA 11.45 0.67 NA 22.36 090 31225 A Removal of upper jaw 19.24 NA 17.49 1.59 NA 38.32 090 31230 A Removal of upper jaw 21.95 NA 18.89 1.77 NA 42.62 090 31231 A Nasal endoscopy, dx 1.10 3.34 0.86 0.09 4.54 2.05 000 31233 A Nasal/sinus endoscopy, dx 2.18 4.23 1.44 0.20 6.62 3.82 000 31235 A Nasal/sinus endoscopy, dx 2.65 4.82 1.67 0.26 7.72 4.57 000 31237 A Nasal/sinus endoscopy, surg 2.99 5.08 1.82 0.28 8.35 5.09 000 31238 A Nasal/sinus endoscopy, surg 3.27 5.11 2.02 0.27 8.65 5.56 000 31239 A Nasal/sinus endoscopy, surg 8.71 NA 7.73 0.62 NA 17.05 010 31240 A Nasal/sinus endoscopy, surg 2.62 NA 1.68 0.24 NA 4.53 000 31254 A Revision of ethmoid sinus 4.65 NA 2.75 0.45 NA 7.85 000 31255 A Removal of ethmoid sinus 6.96 NA 3.96 0.73 NA 11.65 000 31256 A Exploration maxillary sinus 3.30 NA 2.04 0.33 NA 5.67 000 31267 A Endoscopy, maxillary sinus 5.46 NA 3.17 0.55 NA 9.18 000 31276 A Sinus endoscopy, surgical 8.86 NA 4.93 0.92 NA 14.71 000 31287 A Nasal/sinus endoscopy, surg 3.92 NA 2.37 0.39 NA 6.68 000 31288 A Nasal/sinus endoscopy, surg 4.58 NA 2.71 0.46 NA 7.75 000 31290 A Nasal/sinus endoscopy, surg 17.24 NA 11.64 1.40 NA 30.29 010 31291 A Nasal/sinus endoscopy, surg 18.20 NA 12.08 1.68 NA 31.95 010 31292 A Nasal/sinus endoscopy, surg 14.77 NA 10.26 1.21 NA 26.24 010
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 31293 A Nasal/sinus endoscopy, surg 16.22 NA 11.00 1.28 NA 28.50 010 31294 A Nasal/sinus endoscopy, surg 19.07 NA 12.43 1.53 NA 33.03 010 31299 C Sinus surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 31300 A Removal of larynx lesion 14.30 NA 14.71 1.17 NA 30.18 090 31320 A Diagnostic incision, larynx 5.26 NA 10.05 0.46 NA 15.77 090 31360 A Removal of larynx 17.08 NA 16.42 1.38 NA 34.88 090 31365 A Removal of larynx 24.17 NA 19.92 1.97 NA 46.06 090 31367 A Partial removal of larynx 21.87 NA 21.49 1.78 NA 45.14 090 31368 A Partial removal of larynx 27.10 NA 25.03 2.20 NA 54.33 090 31370 A Partial removal of larynx 21.39 NA 21.85 1.74 NA 44.98 090 31375 A Partial removal of larynx 20.22 NA 20.05 1.63 NA 41.90 090 31380 A Partial removal of larynx 20.22 NA 20.20 1.70 NA 42.12 090 31382 A Partial removal of larynx 20.53 NA 21.26 1.67 NA 43.46 090 31390 A Removal of larynx & pharynx 27.54 NA 23.90 2.23 NA 53.67 090 31395 A Reconstruct larynx & pharynx 31.10 NA 27.81 2.48 NA 61.39 090 31400 A Revision of larynx 10.31 NA 13.38 0.83 NA 24.52 090 31420 A Removal of epiglottis 10.22 NA 9.33 0.83 NA 20.38 090 31500 A Insert emergency airway 2.33 NA 0.54 0.17 NA 3.04 000 31502 A Change of windpipe airway 0.65 NA 0.28 0.05 NA 0.98 000 31505 A Diagnostic laryngoscopy 0.61 1.43 0.60 0.05 2.09 1.26 000 31510 A Laryngoscopy with biopsy 1.92 3.23 1.22 0.16 5.31 3.30 000 31511 A Remove foreign body, larynx 2.16 3.06 1.03 0.19 5.41 3.38 000 31512 A Removal of larynx lesion 2.07 3.15 1.32 0.18 5.40 3.58 000 31513 A Injection into vocal cord 2.10 NA 1.42 0.17 NA 3.69 000 31515 A Laryngoscopy for aspiration 1.80 3.44 1.04 0.14 5.38 2.98 000 31520 A Diagnostic laryngoscopy 2.57 NA 1.52 0.20 NA 4.28 000 31525 A Diagnostic laryngoscopy 2.64 3.59 1.61 0.21 6.43 4.46 000 31526 A Diagnostic laryngoscopy 2.58 NA 1.67 0.21 NA 4.45 000 31527 A Laryngoscopy for treatment 3.28 NA 1.82 0.26 NA 5.36 000 31528 A Laryngoscopy and dilation 2.37 NA 1.43 0.19 NA 3.99 000
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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 411 and 412: 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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