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 31529 A Laryngoscopy and dilation 2.69 NA 1.66 0.22 NA 4.56 000 31530 A Operative laryngoscopy 3.39 NA 1.89 0.29 NA 5.57 000 31531 A Operative laryngoscopy 3.59 NA 2.20 0.29 NA 6.07 000 31535 A Operative laryngoscopy 3.17 NA 1.93 0.26 NA 5.36 000 31536 A Operative laryngoscopy 3.56 NA 2.18 0.29 NA 6.02 000 31540 A Operative laryngoscopy 4.13 NA 2.45 0.33 NA 6.91 000 31541 A Operative laryngoscopy 4.53 NA 2.69 0.37 NA 7.58 000 31545 A Remove vc lesion w/scope 6.31 NA 3.38 0.37 NA 10.07 000 31546 A Remove vc lesion scope/graft 9.75 NA 4.88 0.78 NA 15.41 000 31560 A Operative laryngoscopy 5.46 NA 3.04 0.43 NA 8.93 000 31561 A Operative laryngoscopy 6.00 NA 3.25 0.49 NA 9.74 000 31570 A Laryngoscopy with injection 3.87 5.43 2.30 0.31 9.61 6.48 000 31571 A Laryngoscopy with injection 4.27 NA 2.51 0.35 NA 7.13 000 31575 A Diagnostic laryngoscopy 1.10 1.86 0.87 0.09 3.05 2.06 000 31576 A Laryngoscopy with biopsy 1.97 3.62 1.26 0.14 5.73 3.37 000 31577 A Remove foreign body, larynx 2.47 3.67 1.49 0.21 6.36 4.17 000 31578 A Removal of larynx lesion 2.85 4.19 1.48 0.23 7.27 4.55 000 31579 A Diagnostic laryngoscopy 2.26 3.64 1.44 0.18 6.09 3.88 000 31580 A Revision of larynx 12.38 NA 15.50 1.00 NA 28.89 090 31582 A Revision of larynx 21.63 NA 25.01 1.75 NA 48.40 090 31584 A Treat larynx fracture 19.65 NA 17.74 1.71 NA 39.10 090 31585 A Treat larynx fracture 4.64 NA 6.55 0.38 NA 11.57 090 31586 A Treat larynx fracture 8.04 NA 10.59 0.67 NA 19.29 090 31587 A Revision of larynx 11.99 NA 9.04 0.97 NA 22.00 090 31588 A Revision of larynx 13.12 NA 13.31 1.06 NA 27.48 090 31590 A Reinnervate larynx 6.97 NA 14.97 0.84 NA 22.79 090 31595 A Larynx nerve surgery 8.35 NA 10.28 0.68 NA 19.31 090 31599 C Larynx surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 31600 A Incision of windpipe 7.18 NA 3.09 0.80 NA 11.08 000 31601 A Incision of windpipe 4.45 NA 2.32 0.40 NA 7.17 000
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 31603 A Incision of windpipe 4.15 NA 1.65 0.44 NA 6.24 000 31605 A Incision of windpipe 3.58 NA 1.15 0.40 NA 5.13 000 31610 A Incision of windpipe 8.77 NA 8.10 0.79 NA 17.66 090 31611 A Surgery/speech prosthesis 5.64 NA 6.98 0.46 NA 13.08 090 31612 A Puncture/clear windpipe 0.91 1.10 0.34 0.08 2.09 1.33 000 31613 A Repair windpipe opening 4.59 NA 5.91 0.42 NA 10.92 090 31614 A Repair windpipe opening 7.12 NA 8.67 0.58 NA 16.38 090 31615 A Visualization of windpipe 2.09 2.55 1.17 0.16 4.80 3.43 000 31620 A Endobronchial us add-on 1.40 5.59 0.54 0.11 7.10 2.05 ZZZ 31622 A Dx bronchoscope/wash 2.79 5.46 1.04 0.18 8.42 4.00 000 31623 A Dx bronchoscope/brush 2.89 6.17 1.03 0.13 9.19 4.05 000 31624 A Dx bronchoscope/lavage 2.89 5.56 1.03 0.13 8.57 4.05 000 31625 A Bronchoscopy w/biopsy(s) 3.37 5.61 1.18 0.18 9.16 4.73 000 31628 A Bronchoscopy/lung bx, each 3.81 6.81 1.28 0.18 10.80 5.26 000 31629 A Bronchoscopy/needle bx, each 4.10 13.48 1.37 0.16 17.74 5.63 000 31630 A Bronchoscopy dilate/fx repr 3.82 NA 1.66 0.32 NA 5.80 000 31631 A Bronchoscopy, dilate w/stent 4.37 NA 1.72 0.34 NA 6.43 000 31632 A Bronchoscopy/lung bx, addªl 1.03 0.80 0.30 0.18 2.01 1.52 ZZZ 31633 A Bronchoscopy/needle bx addªl 1.32 0.91 0.39 0.16 2.39 1.87 ZZZ 31635 A Bronchoscopy w/fb removal 3.68 5.90 1.39 0.24 9.81 5.31 000 31636 A Bronchoscopy, bronch stents 4.31 NA 1.72 0.31 NA 6.34 000 31637 A Bronchoscopy, stent add-on 1.58 NA 0.55 0.13 NA 2.26 ZZZ 31638 A Bronchoscopy, revise stent 4.89 NA 1.92 0.22 NA 7.03 000 31640 A Bronchoscopy w/tumor excise 4.94 NA 2.01 0.46 NA 7.41 000 31641 A Bronchoscopy, treat blockage 5.03 NA 1.83 0.35 NA 7.21 000 31643 A Diag bronchoscope/catheter 3.50 NA 1.20 0.20 NA 4.90 000 31645 A Bronchoscopy, clear airways 3.17 4.95 1.10 0.16 8.28 4.43 000 31646 A Bronchoscopy, reclear airway 2.73 4.68 0.98 0.14 7.54 3.85 000 31656 A Bronchoscopy, inj for x-ray 2.17 6.94 0.83 0.15 9.27 3.16 000 31700 A Insertion of airway catheter 1.34 2.16 0.67 0.08 3.58 2.10 000
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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 413 and 414: 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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