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 31708 A Instill airway contrast dye 1.41 NA 0.48 0.07 NA 1.97 000 31710 A Insertion of airway catheter 1.30 NA 0.42 0.12 NA 1.84 000 31715 A Injection for bronchus x-ray 1.11 NA 0.34 0.07 NA 1.53 000 31717 A Bronchial brush biopsy 2.12 7.76 0.78 0.14 10.02 3.05 000 31720 A Clearance of airways 1.06 NA 0.32 0.07 NA 1.46 000 31725 A Clearance of airways 1.96 NA 0.57 0.14 NA 2.67 000 31730 A Intro, windpipe wire/tube 2.86 7.21 0.97 0.21 10.27 4.03 000 31750 A Repair of windpipe 13.03 NA 17.23 1.05 NA 31.30 090 31755 A Repair of windpipe 15.94 NA 24.11 1.29 NA 41.34 090 31760 A Repair of windpipe 22.36 NA 10.59 2.94 NA 35.89 090 31766 A Reconstruction of windpipe 30.44 NA 13.49 4.52 NA 48.45 090 31770 A Repair/graft of bronchus 22.52 NA 10.00 2.83 NA 35.35 090 31775 A Reconstruct bronchus 23.55 NA 11.47 3.01 NA 38.02 090 31780 A Reconstruct windpipe 17.73 NA 10.66 1.65 NA 30.03 090 31781 A Reconstruct windpipe 23.54 NA 11.70 2.24 NA 37.48 090 31785 A Remove windpipe lesion 17.23 NA 9.85 1.59 NA 28.67 090 31786 A Remove windpipe lesion 23.99 NA 12.72 3.29 NA 40.00 090 31800 A Repair of windpipe injury 7.43 NA 8.95 0.79 NA 17.17 090 31805 A Repair of windpipe injury 13.14 NA 7.04 1.82 NA 22.00 090 31820 A Closure of windpipe lesion 4.49 5.62 3.57 0.38 10.49 8.44 090 31825 A Repair of windpipe defect 6.81 7.56 5.24 0.53 14.90 12.58 090 31830 A Revise windpipe scar 4.50 5.72 3.90 0.44 10.66 8.83 090 31899 C Airways surgical procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 32000 A Drainage of chest 1.54 2.92 0.48 0.08 4.54 2.10 000 32002 A Treatment of collapsed lung 2.19 3.14 1.08 0.12 5.45 3.39 000 32005 A Treat lung lining chemically 2.19 6.09 0.68 0.23 8.51 3.11 000 32019 A Insert pleural catheter 4.18 18.66 1.62 0.42 23.26 6.22 000 32020 A Insertion of chest tube 3.98 NA 1.32 0.43 NA 5.73 000 32035 A Exploration of chest 8.68 NA 5.73 1.26 NA 15.67 090 32036 A Exploration of chest 9.69 NA 6.26 1.43 NA 17.38 090
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 32095 A Biopsy through chest wall 8.37 NA 5.25 1.22 NA 14.83 090 32100 A Exploration/biopsy of chest 15.25 NA 7.65 2.23 NA 25.13 090 32110 A Explore/repair chest 23.02 NA 10.50 3.21 NA 36.72 090 32120 A Re-exploration of chest 11.54 NA 6.89 1.63 NA 20.06 090 32124 A Explore chest free adhesions 12.73 NA 7.08 1.89 NA 21.69 090 32140 A Removal of lung lesion(s) 13.94 NA 7.53 1.96 NA 23.43 090 32141 A Remove/treat lung lesions 14.01 NA 7.39 2.00 NA 23.40 090 32150 A Removal of lung lesion(s) 14.16 NA 7.47 2.00 NA 23.63 090 32151 A Remove lung foreign body 14.22 NA 7.93 2.03 NA 24.18 090 32160 A Open chest heart massage 9.31 NA 5.19 1.31 NA 15.81 090 32200 A Drain, open, lung lesion 15.30 NA 8.72 2.13 NA 26.16 090 32201 A Drain, percut, lung lesion 4.00 21.42 1.37 0.24 25.66 5.60 000 32215 A Treat chest lining 11.33 NA 6.72 1.68 NA 19.73 090 32220 A Release of lung 24.01 NA 12.63 3.56 NA 40.20 090 32225 A Partial release of lung 13.97 NA 7.49 2.06 NA 23.52 090 32310 A Removal of chest lining 13.45 NA 7.24 1.99 NA 22.67 090 32320 A Free/remove chest lining 24.01 NA 11.91 3.51 NA 39.42 090 32400 A Needle biopsy chest lining 1.76 2.16 0.56 0.10 4.03 2.42 000 32402 A Open biopsy chest lining 7.57 NA 4.98 1.07 NA 13.62 090 32405 A Biopsy, lung or mediastinum 1.93 0.69 0.66 0.11 2.74 2.71 000 32420 A Puncture/clear lung 2.18 NA 0.69 0.12 NA 2.99 000 32440 A Removal of lung 25.01 NA 12.36 3.68 NA 41.05 090 32442 A Sleeve pneumonectomy 26.25 NA 14.11 3.84 NA 44.21 090 32445 A Removal of lung 25.10 NA 13.42 3.71 NA 42.23 090 32480 A Partial removal of lung 23.76 NA 11.57 3.49 NA 38.82 090 32482 A Bilobectomy 25.01 NA 12.42 3.66 NA 41.09 090 32484 A Segmentectomy 20.70 NA 10.89 3.03 NA 34.62 090 32486 A Sleeve lobectomy 23.93 NA 12.60 3.51 NA 40.04 090 32488 A Completion pneumonectomy 25.72 NA 13.17 3.80 NA 42.69 090 32491 R Lung volume reduction 21.26 NA 11.97 2.98 NA 36.21 090
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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 415 and 416: 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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