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 33420 A Revision of mitral valve 22.72 NA 9.43 1.81 NA 33.95 090 33422 A Revision of mitral valve 25.95 NA 12.99 3.93 NA 42.87 090 33425 A Repair of mitral valve 27.01 NA 12.48 4.06 NA 43.56 090 33426 A Repair of mitral valve 33.02 NA 16.35 5.01 NA 54.37 090 33427 A Repair of mitral valve 40.02 NA 18.50 6.07 NA 64.59 090 33430 A Replacement of mitral valve 33.52 NA 16.51 5.08 NA 55.10 090 33460 A Revision of tricuspid valve 23.61 NA 10.97 3.44 NA 38.02 090 33463 A Valvuloplasty, tricuspid 25.63 NA 12.58 3.86 NA 42.07 090 33464 A Valvuloplasty, tricuspid 27.34 NA 13.16 4.14 NA 44.65 090 33465 A Replace tricuspid valve 28.81 NA 12.64 4.38 NA 45.82 090 33468 A Revision of tricuspid valve 30.13 NA 13.24 4.06 NA 47.43 090 33470 A Revision of pulmonary valve 20.82 NA 10.71 1.03 NA 32.56 090 33471 A Valvotomy, pulmonary valve 22.26 NA 9.77 3.38 NA 35.41 090 33472 A Revision of pulmonary valve 22.26 NA 11.93 3.54 NA 37.73 090 33474 A Revision of pulmonary valve 23.06 NA 10.74 3.21 NA 37.00 090 33475 A Replacement, pulmonary valve 33.02 NA 15.10 4.92 NA 53.04 090 33476 A Revision of heart chamber 25.78 NA 12.17 2.41 NA 40.36 090 33478 A Revision of heart chamber 26.75 NA 12.66 3.88 NA 43.29 090 33496 A Repair, prosth valve clot 27.26 NA 12.45 4.12 NA 43.83 090 33500 A Repair heart vessel fistula 25.56 NA 11.23 3.86 NA 40.65 090 33501 A Repair heart vessel fistula 17.79 NA 8.19 1.90 NA 27.87 090 33502 A Coronary artery correction 21.05 NA 10.82 2.99 NA 34.86 090 33503 A Coronary artery graft 21.79 NA 9.79 1.77 NA 33.36 090 33504 A Coronary artery graft 24.67 NA 11.64 3.35 NA 39.66 090 33505 A Repair artery w/tunnel 26.85 NA 12.68 2.18 NA 41.72 090 33506 A Repair artery, translocation 35.52 NA 14.19 4.65 NA 54.36 090 33508 A Endoscopic vein harvest 0.31 NA 0.10 0.04 NA 0.45 ZZZ 33510 A CABG, vein, single 29.02 NA 15.53 4.40 NA 48.95 090 33511 A CABG, vein, two 30.02 NA 16.23 4.55 NA 50.80 090 33512 A CABG, vein, three 31.81 NA 16.76 4.66 NA 53.24 090
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 33513 A CABG, vein, four 32.01 NA 16.93 4.87 NA 53.81 090 33514 A CABG, vein, five 32.77 NA 17.19 4.76 NA 54.72 090 33516 A Cabg, vein, six or more 35.02 NA 17.95 5.11 NA 58.08 090 33517 A CABG, artery-vein, single 2.58 NA 0.82 0.39 NA 3.79 ZZZ 33518 A CABG, artery-vein, two 4.85 NA 1.55 0.73 NA 7.13 ZZZ 33519 A CABG, artery-vein, three 7.12 NA 2.28 1.04 NA 10.44 ZZZ 33521 A CABG, artery-vein, four 9.41 NA 3.01 1.37 NA 13.79 ZZZ 33522 A CABG, artery-vein, five 11.67 NA 3.74 1.77 NA 17.18 ZZZ 33523 A Cabg, art-vein, six or more 13.96 NA 4.44 2.12 NA 20.52 ZZZ 33530 A Coronary artery, bypass/reop 5.86 NA 1.87 0.88 NA 8.61 ZZZ 33533 A CABG, arterial, single 30.02 NA 15.67 4.55 NA 50.24 090 33534 A CABG, arterial, two 32.21 NA 16.85 4.69 NA 53.75 090 33535 A CABG, arterial, three 34.52 NA 17.30 5.01 NA 56.83 090 33536 A Cabg, arterial, four or more 37.51 NA 17.58 5.42 NA 60.52 090 33542 A Removal of heart lesion 28.87 NA 12.67 4.37 NA 45.91 090 33545 A Repair of heart damage 36.79 NA 15.37 5.19 NA 57.35 090 33572 A Open coronary endarterectomy 4.45 NA 1.42 0.65 NA 6.52 ZZZ 33600 A Closure of valve 29.53 NA 12.38 4.41 NA 46.32 090 33602 A Closure of valve 28.56 NA 12.52 3.81 NA 44.88 090 33606 A Anastomosis/artery-aorta 30.75 NA 13.32 4.40 NA 48.47 090 33608 A Repair anomaly w/conduit 31.10 NA 13.68 4.73 NA 49.51 090 33610 A Repair by enlargement 30.62 NA 13.44 4.55 NA 48.61 090 33611 A Repair double ventricle 34.02 NA 13.78 4.36 NA 52.16 090 33612 A Repair double ventricle 35.02 NA 14.82 5.28 NA 55.12 090 33615 A Repair, modified fontan 34.02 NA 12.93 4.31 NA 51.26 090 33617 A Repair single ventricle 37.01 NA 15.54 5.64 NA 58.19 090 33619 A Repair single ventricle 45.02 NA 20.23 6.44 NA 71.69 090 33641 A Repair heart septum defect 21.40 NA 9.33 3.22 NA 33.95 090 33645 A Revision of heart veins 24.83 NA 11.50 3.78 NA 40.11 090 33647 A Repair heart septum defects 28.75 NA 13.50 3.31 NA 45.56 090
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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 421 and 422: 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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