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 33660 A Repair of heart defects 30.02 NA 13.24 4.48 NA 47.74 090 33665 A Repair of heart defects 28.62 NA 13.32 3.99 NA 45.93 090 33670 A Repair of heart chambers 35.02 NA 13.52 4.64 NA 53.18 090 33681 A Repair heart septum defect 30.62 NA 14.26 4.44 NA 49.32 090 33684 A Repair heart septum defect 29.67 NA 13.27 3.38 NA 46.32 090 33688 A Repair heart septum defect 30.63 NA 10.17 4.72 NA 45.52 090 33690 A Reinforce pulmonary artery 19.56 NA 9.86 1.96 NA 31.38 090 33692 A Repair of heart defects 30.76 NA 13.32 4.57 NA 48.66 090 33694 A Repair of heart defects 34.02 NA 13.87 5.26 NA 53.15 090 33697 A Repair of heart defects 36.02 NA 14.41 4.08 NA 54.51 090 33702 A Repair of heart defects 26.55 NA 12.26 3.67 NA 42.48 090 33710 A Repair of heart defects 29.73 NA 13.76 4.42 NA 47.91 090 33720 A Repair of heart defect 26.57 NA 11.98 3.83 NA 42.38 090 33722 A Repair of heart defect 28.43 NA 13.09 1.30 NA 42.82 090 33730 A Repair heart-vein defect(s) 34.27 NA 14.33 5.01 NA 53.61 090 33732 A Repair heart-vein defect 28.18 NA 13.51 3.67 NA 45.36 090 33735 A Revision of heart chamber 21.40 NA 9.04 1.91 NA 32.35 090 33736 A Revision of heart chamber 23.53 NA 11.97 3.08 NA 38.57 090 33737 A Revision of heart chamber 21.77 NA 11.26 3.24 NA 36.27 090 33750 A Major vessel shunt 21.42 NA 10.37 1.16 NA 32.95 090 33755 A Major vessel shunt 21.80 NA 8.58 3.25 NA 33.64 090 33762 A Major vessel shunt 21.80 NA 10.24 3.13 NA 35.18 090 33764 A Major vessel shunt & graft 21.80 NA 10.24 3.00 NA 35.04 090 33766 A Major vessel shunt 22.78 NA 11.07 3.69 NA 37.53 090 33767 A Major vessel shunt 24.51 NA 11.37 3.81 NA 39.69 090 33770 A Repair great vessels defect 37.01 NA 14.36 5.72 NA 57.09 090 33771 A Repair great vessels defect 34.67 NA 12.11 5.66 NA 52.44 090 33774 A Repair great vessels defect 30.99 NA 14.46 4.80 NA 50.25 090 33775 A Repair great vessels defect 32.21 NA 14.39 4.98 NA 51.58 090 33776 A Repair great vessels defect 34.06 NA 15.27 5.07 NA 54.40 090
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 33777 A Repair great vessels defect 33.48 NA 14.86 5.47 NA 53.81 090 33778 A Repair great vessels defect 40.02 NA 16.36 6.18 NA 62.56 090 33779 A Repair great vessels defect 36.23 NA 15.87 2.91 NA 55.01 090 33780 A Repair great vessels defect 41.77 NA 18.55 3.67 NA 64.00 090 33781 A Repair great vessels defect 36.47 NA 13.19 5.95 NA 55.61 090 33786 A Repair arterial trunk 39.02 NA 15.99 5.69 NA 60.69 090 33788 A Revision of pulmonary artery 26.63 NA 11.48 4.02 NA 42.13 090 33800 A Aortic suspension 16.25 NA 7.95 2.45 NA 26.65 090 33802 A Repair vessel defect 17.67 NA 9.00 2.26 NA 28.93 090 33803 A Repair vessel defect 19.61 NA 9.30 3.19 NA 32.10 090 33813 A Repair septal defect 20.66 NA 10.52 3.12 NA 34.30 090 33814 A Repair septal defect 25.78 NA 12.31 3.84 NA 41.93 090 33820 A Revise major vessel 16.30 NA 8.10 2.34 NA 26.74 090 33822 A Revise major vessel 17.32 NA 8.59 2.67 NA 28.59 090 33824 A Revise major vessel 19.53 NA 9.68 2.88 NA 32.09 090 33840 A Remove aorta constriction 20.64 NA 9.97 2.15 NA 32.76 090 33845 A Remove aorta constriction 22.13 NA 10.97 3.21 NA 36.31 090 33851 A Remove aorta constriction 21.28 NA 10.39 3.17 NA 34.84 090 33852 A Repair septal defect 23.72 NA 11.20 2.15 NA 37.07 090 33853 A Repair septal defect 31.73 NA 14.43 4.47 NA 50.63 090 33860 A Ascending aortic graft 38.02 NA 16.03 5.74 NA 59.79 090 33861 A Ascending aortic graft 42.02 NA 17.31 6.35 NA 65.68 090 33863 A Ascending aortic graft 45.02 NA 18.24 6.57 NA 69.83 090 33870 A Transverse aortic arch graft 44.02 NA 17.91 6.60 NA 68.53 090 33875 A Thoracic aortic graft 33.08 NA 13.78 4.88 NA 51.73 090 33877 A Thoracoabdominal graft 42.63 NA 16.01 5.92 NA 64.56 090 33910 A Remove lung artery emboli 24.60 NA 11.12 3.69 NA 39.41 090 33915 A Remove lung artery emboli 21.03 NA 9.71 1.44 NA 32.18 090 33916 A Surgery of great vessel 25.84 NA 11.10 3.66 NA 40.60 090 33917 A Repair pulmonary artery 24.51 NA 11.84 3.69 NA 40.04 090
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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 423 and 424: 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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