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 33918 A Repair pulmonary atresia 26.46 NA 11.61 4.14 NA 42.21 090 33919 A Repair pulmonary atresia 40.02 NA 17.47 5.95 NA 63.44 090 33920 A Repair pulmonary atresia 31.96 NA 13.44 4.37 NA 49.77 090 33922 A Transect pulmonary artery 23.53 NA 10.87 3.09 NA 37.48 090 33924 A Remove pulmonary shunt 5.50 NA 1.79 0.82 NA 8.11 ZZZ 33933 C Prepare donor heart/lung 0.00 0.00 0.00 0.00 0.00 0.00 XXX 33935 R Transplantation, heart/lung 60.99 NA 27.47 9.03 NA 97.50 090 33944 C Prepare donor heart 0.00 0.00 0.00 0.00 0.00 0.00 XXX 33945 R Transplantation of heart 42.12 NA 20.34 6.24 NA 68.70 090 33960 A External circulation assist 19.37 NA 4.83 2.66 NA 26.86 000 33961 A External circulation assist 10.93 NA 3.52 0.88 NA 15.33 ZZZ 33967 A Insert ia percut device 4.85 NA 1.91 0.35 NA 7.11 000 33968 A Remove aortic assist device 0.64 NA 0.23 0.07 NA 0.94 000 33970 A Aortic circulation assist 6.75 NA 2.27 0.82 NA 9.84 000 33971 A Aortic circulation assist 9.70 NA 6.06 1.25 NA 17.01 090 33973 A Insert balloon device 9.77 NA 3.29 1.26 NA 14.32 000 33974 A Remove intra-aortic balloon 14.42 NA 7.94 1.73 NA 24.09 090 33975 A Implant ventricular device 21.01 NA 6.15 3.06 NA 30.22 XXX 33976 A Implant ventricular device 23.02 NA 7.41 3.25 NA 33.68 XXX 33977 A Remove ventricular device 19.30 NA 10.77 2.80 NA 32.87 090 33978 A Remove ventricular device 21.74 NA 11.54 3.30 NA 36.58 090 33979 A Insert intracorporeal device 46.02 NA 14.63 6.95 NA 67.60 XXX 33980 A Remove intracorporeal device 56.28 NA 24.71 8.56 NA 89.55 090 33999 C Cardiac surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 34001 A Removal of artery clot 12.92 NA 6.54 1.84 NA 21.29 090 34051 A Removal of artery clot 15.22 NA 7.62 2.20 NA 25.04 090 34101 A Removal of artery clot 10.01 NA 5.21 1.41 NA 16.63 090 34111 A Removal of arm artery clot 10.01 NA 5.24 1.40 NA 16.65 090 34151 A Removal of artery clot 25.01 NA 10.17 3.55 NA 38.73 090 34201 A Removal of artery clot 10.03 NA 5.25 1.45 NA 16.73 090
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 34203 A Removal of leg artery clot 16.51 NA 7.83 2.35 NA 26.70 090 34401 A Removal of vein clot 25.01 NA 10.75 3.09 NA 38.85 090 34421 A Removal of vein clot 12.00 NA 6.19 1.55 NA 19.75 090 34451 A Removal of vein clot 27.01 NA 11.17 3.83 NA 42.02 090 34471 A Removal of vein clot 10.18 NA 5.27 1.18 NA 16.63 090 34490 A Removal of vein clot 9.87 NA 5.32 1.41 NA 16.60 090 34501 A Repair valve, femoral vein 16.01 NA 8.30 2.34 NA 26.66 090 34502 A Reconstruct vena cava 26.96 NA 12.14 3.62 NA 42.72 090 34510 A Transposition of vein valve 18.96 NA 9.10 2.32 NA 30.37 090 34520 A Cross-over vein graft 17.96 NA 8.32 2.28 NA 28.56 090 34530 A Leg vein fusion 16.65 NA 8.38 1.73 NA 26.77 090 34800 A Endovas aaa repr w/sm tube 20.76 NA 9.00 2.45 NA 32.21 090 34802 A Endovas aaa repr w/2-p part 23.02 NA 9.69 2.32 NA 35.03 090 34803 A Endovas aaa repr w/3-p part 24.05 NA 10.04 2.00 NA 36.08 090 34804 A Endovas aaa repr w/1-p part 23.02 NA 9.71 2.29 NA 35.02 090 34805 A Endovas aaa repr w/long tube 21.89 NA 9.29 2.00 NA 33.18 090 34808 A Endovas iliac a device addon 4.13 NA 1.36 0.59 NA 6.08 ZZZ 34812 A Xpose for endoprosth, femorl 6.75 NA 2.18 1.18 NA 10.12 000 34813 A Femoral endovas graft add-on 4.80 NA 1.54 0.67 NA 7.01 ZZZ 34820 A Xpose for endoprosth, iliac 9.76 NA 3.16 1.50 NA 14.42 000 34825 A Endovasc extend prosth, init 12.00 NA 6.06 1.28 NA 19.35 090 34826 A Endovasc exten prosth, addªl 4.13 NA 1.36 0.44 NA 5.93 ZZZ 34830 A Open aortic tube prosth repr 32.61 NA 13.30 4.54 NA 50.45 090 34831 A Open aortoiliac prosth repr 35.36 NA 11.49 4.88 NA 51.73 090 34832 A Open aortofemor prosth repr 35.36 NA 14.18 4.84 NA 54.38 090 34833 A Xpose for endoprosth, iliac 12.00 NA 4.44 1.69 NA 18.14 000 34834 A Xpose, endoprosth, brachial 5.35 NA 2.20 0.76 NA 8.31 000 34900 A Endovasc iliac repr w/graft 16.39 NA 7.46 1.99 NA 25.84 090 35001 A Repair defect of artery 19.65 NA 9.25 2.80 NA 31.70 090 35002 A Repair artery rupture, neck 21.01 NA 9.62 2.99 NA 33.62 090
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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 425 and 426: 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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