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 35005 A Repair defect of artery 18.13 NA 8.98 1.76 NA 28.87 090 35011 A Repair defect of artery 18.01 NA 7.76 2.54 NA 28.31 090 35013 A Repair artery rupture, arm 22.01 NA 9.41 3.09 NA 34.52 090 35021 A Repair defect of artery 19.66 NA 9.21 2.86 NA 31.73 090 35022 A Repair artery rupture, chest 23.20 NA 9.69 3.16 NA 36.05 090 35045 A Repair defect of arm artery 17.58 NA 7.31 2.44 NA 27.33 090 35081 A Repair defect of artery 28.03 NA 11.15 4.00 NA 43.18 090 35082 A Repair artery rupture, aorta 38.52 NA 14.91 5.42 NA 58.85 090 35091 A Repair defect of artery 35.42 NA 13.20 5.12 NA 53.74 090 35092 A Repair artery rupture, aorta 45.02 NA 17.18 6.38 NA 68.58 090 35102 A Repair defect of artery 30.77 NA 12.04 4.47 NA 47.28 090 35103 A Repair artery rupture, groin 40.52 NA 15.45 5.74 NA 61.71 090 35111 A Repair defect of artery 25.01 NA 10.22 3.46 NA 38.69 090 35112 A Repair artery rupture,spleen 30.02 NA 11.74 4.07 NA 45.83 090 35121 A Repair defect of artery 30.02 NA 12.04 4.29 NA 46.35 090 35122 A Repair artery rupture, belly 35.02 NA 13.53 4.74 NA 53.29 090 35131 A Repair defect of artery 25.01 NA 10.45 3.79 NA 39.25 090 35132 A Repair artery rupture, groin 30.02 NA 12.07 4.29 NA 46.38 090 35141 A Repair defect of artery 20.01 NA 8.64 2.89 NA 31.54 090 35142 A Repair artery rupture, thigh 23.32 NA 10.07 3.35 NA 36.73 090 35151 A Repair defect of artery 22.66 NA 9.70 3.23 NA 35.59 090 35152 A Repair artery rupture, knee 25.63 NA 11.02 3.60 NA 40.25 090 35180 A Repair blood vessel lesion 13.63 NA 6.76 1.00 NA 21.39 090 35182 A Repair blood vessel lesion 30.02 NA 12.67 4.35 NA 47.04 090 35184 A Repair blood vessel lesion 18.01 NA 8.08 2.52 NA 28.60 090 35188 A Repair blood vessel lesion 14.29 NA 7.41 2.15 NA 23.85 090 35189 A Repair blood vessel lesion 28.02 NA 11.63 4.00 NA 43.65 090 35190 A Repair blood vessel lesion 12.76 NA 6.29 1.79 NA 20.83 090 35201 A Repair blood vessel lesion 16.15 NA 7.72 2.33 NA 26.20 090 35206 A Repair blood vessel lesion 13.26 NA 6.37 1.86 NA 21.48 090
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 35207 A Repair blood vessel lesion 10.15 NA 7.14 1.48 NA 18.77 090 35211 A Repair blood vessel lesion 22.13 NA 10.31 3.19 NA 35.63 090 35216 A Repair blood vessel lesion 18.76 NA 8.81 2.64 NA 30.21 090 35221 A Repair blood vessel lesion 24.40 NA 9.73 3.36 NA 37.49 090 35226 A Repair blood vessel lesion 14.51 NA 7.48 2.01 NA 24.00 090 35231 A Repair blood vessel lesion 20.01 NA 9.46 2.88 NA 32.35 090 35236 A Repair blood vessel lesion 17.11 NA 7.66 2.42 NA 27.19 090 35241 A Repair blood vessel lesion 23.14 NA 10.80 3.52 NA 37.46 090 35246 A Repair blood vessel lesion 26.46 NA 11.26 3.85 NA 41.58 090 35251 A Repair blood vessel lesion 30.21 NA 11.57 4.12 NA 45.90 090 35256 A Repair blood vessel lesion 18.37 NA 8.09 2.62 NA 29.08 090 35261 A Repair blood vessel lesion 17.81 NA 7.90 2.60 NA 28.31 090 35266 A Repair blood vessel lesion 14.92 NA 6.83 2.09 NA 23.84 090 35271 A Repair blood vessel lesion 22.13 NA 10.20 3.15 NA 35.48 090 35276 A Repair blood vessel lesion 24.26 NA 10.98 3.48 NA 38.72 090 35281 A Repair blood vessel lesion 28.02 NA 11.44 3.96 NA 43.42 090 35286 A Repair blood vessel lesion 16.17 NA 7.82 2.34 NA 26.34 090 35301 A Rechanneling of artery 18.71 NA 8.19 2.67 NA 29.56 090 35311 A Rechanneling of artery 27.01 NA 11.26 3.41 NA 41.69 090 35321 A Rechanneling of artery 16.01 NA 7.16 2.24 NA 25.41 090 35331 A Rechanneling of artery 26.21 NA 10.90 3.82 NA 40.93 090 35341 A Rechanneling of artery 25.12 NA 10.55 3.77 NA 39.44 090 35351 A Rechanneling of artery 23.02 NA 9.34 3.34 NA 35.69 090 35355 A Rechanneling of artery 18.51 NA 7.87 2.66 NA 29.04 090 35361 A Rechanneling of artery 28.22 NA 11.40 4.14 NA 43.75 090 35363 A Rechanneling of artery 30.21 NA 12.24 4.32 NA 46.77 090 35371 A Rechanneling of artery 14.73 NA 6.75 2.13 NA 23.61 090 35372 A Rechanneling of artery 18.01 NA 7.81 2.62 NA 28.44 090 35381 A Rechanneling of artery 15.82 NA 7.58 2.25 NA 25.65 090 35390 A Reoperation, carotid add-on 3.20 NA 1.04 0.46 NA 4.69 ZZZ
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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 427 and 428: 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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