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 35400 A Angioscopy 3.01 NA 1.08 0.43 NA 4.52 ZZZ 35450 A Repair arterial blockage 10.07 NA 3.53 1.25 NA 14.85 000 35452 A Repair arterial blockage 6.91 NA 2.54 0.94 NA 10.40 000 35454 A Repair arterial blockage 6.04 NA 2.26 0.87 NA 9.17 000 35456 A Repair arterial blockage 7.35 NA 2.70 1.04 NA 11.10 000 35458 A Repair arterial blockage 9.50 NA 3.38 1.26 NA 14.14 000 35459 A Repair arterial blockage 8.64 NA 3.10 1.21 NA 12.95 000 35460 A Repair venous blockage 6.04 NA 2.22 0.83 NA 9.09 000 35470 A Repair arterial blockage 8.64 87.06 3.50 0.69 96.39 12.82 000 35471 A Repair arterial blockage 10.07 97.32 4.16 0.67 108.06 14.90 000 35472 A Repair arterial blockage 6.91 63.69 2.86 0.58 71.19 10.36 000 35473 A Repair arterial blockage 6.04 59.64 2.53 0.51 66.20 9.08 000 35474 A Repair arterial blockage 7.36 85.82 3.03 0.57 93.76 10.96 000 35475 R Repair arterial blockage 9.50 57.78 3.73 0.62 67.90 13.85 000 35476 A Repair venous blockage 6.04 45.66 2.47 0.34 52.04 8.85 000 35480 A Atherectomy, open 11.08 NA 4.00 1.28 NA 16.36 000 35481 A Atherectomy, open 7.62 NA 2.83 1.13 NA 11.58 000 35482 A Atherectomy, open 6.65 NA 2.54 0.89 NA 10.08 000 35483 A Atherectomy, open 8.11 NA 2.98 1.15 NA 12.24 000 35484 A Atherectomy, open 10.44 NA 3.69 1.27 NA 15.40 000 35485 A Atherectomy, open 9.50 NA 3.49 1.35 NA 14.34 000 35490 A Atherectomy, percutaneous 11.08 NA 4.92 0.71 NA 16.72 000 35491 A Atherectomy, percutaneous 7.62 NA 3.37 0.74 NA 11.72 000 35492 A Atherectomy, percutaneous 6.65 NA 3.29 0.43 NA 10.37 000 35493 A Atherectomy, percutaneous 8.11 NA 3.99 0.56 NA 12.66 000 35494 A Atherectomy, percutaneous 10.44 NA 4.70 0.59 NA 15.73 000 35495 A Atherectomy, percutaneous 9.50 NA 4.63 0.69 NA 14.82 000 35500 A Harvest vein for bypass 6.45 NA 1.97 0.93 NA 9.35 ZZZ 35501 A Artery bypass graft 19.20 NA 8.16 2.80 NA 30.16 090 35506 A Artery bypass graft 19.68 NA 9.16 2.86 NA 31.70 090
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 35507 A Artery bypass graft 19.68 NA 9.10 2.84 NA 31.62 090 35508 A Artery bypass graft 18.66 NA 9.26 2.77 NA 30.68 090 35509 A Artery bypass graft 18.08 NA 8.46 2.61 NA 29.14 090 35510 A Artery bypass graft 23.02 NA 10.15 2.11 NA 35.27 090 35511 A Artery bypass graft 21.21 NA 9.12 2.90 NA 33.23 090 35512 A Artery bypass graft 22.51 NA 9.96 2.11 NA 34.58 090 35515 A Artery bypass graft 18.66 NA 9.19 2.77 NA 30.61 090 35516 A Artery bypass graft 16.33 NA 6.58 2.33 NA 25.25 090 35518 A Artery bypass graft 21.21 NA 8.73 3.02 NA 32.97 090 35521 A Artery bypass graft 22.21 NA 9.54 3.12 NA 34.88 090 35522 A Artery bypass graft 21.77 NA 9.61 2.11 NA 33.50 090 35525 A Artery bypass graft 20.64 NA 9.13 2.11 NA 31.88 090 35526 A Artery bypass graft 29.97 NA 12.27 3.62 NA 45.86 090 35531 A Artery bypass graft 36.22 NA 14.08 5.16 NA 55.47 090 35533 A Artery bypass graft 28.02 NA 11.43 3.84 NA 43.28 090 35536 A Artery bypass graft 31.71 NA 12.60 4.61 NA 48.93 090 35541 A Artery bypass graft 25.81 NA 10.90 3.70 NA 40.41 090 35546 A Artery bypass graft 25.55 NA 10.58 3.69 NA 39.82 090 35548 A Artery bypass graft 21.58 NA 9.19 2.97 NA 33.74 090 35549 A Artery bypass graft 23.36 NA 10.07 3.29 NA 36.72 090 35551 A Artery bypass graft 26.68 NA 11.14 3.74 NA 41.57 090 35556 A Artery bypass graft 21.77 NA 9.44 3.09 NA 34.30 090 35558 A Artery bypass graft 21.21 NA 9.28 2.99 NA 33.48 090 35560 A Artery bypass graft 32.01 NA 12.93 4.74 NA 49.68 090 35563 A Artery bypass graft 24.21 NA 10.24 3.51 NA 37.95 090 35565 A Artery bypass graft 23.22 NA 9.85 3.29 NA 36.36 090 35566 A Artery bypass graft 26.93 NA 11.05 3.82 NA 41.81 090 35571 A Artery bypass graft 24.07 NA 10.52 3.42 NA 38.01 090 35572 A Harvest femoropopliteal vein 6.82 NA 2.20 0.99 NA 10.02 ZZZ 35583 A Vein bypass graft 22.38 NA 9.86 3.16 NA 35.41 090
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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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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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