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 35585 A Vein bypass graft 28.41 NA 11.88 4.01 NA 44.30 090 35587 A Vein bypass graft 24.76 NA 11.12 3.51 NA 39.39 090 35600 A Harvest artery for cabg 4.95 NA 1.59 0.73 NA 7.27 ZZZ 35601 A Artery bypass graft 17.50 NA 8.32 2.49 NA 28.31 090 35606 A Artery bypass graft 18.72 NA 8.71 2.69 NA 30.12 090 35612 A Artery bypass graft 15.77 NA 7.64 2.08 NA 25.49 090 35616 A Artery bypass graft 15.71 NA 7.81 2.19 NA 25.71 090 35621 A Artery bypass graft 20.01 NA 8.42 2.91 NA 31.34 090 35623 A Bypass graft, not vein 24.01 NA 10.18 3.45 NA 37.63 090 35626 A Artery bypass graft 27.77 NA 11.71 4.07 NA 43.54 090 35631 A Artery bypass graft 34.02 NA 13.43 4.95 NA 52.40 090 35636 A Artery bypass graft 29.52 NA 12.07 4.09 NA 45.68 090 35641 A Artery bypass graft 24.58 NA 10.71 3.53 NA 38.82 090 35642 A Artery bypass graft 17.99 NA 8.74 2.27 NA 28.99 090 35645 A Artery bypass graft 17.47 NA 8.09 2.49 NA 28.06 090 35646 A Artery bypass graft 31.01 NA 12.72 4.43 NA 48.16 090 35647 A Artery bypass graft 28.02 NA 11.42 3.98 NA 43.42 090 35650 A Artery bypass graft 19.01 NA 8.12 2.71 NA 29.84 090 35651 A Artery bypass graft 25.05 NA 10.43 3.35 NA 38.83 090 35654 A Artery bypass graft 25.01 NA 10.36 3.52 NA 38.89 090 35656 A Artery bypass graft 19.54 NA 8.36 2.79 NA 30.69 090 35661 A Artery bypass graft 19.01 NA 8.66 2.71 NA 30.38 090 35663 A Artery bypass graft 22.01 NA 9.68 3.10 NA 34.80 090 35665 A Artery bypass graft 21.01 NA 9.17 3.00 NA 33.18 090 35666 A Artery bypass graft 22.20 NA 10.32 3.15 NA 35.67 090 35671 A Artery bypass graft 19.34 NA 9.08 2.77 NA 31.19 090 35681 A Composite bypass graft 1.60 NA 0.52 0.23 NA 2.35 ZZZ 35682 A Composite bypass graft 7.20 NA 2.32 1.03 NA 10.56 ZZZ 35683 A Composite bypass graft 8.51 NA 2.75 1.20 NA 12.46 ZZZ 35685 A Bypass graft patency/patch 4.05 NA 1.34 0.58 NA 5.96 ZZZ
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 35686 A Bypass graft/av fist patency 3.35 NA 1.12 0.47 NA 4.94 ZZZ 35691 A Arterial transposition 18.06 NA 8.16 2.58 NA 28.79 090 35693 A Arterial transposition 15.37 NA 7.60 2.21 NA 25.18 090 35694 A Arterial transposition 19.17 NA 8.36 2.69 NA 30.22 090 35695 A Arterial transposition 19.17 NA 8.30 2.73 NA 30.20 090 35697 A Reimplant artery each 3.01 NA 1.00 0.41 NA 4.42 ZZZ 35700 A Reoperation, bypass graft 3.09 NA 1.00 0.44 NA 4.52 ZZZ 35701 A Exploration, carotid artery 8.51 NA 5.00 1.12 NA 14.63 090 35721 A Exploration, femoral artery 7.18 NA 4.28 1.03 NA 12.49 090 35741 A Exploration popliteal artery 8.01 NA 4.53 1.12 NA 13.65 090 35761 A Exploration of artery/vein 5.37 NA 3.89 0.75 NA 10.01 090 35800 A Explore neck vessels 7.02 NA 4.49 0.95 NA 12.47 090 35820 A Explore chest vessels 12.89 NA 7.01 1.94 NA 21.84 090 35840 A Explore abdominal vessels 9.78 NA 5.16 1.34 NA 16.28 090 35860 A Explore limb vessels 5.55 NA 3.90 0.78 NA 10.23 090 35870 A Repair vessel graft defect 22.18 NA 9.48 3.00 NA 34.67 090 35875 A Removal of clot in graft 10.13 NA 5.10 1.41 NA 16.64 090 35876 A Removal of clot in graft 17.00 NA 7.33 2.39 NA 26.72 090 35879 A Revise graft w/vein 16.01 NA 7.48 2.27 NA 25.76 090 35881 A Revise graft w/vein 18.01 NA 8.43 2.55 NA 28.99 090 35901 A Excision, graft, neck 8.20 NA 5.13 1.15 NA 14.48 090 35903 A Excision, graft, extremity 9.40 NA 5.97 1.30 NA 16.67 090 35905 A Excision, graft, thorax 31.26 NA 12.78 4.43 NA 48.47 090 35907 A Excision, graft, abdomen 35.02 NA 13.79 4.91 NA 53.71 090 36000 A Place needle in vein 0.18 0.56 0.05 0.01 0.75 0.24 XXX 36002 A Pseudoaneurysm injection trt 1.96 2.77 1.00 0.17 4.90 3.13 000 36005 A Injection ext venography 0.95 8.00 0.33 0.05 9.00 1.33 000 36010 A Place catheter in vein 2.43 18.12 0.80 0.20 20.76 3.44 XXX 36011 A Place catheter in vein 3.15 27.36 1.09 0.27 30.78 4.51 XXX 36012 A Place catheter in vein 3.52 20.90 1.26 0.23 24.64 5.00 XXX
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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 431 and 432: 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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