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 36565 A Insert tunneled cv cath 6.00 24.32 2.91 0.57 30.89 9.48 010 36566 A Insert tunneled cv cath 6.50 24.65 3.04 0.57 31.72 10.12 010 36568 A Insert picc cath 1.92 7.06 0.60 0.11 9.10 2.64 000 36569 A Insert picc cath 1.82 7.26 0.62 0.19 9.27 2.63 000 36570 A Insert picvad cath 5.32 31.95 2.74 0.57 37.84 8.63 010 36571 A Insert picvad cath 5.30 31.47 2.71 0.57 37.34 8.58 010 36575 A Repair tunneled cv cath 0.67 4.06 0.27 0.20 4.93 1.14 000 36576 A Repair tunneled cv cath 3.20 6.61 1.84 0.19 10.00 5.23 010 36578 A Replace tunneled cv cath 3.50 11.13 2.34 0.19 14.82 6.03 010 36580 A Replace cvad cath 1.31 6.63 0.43 0.19 8.13 1.93 000 36581 A Replace tunneled cv cath 3.44 19.51 1.98 0.19 23.13 5.61 010 36582 A Replace tunneled cv cath 5.20 26.90 2.91 0.19 32.29 8.30 010 36583 A Replace tunneled cv cath 5.25 26.86 2.99 0.19 32.30 8.43 010 36584 A Replace picc cath 1.20 6.64 0.61 0.19 8.04 2.00 000 36585 A Replace picvad cath 4.80 28.57 2.80 0.19 33.56 7.79 010 36589 A Removal tunneled cv cath 2.27 2.16 1.41 0.24 4.68 3.92 010 36590 A Removal tunneled cv cath 3.31 3.35 1.72 0.44 7.10 5.46 010 36595 A Mech remov tunneled cv cath 3.60 16.43 1.51 0.21 20.23 5.32 000 36596 A Mech remov tunneled cv cath 0.75 3.62 0.52 0.05 4.43 1.32 000 36597 A Reposition venous catheter 1.21 2.44 0.46 0.07 3.72 1.74 000 36600 A Withdrawal of arterial blood 0.32 0.48 0.09 0.02 0.82 0.43 XXX 36620 A Insertion catheter, artery 1.15 NA 0.23 0.07 NA 1.45 000 36625 A Insertion catheter, artery 2.11 NA 0.52 0.26 NA 2.89 000 36640 A Insertion catheter, artery 2.10 NA 1.02 0.21 NA 3.34 000 36660 A Insertion catheter, artery 1.40 NA 0.43 0.14 NA 1.97 000 36680 A Insert needle, bone cavity 1.20 NA 0.49 0.11 NA 1.81 000 36800 A Insertion of cannula 2.43 NA 1.76 0.25 NA 4.44 000 36810 A Insertion of cannula 3.97 NA 1.67 0.45 NA 6.09 000 36815 A Insertion of cannula 2.63 NA 1.14 0.35 NA 4.12 000 36818 A Av fuse, uppr arm, cephalic 11.54 NA 6.06 1.89 NA 19.49 090
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 36819 A Av fuse, uppr arm, basilic 14.01 NA 6.20 1.95 NA 22.16 090 36820 A Av fusion/forearm vein 14.01 NA 6.21 1.94 NA 22.16 090 36821 A Av fusion direct any site 8.94 NA 4.55 1.23 NA 14.71 090 36822 A Insertion of cannula(s) 5.42 NA 4.32 0.79 NA 10.53 090 36823 A Insertion of cannula(s) 21.01 NA 9.19 2.88 NA 33.09 090 36825 A Artery-vein autograft 9.85 NA 4.92 1.35 NA 16.12 090 36830 A Artery-vein nonautograft 12.00 NA 5.10 1.66 NA 18.77 090 36831 A Open thrombect av fistula 8.01 NA 3.88 1.09 NA 12.98 090 36832 A Av fistula revision, open 10.50 NA 4.62 1.44 NA 16.56 090 36833 A Av fistula revision 11.95 NA 5.08 1.65 NA 18.68 090 36834 A Repair A-V aneurysm 9.94 NA 4.67 1.37 NA 15.98 090 36835 A Artery to vein shunt 7.15 NA 4.23 0.98 NA 12.37 090 36838 A Dist revas ligation, hemo 20.64 NA 9.21 3.01 NA 32.86 090 36860 A External cannula declotting 2.01 2.26 0.70 0.11 4.38 2.82 000 36861 A Cannula declotting 2.53 NA 1.54 0.27 NA 4.33 000 36870 A Percut thrombect av fistula 5.16 52.60 3.30 0.29 58.05 8.75 090 37140 A Revision of circulation 23.61 NA 10.93 2.01 NA 36.54 090 37145 A Revision of circulation 24.62 NA 10.73 3.25 NA 38.60 090 37160 A Revision of circulation 21.61 NA 9.10 2.81 NA 33.52 090 37180 A Revision of circulation 24.62 NA 10.06 3.34 NA 38.02 090 37181 A Splice spleen/kidney veins 26.69 NA 10.89 3.40 NA 40.98 090 37182 A Insert hepatic shunt (tips) 17.00 NA 6.37 1.00 NA 24.37 000 37183 A Remove hepatic shunt (tips) 8.01 NA 3.16 0.47 NA 11.63 000 37195 C Thrombolytic therapy, stroke 0.00 0.00 0.00 0.00 0.00 0.00 XXX 37200 A Transcatheter biopsy 4.56 NA 1.58 0.27 NA 6.41 000 37201 A Transcatheter therapy infuse 5.00 NA 2.67 0.33 NA 8.00 000 37202 A Transcatheter therapy infuse 5.68 NA 3.25 0.43 NA 9.36 000 37203 A Transcatheter retrieval 5.03 33.96 2.14 0.29 39.28 7.46 000 37204 A Transcatheter occlusion 18.15 NA 6.22 1.48 NA 25.84 000 37205 A Transcath iv stent, percut 8.29 NA 3.95 0.60 NA 12.84 000
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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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2006 proposed fee schedule - American Society of Clinical Oncology

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