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 38300 A Drainage, lymph node lesion 1.99 4.20 2.04 0.25 6.45 4.28 010 38305 A Drainage, lymph node lesion 6.00 NA 4.41 0.88 NA 11.29 090 38308 A Incision of lymph channels 6.45 NA 3.68 0.85 NA 10.99 090 38380 A Thoracic duct procedure 7.46 NA 5.54 0.74 NA 13.75 090 38381 A Thoracic duct procedure 12.89 NA 6.70 1.84 NA 21.43 090 38382 A Thoracic duct procedure 10.08 NA 5.67 1.37 NA 17.12 090 38500 A Biopsy/removal, lymph nodes 3.75 3.64 2.06 0.49 7.88 6.30 010 38505 A Needle biopsy, lymph nodes 1.14 2.05 0.80 0.09 3.28 2.03 000 38510 A Biopsy/removal, lymph nodes 6.43 5.44 3.41 0.72 12.59 10.56 010 38520 A Biopsy/removal, lymph nodes 6.67 NA 3.96 0.84 NA 11.47 090 38525 A Biopsy/removal, lymph nodes 6.07 NA 3.27 0.80 NA 10.15 090 38530 A Biopsy/removal, lymph nodes 7.99 NA 4.30 1.12 NA 13.40 090 38542 A Explore deep node(s), neck 5.91 NA 4.39 0.60 NA 10.90 090 38550 A Removal, neck/armpit lesion 6.92 NA 3.86 0.88 NA 11.66 090 38555 A Removal, neck/armpit lesion 14.15 NA 8.26 1.75 NA 24.16 090 38562 A Removal, pelvic lymph nodes 10.49 NA 5.88 1.20 NA 17.57 090 38564 A Removal, abdomen lymph nodes 10.83 NA 5.25 1.32 NA 17.40 090 38570 A Laparoscopy, lymph node biop 9.26 NA 3.99 1.13 NA 14.38 010 38571 A Laparoscopy, lymphadenectomy 14.69 NA 6.36 1.15 NA 22.20 010 38572 A Laparoscopy, lymphadenectomy 16.60 NA 7.09 1.90 NA 25.60 010 38589 C Laparoscope proc, lymphatic 0.00 0.00 0.00 0.00 0.00 0.00 YYY 38700 A Removal of lymph nodes, neck 8.25 NA 6.11 0.72 NA 15.08 090 38720 A Removal of lymph nodes, neck 13.62 NA 9.11 1.20 NA 23.92 090 38724 A Removal of lymph nodes, neck 14.55 NA 9.57 1.28 NA 25.40 090 38740 A Remove armpit lymph nodes 10.03 NA 4.90 1.32 NA 16.25 090 38745 A Remove armpit lymph nodes 13.11 NA 6.02 1.73 NA 20.85 090 38746 A Remove thoracic lymph nodes 4.89 NA 1.57 0.72 NA 7.18 ZZZ 38747 A Remove abdominal lymph nodes 4.89 NA 1.63 0.64 NA 7.16 ZZZ 38760 A Remove groin lymph nodes 12.96 NA 6.08 1.71 NA 20.75 090 38765 A Remove groin lymph nodes 19.99 NA 8.92 2.47 NA 31.38 090
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 38770 A Remove pelvis lymph nodes 13.24 NA 6.35 1.40 NA 20.99 090 38780 A Remove abdomen lymph nodes 16.60 NA 8.20 1.88 NA 26.69 090 38790 A Inject for lymphatic x-ray 1.29 NA 0.78 0.13 NA 2.20 000 38792 A Identify sentinel node 0.52 NA 0.46 0.06 NA 1.04 000 38794 A Access thoracic lymph duct 4.45 NA 3.68 0.32 NA 8.45 090 38999 C Blood/lymph system procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 39000 A Exploration of chest 6.10 NA 4.54 0.89 NA 11.53 090 39010 A Exploration of chest 11.79 NA 7.16 1.75 NA 20.70 090 39200 A Removal chest lesion 13.63 NA 7.22 2.02 NA 22.86 090 39220 A Removal chest lesion 17.42 NA 8.95 2.45 NA 28.83 090 39400 A Visualization of chest 5.61 NA 4.56 0.82 NA 10.99 010 39499 C Chest procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 39501 A Repair diaphragm laceration 13.20 NA 6.33 1.77 NA 21.29 090 39502 A Repair paraesophageal hernia 16.34 NA 7.04 2.16 NA 25.54 090 39503 A Repair of diaphragm hernia 95.05 NA 32.58 10.95 NA 138.58 090 39520 A Repair of diaphragm hernia 16.11 NA 7.79 2.23 NA 26.14 090 39530 A Repair of diaphragm hernia 15.42 NA 6.96 2.10 NA 24.48 090 39531 A Repair of diaphragm hernia 16.43 NA 7.20 2.21 NA 25.84 090 39540 A Repair of diaphragm hernia 13.33 NA 6.11 1.79 NA 21.23 090 39541 A Repair of diaphragm hernia 14.42 NA 6.45 1.92 NA 22.79 090 39545 A Revision of diaphragm 13.38 NA 7.43 1.83 NA 22.64 090 39560 A Resect diaphragm, simple 12.00 NA 6.12 1.59 NA 19.72 090 39561 A Resect diaphragm, complex 17.50 NA 9.27 2.44 NA 29.21 090 39599 C Diaphragm surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 4000F I Tobacco use txmnt counseling 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4001F I Tobacco use txmnt, pharmacol 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4002F I Statin therapy, rx 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4006F I Beta-blocker therapy, rx 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4009F I Ace inhibitor therapy, rx 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4011F I Oral antiplatelet tx, rx 0.00 0.00 0.00 0.00 0.00 0.00 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 439 and 440: 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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