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 41140 A Removal of tongue 25.51 NA 25.94 2.26 NA 53.71 090 41145 A Tongue removal, neck surgery 30.07 NA 29.85 2.54 NA 62.46 090 41150 A Tongue, mouth, jaw surgery 23.06 NA 24.08 1.94 NA 49.08 090 41153 A Tongue, mouth, neck surgery 23.78 NA 24.40 2.00 NA 50.17 090 41155 A Tongue, jaw, & neck surgery 27.74 NA 26.14 2.33 NA 56.21 090 41250 A Repair tongue laceration 1.91 2.94 1.24 0.18 5.03 3.33 010 41251 A Repair tongue laceration 2.27 3.33 1.61 0.22 5.83 4.10 010 41252 A Repair tongue laceration 2.98 3.98 2.22 0.29 7.25 5.49 010 41500 A Fixation of tongue 3.71 NA 7.33 0.30 NA 11.34 090 41510 A Tongue to lip surgery 3.42 NA 7.57 0.20 NA 11.18 090 41520 A Reconstruction, tongue fold 2.74 4.77 3.55 0.27 7.78 6.56 090 41599 C Tongue and mouth surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 41800 A Drainage of gum lesion 1.17 2.92 1.40 0.12 4.21 2.69 010 41805 A Removal foreign body, gum 1.24 3.00 2.30 0.13 4.37 3.68 010 41806 A Removal foreign body,jawbone 2.70 3.96 3.09 0.37 7.03 6.16 010 41820 R Excision, gum, each quadrant 0.00 0.00 0.00 0.00 0.00 0.00 000 41821 R Excision of gum flap 0.00 0.00 0.00 0.00 0.00 0.00 000 41822 R Excision of gum lesion 2.31 3.99 1.90 0.31 6.62 4.53 010 41823 R Excision of gum lesion 3.31 5.68 3.99 0.47 9.46 7.77 090 41825 A Excision of gum lesion 1.31 3.12 2.11 0.15 4.59 3.57 010 41826 A Excision of gum lesion 2.31 2.95 2.19 0.30 5.56 4.81 010 41827 A Excision of gum lesion 3.42 5.67 3.61 0.35 9.44 7.38 090 41828 R Excision of gum lesion 3.10 3.86 2.82 0.44 7.40 6.35 010 41830 R Removal of gum tissue 3.35 5.14 3.57 0.44 8.93 7.35 010 41850 R Treatment of gum lesion 0.00 0.00 0.00 0.00 0.00 0.00 000 41870 R Gum graft 0.00 0.00 0.00 0.00 0.00 0.00 000 41872 R Repair gum 2.60 5.14 3.43 0.30 8.03 6.33 090 41874 R Repair tooth socket 3.10 4.96 3.14 0.45 8.51 6.69 090 41899 C Dental surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 42000 A Drainage mouth roof lesion 1.23 2.52 1.25 0.12 3.87 2.60 010
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 42100 A Biopsy roof of mouth 1.31 2.09 1.34 0.13 3.53 2.78 010 42104 A Excision lesion, mouth roof 1.64 2.69 1.56 0.16 4.49 3.37 010 42106 A Excision lesion, mouth roof 2.10 3.41 2.38 0.25 5.76 4.73 010 42107 A Excision lesion, mouth roof 4.44 5.85 3.92 0.44 10.73 8.80 090 42120 A Remove palate/lesion 6.17 NA 11.56 0.52 NA 18.25 090 42140 A Excision of uvula 1.62 3.76 2.07 0.13 5.52 3.82 090 42145 A Repair palate, pharynx/uvula 8.06 NA 7.39 0.65 NA 16.10 090 42160 A Treatment mouth roof lesion 1.80 4.16 2.20 0.17 6.13 4.17 010 42180 A Repair palate 2.51 3.11 2.06 0.21 5.82 4.78 010 42182 A Repair palate 3.83 3.90 2.95 0.40 8.13 7.18 010 42200 A Reconstruct cleft palate 12.00 NA 9.92 1.27 NA 23.20 090 42205 A Reconstruct cleft palate 13.30 NA 9.82 1.58 NA 24.70 090 42210 A Reconstruct cleft palate 14.51 NA 11.21 2.16 NA 27.88 090 42215 A Reconstruct cleft palate 8.83 NA 8.74 1.31 NA 18.88 090 42220 A Reconstruct cleft palate 7.02 NA 6.92 0.73 NA 14.67 090 42225 A Reconstruct cleft palate 9.55 NA 16.15 0.86 NA 26.56 090 42226 A Lengthening of palate 10.01 NA 14.14 1.01 NA 25.16 090 42227 A Lengthening of palate 9.53 NA 14.78 0.98 NA 25.29 090 42235 A Repair palate 7.88 NA 11.93 0.72 NA 20.52 090 42260 A Repair nose to lip fistula 9.81 10.14 6.90 1.26 21.21 17.97 090 42280 A Preparation, palate mold 1.54 1.98 1.11 0.19 3.71 2.85 010 42281 A Insertion, palate prosthesis 1.93 2.69 1.84 0.17 4.79 3.94 010 42299 C Palate/uvula surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 42300 A Drainage of salivary gland 1.93 2.83 1.80 0.16 4.92 3.89 010 42305 A Drainage of salivary gland 6.07 NA 4.62 0.51 NA 11.21 090 42310 A Drainage of salivary gland 1.56 2.33 1.52 0.13 4.02 3.21 010 42320 A Drainage of salivary gland 2.35 3.31 2.06 0.21 5.88 4.62 010 42325 A Create salivary cyst drain 2.76 4.68 2.36 0.27 7.71 5.38 090 42326 A Create salivary cyst drain 3.78 6.24 3.09 0.29 10.31 7.16 090 42330 A Removal of salivary stone 2.21 3.15 1.81 0.19 5.56 4.21 010
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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 443 and 444: 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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