2006 proposed fee schedule - American Society of Clinical Oncology

More documents

Recommendations

Info

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 42335 A Removal of salivary stone 3.32 4.98 3.10 0.29 8.59 6.71 090 42340 A Removal of salivary stone 4.60 6.10 3.86 0.42 11.12 8.88 090 42400 A Biopsy of salivary gland 0.78 1.68 0.72 0.06 2.52 1.56 000 42405 A Biopsy of salivary gland 3.30 3.98 2.40 0.28 7.56 5.98 010 42408 A Excision of salivary cyst 4.54 5.96 3.55 0.45 10.95 8.54 090 42409 A Drainage of salivary cyst 2.82 4.58 2.72 0.27 7.67 5.80 090 42410 A Excise parotid gland/lesion 9.35 NA 6.08 0.91 NA 16.34 090 42415 A Excise parotid gland/lesion 16.89 NA 10.54 1.43 NA 28.87 090 42420 A Excise parotid gland/lesion 19.60 NA 11.99 1.65 NA 33.24 090 42425 A Excise parotid gland/lesion 13.03 NA 8.37 1.05 NA 22.45 090 42426 A Excise parotid gland/lesion 21.27 NA 12.61 1.80 NA 35.68 090 42440 A Excise submaxillary gland 6.97 NA 4.67 0.59 NA 12.23 090 42450 A Excise sublingual gland 4.62 5.96 4.22 0.42 11.00 9.26 090 42500 A Repair salivary duct 4.30 5.74 4.11 0.41 10.45 8.82 090 42505 A Repair salivary duct 6.18 7.14 5.27 0.55 13.87 12.00 090 42507 A Parotid duct diversion 6.11 NA 6.45 0.49 NA 13.05 090 42508 A Parotid duct diversion 9.11 NA 8.25 1.04 NA 18.40 090 42509 A Parotid duct diversion 11.54 NA 9.97 0.93 NA 22.44 090 42510 A Parotid duct diversion 8.16 NA 7.61 0.66 NA 16.43 090 42550 A Injection for salivary x-ray 1.25 3.10 0.43 0.07 4.43 1.75 000 42600 A Closure of salivary fistula 4.82 6.55 4.03 0.43 11.80 9.28 090 42650 A Dilation of salivary duct 0.77 1.11 0.71 0.07 1.96 1.55 000 42660 A Dilation of salivary duct 1.13 1.37 0.88 0.09 2.60 2.10 000 42665 A Ligation of salivary duct 2.54 4.27 2.55 0.23 7.03 5.31 090 42699 C Salivary surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 42700 A Drainage of tonsil abscess 1.62 2.65 1.68 0.13 4.40 3.43 010 42720 A Drainage of throat abscess 5.42 4.79 3.69 0.44 10.65 9.55 010 42725 A Drainage of throat abscess 10.72 NA 8.03 0.91 NA 19.66 090 42800 A Biopsy of throat 1.39 2.19 1.38 0.11 3.69 2.88 010 42802 A Biopsy of throat 1.54 4.59 1.99 0.12 6.26 3.65 010
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 42804 A Biopsy of upper nose/throat 1.24 3.65 1.68 0.10 4.99 3.02 010 42806 A Biopsy of upper nose/throat 1.58 3.97 1.87 0.13 5.68 3.58 010 42808 A Excise pharynx lesion 2.30 3.08 1.88 0.19 5.58 4.38 010 42809 A Remove pharynx foreign body 1.81 2.30 1.30 0.16 4.27 3.27 010 42810 A Excision of neck cyst 3.26 5.63 3.51 0.29 9.18 7.06 090 42815 A Excision of neck cyst 7.07 NA 6.34 0.61 NA 14.02 090 42820 A Remove tonsils and adenoids 3.91 NA 3.22 0.31 NA 7.44 090 42821 A Remove tonsils and adenoids 4.29 NA 3.43 0.35 NA 8.07 090 42825 A Removal of tonsils 3.42 NA 3.12 0.25 NA 6.78 090 42826 A Removal of tonsils 3.38 NA 2.97 0.27 NA 6.62 090 42830 A Removal of adenoids 2.58 NA 2.52 0.20 NA 5.30 090 42831 A Removal of adenoids 2.72 NA 2.80 0.22 NA 5.73 090 42835 A Removal of adenoids 2.30 NA 2.42 0.21 NA 4.93 090 42836 A Removal of adenoids 3.19 NA 2.91 0.26 NA 6.35 090 42842 A Extensive surgery of throat 8.77 NA 10.81 0.71 NA 20.29 090 42844 A Extensive surgery of throat 14.32 NA 15.91 1.16 NA 31.39 090 42845 A Extensive surgery of throat 24.30 NA 22.66 1.98 NA 48.94 090 42860 A Excision of tonsil tags 2.22 NA 2.37 0.18 NA 4.78 090 42870 A Excision of lingual tonsil 5.40 NA 8.48 0.44 NA 14.32 090 42890 A Partial removal of pharynx 12.95 NA 13.90 1.05 NA 27.90 090 42892 A Revision of pharyngeal walls 15.84 NA 16.83 1.28 NA 33.95 090 42894 A Revision of pharyngeal walls 22.90 NA 21.54 1.86 NA 46.30 090 42900 A Repair throat wound 5.25 NA 3.57 0.50 NA 9.32 010 42950 A Reconstruction of throat 8.11 NA 11.60 0.72 NA 20.42 090 42953 A Repair throat, esophagus 8.97 NA 16.55 0.88 NA 26.40 090 42955 A Surgical opening of throat 7.39 NA 10.46 0.80 NA 18.66 090 42960 A Control throat bleeding 2.33 NA 1.93 0.19 NA 4.46 010 42961 A Control throat bleeding 5.59 NA 4.89 0.45 NA 10.93 090 42962 A Control throat bleeding 7.14 NA 5.80 0.58 NA 13.52 090 42970 A Control nose/throat bleeding 5.43 NA 4.09 0.39 NA 9.91 090
Page 1 and 2:
DEPARTMENT OF HEALTH AND HUMAN SERV
Page 3 and 4:
2. By mail. You may mail written co
Page 5 and 6:
Rick Ensor (410) 786-5617 (for issu
Page 7 and 8:
service of the U.S. Government Prin
Page 9 and 10:
4. Proposed Revisions to §413.170
Page 11 and 12:
AGA American Gastroenterological As
Page 13 and 14:
GAO General Accounting Office GPCI
Page 15 and 16:
PLI Professional liability insuranc
Page 17 and 18:
Initially, only the physician work
Page 19 and 20:
This resource-based system was base
Page 21 and 22:
effect in 1997, published on Novemb
Page 23 and 24:
● Revised requirements for superv
Page 25 and 26:
efinement of work RVUs; and solicit
Page 27 and 28:
historical allowed charges. This le
Page 29 and 30:
November 1, 2001 (66 FR 55246).) Th
Page 31 and 32:
The CPEPs identified specific input
Page 33 and 34:
codes that the RUC has not yet revi
Page 35 and 36:
procedure: $27,305,408. In this exa
Page 37 and 38:
as a whole. Indirect costs include
Page 39 and 40:
● The unscaled indirect expense a
Page 41 and 42:
BNF is applied to (multiplied by) t
Page 43 and 44:
NPWP Step 2--Calculation of Charge-
Page 45 and 46:
In Table 11, the scaled total direc
Page 47 and 48:
TABLE 13--Budget Neutrality and Fin
Page 49 and 50:
The following discussion outlines t
Page 51 and 52:
exist, and suggests that the need f
Page 53 and 54:
TABLE 14--Practice Expense Per Hour
Page 55 and 56:
We believe that we have consistentl
Page 57 and 58:
Due to the ongoing refinement by th
Page 59 and 60:
indirect PE methodology is inaccura
Page 61 and 62:
multi-specialty PEAC that were base
Page 63 and 64:
the needed survey or other data or
Page 65 and 66:
PERC/RUC recommendations for these
Page 67 and 68:
eflect the typical number of cast c
Page 69 and 70:
on comments received and additional
Page 71 and 72:
We have reviewed the PE database an
Page 73 and 74:
the ACR. We have accepted the follo
Page 75 and 76:
● Clinical Labor for G-codes Rela
Page 77 and 78:
proposed associated prices that we
Page 79 and 80:
Supply Code Supply Description Unit
Page 81 and 82:
● Supply and Equipment Items Need
Page 83 and 84:
Code 2005 Description Unit Unit Pri
Page 85 and 86:
Code 2005 Description Price EQ212 p
Page 87 and 88:
Effective January 1, 2006, this pro
Page 89 and 90:
challenge the validity of a new loc
Page 91 and 92:
ones reconfigured). Yet we also rec
Page 93 and 94:
The issue of payment locality desig
Page 95 and 96:
specialties listed infrequently as
Page 97 and 98:
for premium rating purposes. ISO co
Page 99 and 100:
psychology to the nonsurgical risk
Page 101 and 102:
to anesthesiology which is 2.84 rat
Page 103 and 104:
103 However, as noted previously in
Page 105 and 106:
● Category #1: Services that are
Page 107 and 108:
G0270, G0271 and 97802 through 9780
Page 109 and 110:
Group Medical Nutritional Therapy (
Page 111 and 112:
111 furnished in the group setting
Page 113 and 114:
CMS Review 113 As noted previously,
Page 115 and 116:
system that permits the physician a
Page 117 and 118:
117 associated with the provided se
Page 119 and 120:
119 overlapping surgeries, the teac
Page 121 and 122:
anesthesia programs that have arran
Page 123 and 124:
123 Section 623 of the MMA also req
Page 125 and 126:
125 hospital-based facilities; whil
Page 127 and 128:
127 The next step would be to devel
Page 129 and 130:
Drugs Second Quarter ASP +6 Percent
Page 131 and 132:
131 independent facilities, to acco
Page 133 and 134:
133
Page 135 and 136:
distributed this over a total proje
Page 137 and 138:
137 additional 0.7 percent addition
Page 139 and 140:
139 billed drugs regardless of sett
Page 141 and 142:
141 than 0.9000 are paid more than
Page 143 and 144:
adoption of the new hospital wage i
Page 145 and 146:
of geographic designations for purp
Page 147 and 148:
and they may or may not be suitable
Page 149 and 150:
the Medicare Geographic Classificat
Page 151 and 152:
(2) Metropolitan Divisions Under OM
Page 153 and 154:
153 applying revised composite paym
Page 155 and 156:
ased on the labor components establ
Page 157 and 158:
157 actual cost structure faced by
Page 159 and 160:
159 ESRD facilities is 53.711, as s
Page 161 and 162:
from the cost reports. To avoid dou
Page 163 and 164:
from Worksheet A. The resulting mar
Page 165 and 166:
(1) Hospital Data Used In this prop
Page 167 and 168:
wage data ended. However, since the
Page 169 and 170:
approach to phasing-in the proposed
Page 171 and 172:
facilities that would receive lower
Page 173 and 174:
173 wage index values and then simu
Page 175 and 176:
175 Because Neighborhood Dialysis C
Page 177 and 178:
177 detected through our receipt of
Page 179 and 180:
179 CBSA Code Urban Area Wage (Cons
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
TABLE 28--Proposed ESRD Wage Index
Page 219 and 220:
● Extraordinary circumstances (§
Page 221 and 222:
effect as long as the rate exceeds
Page 223 and 224:
● Adding a definition of a “ped
Page 225 and 226:
exception rate. The facility would
Page 227 and 228:
their intermediaries. Current parag
Page 229 and 230:
229 costs are reasonable and allowa
Page 231 and 232:
231 revised paragraph, a facility w
Page 233 and 234:
H. Payment for Covered Outpatient D
Page 235 and 236:
calculation. We also discuss the su
Page 237 and 238:
customers (for example, physicians)
Page 239 and 240:
239 We believe the weighted average
Page 241 and 242:
number of 11-digit NDCs sold for ea
Page 243 and 244:
243 included in the template, it is
Page 245 and 246:
current reporting format is an appr
Page 247 and 248:
247 section 1847A of the Act for th
Page 249 and 250:
each quarter at the following web s
Page 251 and 252:
251 We also note MedPAC’s recomme
Page 253 and 254:
costs and units. We seek comments a
Page 255 and 256:
255 pays for DME and associated sup
Page 257 and 258:
pharmacy activities required to get
Page 259 and 260:
259 representing 42 percent of the
Page 261 and 262:
261 basic pharmacy services such as
Page 263 and 264:
seek comment on the potential impac
Page 265 and 266:
265 overpaying for the costs associ
Page 267 and 268:
267 and information about how pharm
Page 269 and 270:
269 takes good faith efforts to res
Page 271 and 272:
271 Specifically, we consider that
Page 273 and 274:
supplies. Using billing data, we id
Page 275 and 276:
70481 CT orbit/ear/fossa w/ dye 704
Page 277 and 278:
K. Therapy Cap 73223 MRI joint uppe
Page 279 and 280:
provided for an active subluxation
Page 281 and 282:
is less than 2 percent of spending
Page 283 and 284:
(2) entities determined by the Secr
Page 285 and 286:
285 We are proposing a supplemental
Page 287 and 288:
FQHC claim form to effectuate the b
Page 289 and 290:
289 can issue a final determination
Page 291 and 292:
291 conclude that Hispanic persons
Page 293 and 294:
293 nuclear medicine services in ei
Page 295 and 296:
adiopharmaceuticals. In the final r
Page 297 and 298:
297 (including Nuclear Medicine and
Page 299 and 300:
we would resolve any doubt on the m
Page 301 and 302:
facility payment rather than a TC c
Page 303 and 304:
ventures and leases, pose a risk of
Page 305 and 306:
305 Underlying the projected rate r
Page 307 and 308:
decisions are central to the health
Page 309 and 310:
however. We are particularly intere
Page 311 and 312:
The collection requirement in this
Page 313 and 314:
eporting requirements are discussed
Page 315 and 316:
IV. Response to Comments Because of
Page 317 and 318:
achieve the objectives with less si
Page 319 and 320:
319 The analysis and discussion pro
Page 321 and 322:
321 for a new code may change becau
Page 323 and 324:
323 TABLE 30--Impact of Practice Ex
Page 325 and 326:
hour for these specialties. As note
Page 327 and 328:
Both physical/occupational therapy
Page 329 and 330:
329 proposing to add cardiology cat
Page 331 and 332:
Speciality Impact of Removing Aberr
Page 333 and 334:
Family TABLE 32--Impact of Multiple
Page 335 and 336:
335 column includes the current est
Page 337 and 338:
Specialty Medicare Allowed Charges
Page 339 and 340:
339 Non-Facility Facility % % HCPCS
Page 341 and 342:
341 have undertaken a similar analy
Page 343 and 344:
of the updated GPCI data. For the R
Page 345 and 346:
C. Medicare Telehealth Services In
Page 347 and 348:
347 TABLE 37--Impact of Proposed Ch
Page 349 and 350:
349 of the increase to the drug add
Page 351 and 352:
plus current AAP priced drug paymen
Page 353 and 354:
353 the center up to what it would
Page 355 and 356:
satisfies the requirements of the i
Page 357 and 358:
357 certainty the extent of these s
Page 359 and 360:
delivery arrangements and would hel
Page 361 and 362:
List of Subjects 42 CFR Part 405 Ad
Page 363 and 364:
(including by refunding amounts in
Page 365 and 366:
(2) Any financial incentives provid
Page 367 and 368:
7. The authority citation for part
Page 369 and 370:
* * * * * PART 413--PRINCIPLES OF R
Page 371 and 372:
371 D. Redesignating paragraphs (l)
Page 373 and 374:
373 (3) The additional nursing hour
Page 375 and 376:
cost components relating to trainin
Page 377 and 378:
CAPD and CCPD) when the facility ac
Page 379 and 380:
Indirect Sales means from the manuf
Page 381 and 382:
amount for the quarter to the neare
Page 383 and 384:
383 25. The heading for Part 426 is
Page 385 and 386:
385 (Catalog of Federal Domestic As
Page 387 and 388:
1. CPT/HCPCS code. This is the CPT
Page 389 and 390:
grace period. This indicator is no
Page 391 and 392:
5. Physician work RVUs. These are t
Page 393 and 394:
ADDENDUM B: RELATIVE VALUE UNITS (R
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 495: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 547 and 548:
Page 549 and 550:
Page 551 and 552:
Page 553 and 554:
Page 555 and 556:
Page 557 and 558:
Page 559 and 560:
Page 561 and 562:
Page 563 and 564:
Page 565 and 566:
Page 567 and 568:
Page 569 and 570:
Page 571 and 572:
Page 573 and 574:
Page 575 and 576:
Page 577 and 578:
Page 579 and 580:
Page 581 and 582:
Page 583 and 584:
Page 585 and 586:
Page 587 and 588:
Page 589 and 590:
Page 591 and 592:
Page 593 and 594:
Page 595 and 596:
Page 597 and 598:
Page 599 and 600:
Page 601 and 602:
Page 603 and 604:
Page 605 and 606:
Page 607 and 608:
Page 609 and 610:
Page 611 and 612:
Page 613 and 614:
Page 615 and 616:
Page 617 and 618:
Page 619 and 620:
Page 621 and 622:
Page 623 and 624:
Page 625 and 626:
Page 627 and 628:
Page 629 and 630:
Page 631 and 632:
Page 633 and 634:
Page 635 and 636:
Page 637 and 638:
Page 639 and 640:
Page 641 and 642:
Page 643 and 644:
Page 645 and 646:
Page 647 and 648:
Page 649 and 650:
Page 651 and 652:
Page 653 and 654:
Page 655 and 656:
Page 657 and 658:
Page 659 and 660:
Page 661 and 662:
Page 663 and 664:
Page 665 and 666:
Page 667 and 668:
Page 669 and 670:
Page 671 and 672:
Page 673 and 674:
Page 675 and 676:
Page 677 and 678:
Page 679 and 680:
Page 681 and 682:
Page 683 and 684:
Page 685 and 686:
Page 687 and 688:
Page 689 and 690:
Page 691 and 692:
Page 693 and 694:
Page 695 and 696:
Page 697 and 698:
Page 699 and 700:
Page 701 and 702:
Page 703 and 704:
CPT Code Short Descriptors 21480 Re
Page 705 and 706:
CPT Code Short Descriptors 92284 Da
Page 707 and 708:
Addendum D 2006 GEOGRAPHIC PRACTICE
Page 709 and 710:
Carrier Locality Locality name Work
Page 711 and 712:
Carrier Locality Locality Name 2006
Page 713 and 714:
Addendum F ESRD FACILITIES- METROPO
Page 715 and 716:
715 SSA State/County Code County an
Page 717 and 718:
Page 719 and 720:
Page 721 and 722:
Page 723 and 724:
Page 725 and 726:
Page 727 and 728:
Page 729 and 730:
Page 731 and 732:
Page 733 and 734:
Page 735 and 736:
Page 737 and 738:
Page 739 and 740:
Page 741 and 742:
Page 743 and 744:
Page 745 and 746:
Page 747 and 748:
Page 749 and 750:
Page 751 and 752:
Page 753 and 754:
Page 755 and 756:
Page 757 and 758:
Page 759 and 760:
Page 761 and 762:
Page 763 and 764:
Page 765 and 766:
Page 767 and 768:
Page 769 and 770:
Page 771 and 772:
Page 773 and 774:
Page 775 and 776:
Page 777 and 778:
CPT/HCPCS Codes MOD DESCRIPTION STA
Page 779 and 780:
Page 781 and 782:
Page 783 and 784:
Page 785 and 786:
Page 787:
show all

2006 proposed fee schedule - American Society of Clinical Oncology

Create successful ePaper yourself

Delete template?

Save as template?