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 43261 A Endo cholangiopancreatograph 6.27 NA 2.60 0.46 NA 9.33 000 43262 A Endo cholangiopancreatograph 7.39 NA 3.02 0.54 NA 10.96 000 43263 A Endo cholangiopancreatograph 7.29 NA 3.02 0.54 NA 10.85 000 43264 A Endo cholangiopancreatograph 8.91 NA 3.59 0.65 NA 13.15 000 43265 A Endo cholangiopancreatograph 10.02 NA 4.00 0.73 NA 14.75 000 43267 A Endo cholangiopancreatograph 7.39 NA 3.00 0.54 NA 10.94 000 43268 A Endo cholangiopancreatograph 7.39 NA 3.15 0.54 NA 11.08 000 43269 A Endo cholangiopancreatograph 8.22 NA 3.33 0.60 NA 12.15 000 43271 A Endo cholangiopancreatograph 7.39 NA 3.01 0.54 NA 10.94 000 43272 A Endo cholangiopancreatograph 7.39 NA 3.01 0.54 NA 10.94 000 43280 A Laparoscopy, fundoplasty 17.25 NA 7.17 2.27 NA 26.69 090 43289 C Laparoscope proc, esoph 0.00 0.00 0.00 0.00 0.00 0.00 YYY 43300 A Repair of esophagus 9.15 NA 6.22 1.12 NA 16.49 090 43305 A Repair esophagus and fistula 17.39 NA 10.37 1.54 NA 29.30 090 43310 A Repair of esophagus 25.40 NA 10.89 3.60 NA 39.89 090 43312 A Repair esophagus and fistula 28.44 NA 11.55 4.00 NA 43.99 090 43313 A Esophagoplasty congenital 45.30 NA 18.40 5.45 NA 69.15 090 43314 A Tracheo-esophagoplasty cong 50.29 NA 18.88 6.63 NA 75.80 090 43320 A Fuse esophagus & stomach 19.94 NA 9.05 2.73 NA 31.72 090 43324 A Revise esophagus & stomach 20.58 NA 8.62 2.75 NA 31.95 090 43325 A Revise esophagus & stomach 20.07 NA 8.66 2.59 NA 31.32 090 43326 A Revise esophagus & stomach 19.75 NA 9.17 2.84 NA 31.76 090 43330 A Repair of esophagus 19.78 NA 8.46 2.62 NA 30.86 090 43331 A Repair of esophagus 20.14 NA 9.83 2.93 NA 32.90 090 43340 A Fuse esophagus & intestine 19.62 NA 8.81 2.45 NA 30.87 090 43341 A Fuse esophagus & intestine 20.86 NA 10.35 2.91 NA 34.12 090 43350 A Surgical opening, esophagus 15.79 NA 8.31 1.42 NA 25.52 090 43351 A Surgical opening, esophagus 18.36 NA 9.70 2.46 NA 30.51 090 43352 A Surgical opening, esophagus 15.27 NA 8.27 2.05 NA 25.59 090 43360 A Gastrointestinal repair 35.72 NA 14.98 4.96 NA 55.66 090
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 43361 A Gastrointestinal repair 40.52 NA 16.63 4.49 NA 61.64 090 43400 A Ligate esophagus veins 21.21 NA 10.06 1.95 NA 33.22 090 43401 A Esophagus surgery for veins 22.10 NA 9.26 3.04 NA 34.40 090 43405 A Ligate/staple esophagus 20.02 NA 9.60 2.83 NA 32.45 090 43410 A Repair esophagus wound 13.48 NA 7.54 1.71 NA 22.72 090 43415 A Repair esophagus wound 25.01 NA 11.61 3.52 NA 40.14 090 43420 A Repair esophagus opening 14.36 NA 7.24 1.43 NA 23.03 090 43425 A Repair esophagus opening 21.04 NA 9.84 3.02 NA 33.90 090 43450 A Dilate esophagus 1.38 2.83 0.77 0.11 4.32 2.26 000 43453 A Dilate esophagus 1.51 6.53 0.82 0.11 8.15 2.44 000 43456 A Dilate esophagus 2.58 14.11 1.21 0.20 16.89 3.99 000 43458 A Dilate esophagus 3.07 7.20 1.40 0.24 10.51 4.70 000 43460 A Pressure treatment esophagus 3.80 NA 1.57 0.31 NA 5.68 000 43496 C Free jejunum flap, microvasc 0.00 0.00 0.00 0.00 0.00 0.00 090 43499 C Esophagus surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 43500 A Surgical opening of stomach 11.05 NA 4.93 1.45 NA 17.43 090 43501 A Surgical repair of stomach 20.05 NA 8.20 2.64 NA 30.89 090 43502 A Surgical repair of stomach 23.15 NA 9.34 3.09 NA 35.57 090 43510 A Surgical opening of stomach 13.09 NA 6.97 1.48 NA 21.54 090 43520 A Incision of pyloric muscle 10.00 NA 5.09 1.36 NA 16.45 090 43600 A Biopsy of stomach 1.91 NA 0.69 0.14 NA 2.74 000 43605 A Biopsy of stomach 11.98 NA 5.22 1.58 NA 18.79 090 43610 A Excision of stomach lesion 14.61 NA 6.07 1.93 NA 22.61 090 43611 A Excision of stomach lesion 17.85 NA 7.47 2.35 NA 27.67 090 43620 A Removal of stomach 30.05 NA 11.60 3.95 NA 45.60 090 43621 A Removal of stomach 30.74 NA 11.77 4.03 NA 46.54 090 43622 A Removal of stomach 32.54 NA 12.36 4.29 NA 49.20 090 43631 A Removal of stomach, partial 22.61 NA 9.03 2.98 NA 34.61 090 43632 A Removal of stomach, partial 22.61 NA 9.03 2.98 NA 34.61 090 43633 A Removal of stomach, partial 23.12 NA 9.19 3.05 NA 35.35 090
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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 449 and 450: 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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