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 43634 A Removal of stomach, partial 25.13 NA 9.90 3.32 NA 38.35 090 43635 A Removal of stomach, partial 2.06 NA 0.68 0.27 NA 3.02 ZZZ 43638 A Removal of stomach, partial 29.02 NA 11.70 3.80 NA 44.52 090 43639 A Removal of stomach, partial 29.67 NA 11.47 3.90 NA 45.04 090 43640 A Vagotomy & pylorus repair 17.02 NA 7.17 2.25 NA 26.44 090 43641 A Vagotomy & pylorus repair 17.27 NA 7.28 2.24 NA 26.79 090 43644 A Lap gastric bypass/roux-en-y 27.89 NA 11.14 3.15 NA 42.18 090 43645 A Lap gastr bypass incl smll i 30.02 NA 12.02 3.53 NA 45.57 090 43651 A Laparoscopy, vagus nerve 10.15 NA 4.71 1.33 NA 16.19 090 43652 A Laparoscopy, vagus nerve 12.15 NA 5.63 1.55 NA 19.33 090 43653 A Laparoscopy, gastrostomy 7.74 NA 4.16 1.01 NA 12.90 090 43659 C Laparoscope proc, stom 0.00 0.00 0.00 0.00 0.00 0.00 YYY 43750 A Place gastrostomy tube 4.49 NA 2.14 0.43 NA 7.06 010 43752 A Nasal/orogastric w/stent 0.81 NA 0.27 0.02 NA 1.10 000 43760 A Change gastrostomy tube 1.10 5.82 0.45 0.09 7.01 1.65 000 43761 A Reposition gastrostomy tube 2.01 1.18 0.69 0.13 3.32 2.84 000 43800 A Reconstruction of pylorus 13.70 NA 5.81 1.81 NA 21.32 090 43810 A Fusion of stomach and bowel 14.66 NA 6.10 1.93 NA 22.69 090 43820 A Fusion of stomach and bowel 15.38 NA 6.33 2.03 NA 23.74 090 43825 A Fusion of stomach and bowel 19.23 NA 7.91 2.53 NA 29.67 090 43830 A Place gastrostomy tube 9.54 NA 4.85 1.25 NA 15.64 090 43831 A Place gastrostomy tube 7.85 NA 4.53 1.03 NA 13.41 090 43832 A Place gastrostomy tube 15.61 NA 6.83 1.97 NA 24.41 090 43840 A Repair of stomach lesion 15.57 NA 6.69 2.05 NA 24.31 090 43842 A V-band gastroplasty 18.48 NA 7.69 2.44 NA 28.60 090 43843 A Gastroplasty w/o v-band 18.66 NA 7.68 2.45 NA 28.79 090 43845 C Gastroplasty duodenal switch 0.00 0.00 0.00 0.00 0.00 0.00 090 43846 A Gastric bypass for obesity 24.06 NA 9.88 3.18 NA 37.12 090 43847 A Gastric bypass incl small i 26.93 NA 10.74 3.55 NA 41.23 090 43848 A Revision gastroplasty 29.41 NA 11.64 3.87 NA 44.92 090
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 43850 A Revise stomach-bowel fusion 24.73 NA 9.69 3.27 NA 37.69 090 43855 A Revise stomach-bowel fusion 26.17 NA 10.20 3.46 NA 39.83 090 43860 A Revise stomach-bowel fusion 25.01 NA 9.81 3.30 NA 38.12 090 43865 A Revise stomach-bowel fusion 26.53 NA 10.32 3.50 NA 40.35 090 43870 A Repair stomach opening 9.70 NA 4.51 1.27 NA 15.48 090 43880 A Repair stomach-bowel fistula 24.66 NA 9.78 3.26 NA 37.70 090 43999 C Stomach surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 44005 A Freeing of bowel adhesion 16.24 NA 6.64 2.14 NA 25.02 090 44010 A Incision of small bowel 12.53 NA 5.39 1.64 NA 19.56 090 44015 A Insert needle cath bowel 2.63 NA 0.87 0.35 NA 3.84 ZZZ 44020 A Explore small intestine 14.00 NA 5.87 1.85 NA 21.72 090 44021 A Decompress small bowel 14.09 NA 5.92 1.86 NA 21.86 090 44025 A Incision of large bowel 14.29 NA 5.96 1.89 NA 22.14 090 44050 A Reduce bowel obstruction 14.04 NA 5.88 1.85 NA 21.77 090 44055 A Correct malrotation of bowel 22.01 NA 8.59 2.90 NA 33.51 090 44100 A Biopsy of bowel 2.01 NA 0.75 0.17 NA 2.94 000 44110 A Excise intestine lesion(s) 11.81 NA 5.18 1.55 NA 18.54 090 44111 A Excision of bowel lesion(s) 14.30 NA 6.03 1.86 NA 22.19 090 44120 A Removal of small intestine 17.00 NA 6.99 2.24 NA 26.23 090 44121 A Removal of small intestine 4.45 NA 1.49 0.58 NA 6.51 ZZZ 44125 A Removal of small intestine 17.55 NA 7.16 2.26 NA 26.97 090 44126 A Enterectomy w/o taper, cong 35.52 NA 13.91 4.68 NA 54.11 090 44127 A Enterectomy w/taper, cong 41.02 NA 15.47 5.75 NA 62.24 090 44128 A Enterectomy cong, add-on 4.45 NA 1.49 0.61 NA 6.55 ZZZ 44130 A Bowel to bowel fusion 14.50 NA 6.15 1.87 NA 22.52 090 44132 R Enterectomy, cadaver donor 0.00 0.00 0.00 0.00 0.00 0.00 XXX 44133 R Enterectomy, live donor 0.00 0.00 0.00 0.00 0.00 0.00 XXX 44135 R Intestine transplnt, cadaver 0.00 0.00 0.00 0.00 0.00 0.00 XXX 44136 R Intestine transplant, live 0.00 0.00 0.00 0.00 0.00 0.00 XXX 44137 C Remove intestinal allograft 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 451 and 452: 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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