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 44139 A Mobilization of colon 2.23 NA 0.74 0.28 NA 3.26 ZZZ 44140 A Partial removal of colon 21.01 NA 8.53 2.70 NA 32.25 090 44141 A Partial removal of colon 19.52 NA 9.91 2.52 NA 31.95 090 44143 A Partial removal of colon 23.01 NA 10.52 3.04 NA 36.57 090 44144 A Partial removal of colon 21.54 NA 9.50 2.85 NA 33.89 090 44145 A Partial removal of colon 26.43 NA 10.68 3.28 NA 40.39 090 44146 A Partial removal of colon 27.56 NA 12.67 3.40 NA 43.62 090 44147 A Partial removal of colon 20.72 NA 8.60 2.55 NA 31.87 090 44150 A Removal of colon 23.96 NA 11.88 3.03 NA 38.87 090 44151 A Removal of colon/ileostomy 26.89 NA 13.23 3.48 NA 43.60 090 44152 A Removal of colon/ileostomy 27.85 NA 11.39 3.51 NA 42.75 090 44153 A Removal of colon/ileostomy 30.60 NA 14.27 3.54 NA 48.41 090 44155 A Removal of colon/ileostomy 27.88 NA 13.17 3.27 NA 44.31 090 44156 A Removal of colon/ileostomy 30.80 NA 14.81 3.94 NA 49.56 090 44160 A Removal of colon 18.63 NA 7.65 2.36 NA 28.64 090 44200 A Laparoscopy, enterolysis 14.45 NA 6.12 1.89 NA 22.46 090 44201 A Laparoscopy, jejunostomy 9.79 NA 4.60 1.30 NA 15.69 090 44202 A Lap resect s/intestine singl 22.05 NA 8.81 2.84 NA 33.71 090 44203 A Lap resect s/intestine, addl 4.45 NA 1.46 0.57 NA 6.48 ZZZ 44204 A Laparo partial colectomy 25.09 NA 9.81 3.10 NA 38.00 090 44205 A Lap colectomy part w/ileum 22.24 NA 8.72 2.74 NA 33.71 090 44206 A Lap part colectomy w/stoma 27.01 NA 11.08 3.45 NA 41.54 090 44207 A L colectomy/coloproctostomy 30.02 NA 11.32 3.66 NA 45.00 090 44208 A L colectomy/coloproctostomy 32.01 NA 12.97 3.87 NA 48.85 090 44210 A Laparo total proctocolectomy 28.02 NA 11.74 3.41 NA 43.17 090 44211 A Laparo total proctocolectomy 35.02 NA 14.52 4.16 NA 53.70 090 44212 A Laparo total proctocolectomy 32.51 NA 13.56 3.77 NA 49.84 090 44238 C Laparoscope proc, intestine 0.00 0.00 0.00 0.00 0.00 0.00 YYY 44239 C Laparoscope proc, rectum 0.00 0.00 0.00 0.00 0.00 0.00 YYY 44300 A Open bowel to skin 12.11 NA 5.43 1.60 NA 19.15 090
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 44310 A Ileostomy/jejunostomy 15.96 NA 6.62 1.98 NA 24.57 090 44312 A Revision of ileostomy 8.03 NA 4.12 0.92 NA 13.06 090 44314 A Revision of ileostomy 15.06 NA 6.65 1.74 NA 23.45 090 44316 A Devise bowel pouch 21.10 NA 8.65 2.37 NA 32.12 090 44320 A Colostomy 17.65 NA 7.58 2.25 NA 27.48 090 44322 A Colostomy with biopsies 11.98 NA 8.49 1.54 NA 22.01 090 44340 A Revision of colostomy 7.73 NA 4.26 0.99 NA 12.98 090 44345 A Revision of colostomy 15.44 NA 6.83 1.96 NA 24.23 090 44346 A Revision of colostomy 16.99 NA 7.34 2.12 NA 26.45 090 44360 A Small bowel endoscopy 2.60 NA 1.21 0.19 NA 4.00 000 44361 A Small bowel endoscopy/biopsy 2.88 NA 1.32 0.21 NA 4.40 000 44363 A Small bowel endoscopy 3.50 NA 1.48 0.27 NA 5.25 000 44364 A Small bowel endoscopy 3.74 NA 1.62 0.27 NA 5.63 000 44365 A Small bowel endoscopy 3.32 NA 1.49 0.24 NA 5.05 000 44366 A Small bowel endoscopy 4.41 NA 1.88 0.32 NA 6.61 000 44369 A Small bowel endoscopy 4.52 NA 1.85 0.33 NA 6.70 000 44370 A Small bowel endoscopy/stent 4.80 NA 2.16 0.37 NA 7.33 000 44372 A Small bowel endoscopy 4.41 NA 1.85 0.35 NA 6.61 000 44373 A Small bowel endoscopy 3.50 NA 1.53 0.27 NA 5.30 000 44376 A Small bowel endoscopy 5.26 NA 2.17 0.42 NA 7.85 000 44377 A Small bowel endoscopy/biopsy 5.53 NA 2.32 0.40 NA 8.25 000 44378 A Small bowel endoscopy 7.13 NA 2.92 0.52 NA 10.58 000 44379 A S bowel endoscope w/stent 7.47 NA 3.13 0.62 NA 11.23 000 44380 A Small bowel endoscopy 1.05 NA 0.63 0.08 NA 1.76 000 44382 A Small bowel endoscopy 1.27 NA 0.71 0.12 NA 2.10 000 44383 A Ileoscopy w/stent 2.95 NA 1.42 0.21 NA 4.57 000 44385 A Endoscopy of bowel pouch 1.82 3.53 0.83 0.15 5.51 2.80 000 44386 A Endoscopy, bowel pouch/biop 2.12 7.02 0.93 0.20 9.34 3.26 000 44388 A Colonoscopy 2.83 5.31 1.21 0.26 8.40 4.30 000 44389 A Colonoscopy with biopsy 3.14 7.02 1.36 0.27 10.43 4.76 000
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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 453 and 454: 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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