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 46050 A Incision of anal abscess 1.19 2.55 0.84 0.14 3.88 2.17 010 46060 A Incision of rectal abscess 5.69 NA 3.28 0.67 NA 9.64 090 46070 A Incision of anal septum 2.72 NA 1.86 0.36 NA 4.93 090 46080 A Incision of anal sphincter 2.49 2.40 1.13 0.30 5.20 3.92 010 46083 A Incise external hemorrhoid 1.40 2.46 0.91 0.15 4.01 2.47 010 46200 A Removal of anal fissure 3.42 4.08 2.92 0.39 7.89 6.73 090 46210 A Removal of anal crypt 2.68 5.04 2.65 0.31 8.02 5.64 090 46211 A Removal of anal crypts 4.25 5.43 3.67 0.48 10.16 8.40 090 46220 A Removal of anal tag 1.56 2.33 0.96 0.17 4.06 2.70 010 46221 A Ligation of hemorrhoid(s) 2.04 2.71 1.77 0.23 4.98 4.05 010 46230 A Removal of anal tags 2.58 3.06 1.29 0.30 5.94 4.17 010 46250 A Hemorrhoidectomy 3.89 5.25 2.60 0.48 9.62 6.97 090 46255 A Hemorrhoidectomy 4.60 5.85 2.82 0.58 11.03 8.00 090 46257 A Remove hemorrhoids & fissure 5.40 NA 2.89 0.64 NA 8.93 090 46258 A Remove hemorrhoids & fistula 5.73 NA 3.31 0.68 NA 9.72 090 46260 A Hemorrhoidectomy 6.37 NA 3.20 0.76 NA 10.33 090 46261 A Remove hemorrhoids & fissure 7.08 NA 3.64 0.79 NA 11.51 090 46262 A Remove hemorrhoids & fistula 7.50 NA 3.77 0.83 NA 12.10 090 46270 A Removal of anal fistula 3.72 4.97 2.85 0.46 9.15 7.02 090 46275 A Removal of anal fistula 4.56 4.76 3.00 0.52 9.84 8.08 090 46280 A Removal of anal fistula 5.98 NA 3.29 0.66 NA 9.94 090 46285 A Removal of anal fistula 4.09 3.95 2.77 0.44 8.48 7.30 090 46288 A Repair anal fistula 7.13 NA 3.69 0.79 NA 11.62 090 46320 A Removal of hemorrhoid clot 1.61 2.12 0.84 0.18 3.91 2.63 010 46500 A Injection into hemorrhoid(s) 1.61 2.26 1.26 0.16 4.04 3.04 010 46600 A Diagnostic anoscopy 0.50 1.52 0.34 0.05 2.07 0.89 000 46604 A Anoscopy and dilation 1.31 9.37 0.64 0.12 10.81 2.08 000 46606 A Anoscopy and biopsy 0.81 3.69 0.44 0.09 4.59 1.34 000 46608 A Anoscopy, remove for body 1.51 4.23 0.65 0.16 5.91 2.32 000 46610 A Anoscopy, remove lesion 1.32 3.92 0.62 0.15 5.40 2.10 000
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 46611 A Anoscopy 1.81 3.20 0.78 0.19 5.20 2.78 000 46612 A Anoscopy, remove lesions 2.34 5.32 1.01 0.28 7.95 3.64 000 46614 A Anoscopy, control bleeding 2.01 2.48 0.87 0.20 4.69 3.08 000 46615 A Anoscopy 2.69 2.43 1.07 0.33 5.45 4.09 000 46700 A Repair of anal stricture 9.14 NA 4.24 0.94 NA 14.32 090 46705 A Repair of anal stricture 6.90 NA 3.77 0.91 NA 11.58 090 46706 A Repr of anal fistula w/glue 2.39 0.00 1.27 0.28 2.67 3.94 010 46715 A Rep perf anoper fistu 7.20 NA 3.63 0.92 NA 11.75 090 46716 A Rep perf anoper/vestib fistu 15.08 NA 7.93 1.58 NA 24.59 090 46730 A Construction of absent anus 26.76 NA 11.97 2.46 NA 41.19 090 46735 A Construction of absent anus 32.18 NA 13.46 3.20 NA 48.85 090 46740 A Construction of absent anus 30.02 NA 13.17 2.41 NA 45.60 090 46742 A Repair of imperforated anus 35.82 NA 16.88 3.19 NA 55.89 090 46744 A Repair of cloacal anomaly 52.66 NA 21.39 6.38 NA 80.42 090 46746 A Repair of cloacal anomaly 58.25 NA 24.73 7.68 NA 90.65 090 46748 A Repair of cloacal anomaly 64.24 NA 25.56 3.36 NA 93.15 090 46750 A Repair of anal sphincter 10.25 NA 5.05 1.10 NA 16.40 090 46751 A Repair of anal sphincter 8.78 NA 5.23 0.94 NA 14.94 090 46753 A Reconstruction of anus 8.30 NA 3.85 0.94 NA 13.08 090 46754 A Removal of suture from anus 2.20 3.53 1.72 0.19 5.93 4.11 010 46760 A Repair of anal sphincter 14.44 NA 7.10 1.59 NA 23.13 090 46761 A Repair of anal sphincter 13.85 NA 6.00 1.43 NA 21.28 090 46762 A Implant artificial sphincter 12.72 NA 5.77 1.24 NA 19.72 090 46900 A Destruction, anal lesion(s) 1.91 2.72 1.33 0.17 4.80 3.41 010 46910 A Destruction, anal lesion(s) 1.86 3.04 1.07 0.19 5.09 3.13 010 46916 A Cryosurgery, anal lesion(s) 1.86 3.30 1.52 0.11 5.27 3.49 010 46917 A Laser surgery, anal lesions 1.86 9.15 1.15 0.21 11.23 3.22 010 46922 A Excision of anal lesion(s) 1.86 3.33 1.08 0.22 5.42 3.16 010 46924 A Destruction, anal lesion(s) 2.77 8.93 1.36 0.26 11.95 4.39 010 46934 A Destruction of hemorrhoids 3.51 5.32 3.23 0.32 9.14 7.06 090
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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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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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