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 46935 A Destruction of hemorrhoids 2.43 3.49 1.25 0.23 6.15 3.91 010 46936 A Destruction of hemorrhoids 3.69 5.13 2.63 0.34 9.16 6.66 090 46937 A Cryotherapy of rectal lesion 2.70 3.09 1.23 0.14 5.92 4.07 010 46938 A Cryotherapy of rectal lesion 4.66 4.24 3.08 0.58 9.48 8.32 090 46940 A Treatment of anal fissure 2.32 2.08 1.10 0.23 4.63 3.65 010 46942 A Treatment of anal fissure 2.04 1.94 1.07 0.19 4.17 3.31 010 46945 A Ligation of hemorrhoids 1.84 3.37 2.65 0.19 5.41 4.69 090 46946 A Ligation of hemorrhoids 2.59 3.73 2.58 0.27 6.59 5.44 090 46947 A Hemorrhoidopexy by stapling 5.21 NA 2.73 0.75 NA 8.69 090 46999 C Anus surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 47000 A Needle biopsy of liver 1.90 4.66 0.66 0.12 6.69 2.69 000 47001 A Needle biopsy, liver add-on 1.90 NA 0.64 0.25 NA 2.79 ZZZ 47010 A Open drainage, liver lesion 16.02 NA 8.67 1.80 NA 26.49 090 47011 A Percut drain, liver lesion 3.70 NA 1.27 0.22 NA 5.18 000 47015 A Inject/aspirate liver cyst 15.12 NA 7.48 1.83 NA 24.43 090 47100 A Wedge biopsy of liver 11.67 NA 5.98 1.53 NA 19.18 090 47120 A Partial removal of liver 35.52 NA 14.87 4.65 NA 55.05 090 47122 A Extensive removal of liver 55.16 NA 20.98 7.19 NA 83.33 090 47125 A Partial removal of liver 49.22 NA 19.10 6.45 NA 74.76 090 47130 A Partial removal of liver 53.38 NA 20.51 6.94 NA 80.83 090 47135 R Transplantation of liver 81.56 NA 31.02 9.93 NA 122.51 090 47136 R Transplantation of liver 68.64 NA 26.67 8.41 NA 103.72 090 47140 A Partial removal, donor liver 55.03 NA 22.05 5.17 NA 82.25 090 47141 A Partial removal, donor liver 67.53 NA 26.60 5.17 NA 99.30 090 47142 A Partial removal, donor liver 75.04 NA 29.09 5.17 NA 109.30 090 47143 C Prep donor liver, whole 0.00 0.00 0.00 0.00 0.00 0.00 XXX 47144 C Prep donor liver, 3-segment 0.00 0.00 0.00 0.00 0.00 0.00 090 47145 C Prep donor liver, lobe split 0.00 0.00 0.00 0.00 0.00 0.00 090 47146 A Prep donor liver/venous 6.01 NA 2.00 0.83 NA 8.84 XXX 47147 A Prep donor liver/arterial 7.01 NA 2.33 0.97 NA 10.32 XXX
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 47300 A Surgery for liver lesion 15.09 NA 7.14 1.98 NA 24.21 090 47350 A Repair liver wound 19.57 NA 8.75 2.58 NA 30.90 090 47360 A Repair liver wound 26.93 NA 11.43 3.37 NA 41.73 090 47361 A Repair liver wound 47.14 NA 18.17 5.85 NA 71.16 090 47362 A Repair liver wound 18.52 NA 8.58 2.50 NA 29.60 090 47370 A Laparo ablate liver tumor rf 19.70 NA 8.04 2.55 NA 30.29 090 47371 A Laparo ablate liver cryosurg 19.70 NA 8.03 2.60 NA 30.33 090 47379 C Laparoscope procedure, liver 0.00 0.00 0.00 0.00 0.00 0.00 YYY 47380 A Open ablate liver tumor rf 23.02 NA 9.22 2.86 NA 35.10 090 47381 A Open ablate liver tumor cryo 23.29 NA 9.55 2.84 NA 35.68 090 47382 A Percut ablate liver rf 15.20 NA 6.19 0.96 NA 22.35 010 47399 C Liver surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 47400 A Incision of liver duct 32.50 NA 13.33 3.07 NA 48.90 090 47420 A Incision of bile duct 19.89 NA 8.62 2.62 NA 31.13 090 47425 A Incision of bile duct 19.84 NA 8.70 2.61 NA 31.15 090 47460 A Incise bile duct sphincter 18.05 NA 8.55 2.20 NA 28.80 090 47480 A Incision of gallbladder 10.82 NA 5.85 1.42 NA 18.09 090 47490 A Incision of gallbladder 7.23 NA 5.80 0.43 NA 13.47 090 47500 A Injection for liver x-rays 1.96 NA 0.68 0.12 NA 2.76 000 47505 A Injection for liver x-rays 0.76 NA 0.26 0.04 NA 1.06 000 47510 A Insert catheter, bile duct 7.84 NA 5.27 0.46 NA 13.56 090 47511 A Insert bile duct drain 10.50 NA 5.35 0.62 NA 16.47 090 47525 A Change bile duct catheter 5.55 15.88 2.95 0.33 21.77 8.83 010 47530 A Revise/reinsert bile tube 5.85 34.20 3.89 0.37 40.42 10.11 090 47550 A Bile duct endoscopy add-on 3.03 NA 1.00 0.40 NA 4.42 ZZZ 47552 A Biliary endoscopy thru skin 6.04 NA 2.43 0.42 NA 8.89 000 47553 A Biliary endoscopy thru skin 6.35 NA 2.17 0.37 NA 8.89 000 47554 A Biliary endoscopy thru skin 9.07 NA 3.38 0.96 NA 13.41 000 47555 A Biliary endoscopy thru skin 7.57 NA 2.60 0.45 NA 10.62 000 47556 A Biliary endoscopy thru skin 8.57 NA 2.94 0.50 NA 12.01 000
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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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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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