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 47560 A Laparoscopy w/cholangio 4.89 NA 1.63 0.65 NA 7.17 000 47561 A Laparo w/cholangio/biopsy 5.18 NA 1.88 0.66 NA 7.72 000 47562 A Laparoscopic cholecystectomy 11.09 NA 4.93 1.46 NA 17.48 090 47563 A Laparo cholecystectomy/graph 11.94 NA 5.24 1.58 NA 18.76 090 47564 A Laparo cholecystectomy/explr 14.24 NA 5.87 1.88 NA 21.99 090 47570 A Laparo cholecystoenterostomy 12.59 NA 5.31 1.65 NA 19.55 090 47579 C Laparoscope proc, biliary 0.00 0.00 0.00 0.00 0.00 0.00 YYY 47600 A Removal of gallbladder 13.59 NA 6.04 1.79 NA 21.42 090 47605 A Removal of gallbladder 14.70 NA 6.41 1.94 NA 23.04 090 47610 A Removal of gallbladder 18.83 NA 7.80 2.48 NA 29.11 090 47612 A Removal of gallbladder 18.79 NA 7.76 2.47 NA 29.01 090 47620 A Removal of gallbladder 20.65 NA 8.37 2.73 NA 31.76 090 47630 A Remove bile duct stone 9.12 NA 5.10 0.65 NA 14.86 090 47700 A Exploration of bile ducts 15.63 NA 7.31 2.06 NA 25.00 090 47701 A Bile duct revision 27.83 NA 11.28 3.67 NA 42.77 090 47711 A Excision of bile duct tumor 23.05 NA 9.75 3.04 NA 35.84 090 47712 A Excision of bile duct tumor 30.25 NA 12.16 3.92 NA 46.33 090 47715 A Excision of bile duct cyst 18.81 NA 8.31 2.48 NA 29.60 090 47716 A Fusion of bile duct cyst 16.45 NA 7.69 2.14 NA 26.29 090 47720 A Fuse gallbladder & bowel 15.92 NA 7.37 2.10 NA 25.39 090 47721 A Fuse upper gi structures 19.13 NA 8.43 2.52 NA 30.08 090 47740 A Fuse gallbladder & bowel 18.49 NA 8.24 2.41 NA 29.14 090 47741 A Fuse gallbladder & bowel 21.35 NA 9.13 2.82 NA 33.31 090 47760 A Fuse bile ducts and bowel 25.86 NA 10.66 3.41 NA 39.93 090 47765 A Fuse liver ducts & bowel 24.89 NA 10.59 3.29 NA 38.77 090 47780 A Fuse bile ducts and bowel 26.51 NA 11.02 3.49 NA 41.02 090 47785 A Fuse bile ducts and bowel 31.19 NA 12.65 4.09 NA 47.93 090 47800 A Reconstruction of bile ducts 23.32 NA 9.89 3.07 NA 36.27 090 47801 A Placement, bile duct support 15.18 NA 8.39 1.16 NA 24.73 090 47802 A Fuse liver duct & intestine 21.56 NA 9.49 2.85 NA 33.90 090
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 47900 A Suture bile duct injury 19.91 NA 8.73 2.64 NA 31.28 090 47999 C Bile tract surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 48000 A Drainage of abdomen 28.09 NA 11.45 3.47 NA 43.01 090 48001 A Placement of drain, pancreas 35.47 NA 13.61 4.68 NA 53.77 090 48005 A Resect/debride pancreas 42.19 NA 16.29 5.54 NA 64.02 090 48020 A Removal of pancreatic stone 15.71 NA 7.25 2.12 NA 25.09 090 48100 A Biopsy of pancreas, open 12.23 NA 5.54 1.62 NA 19.39 090 48102 A Needle biopsy, pancreas 4.68 8.56 2.01 0.28 13.52 6.97 010 48120 A Removal of pancreas lesion 15.86 NA 6.81 2.09 NA 24.76 090 48140 A Partial removal of pancreas 22.96 NA 9.40 3.02 NA 35.37 090 48145 A Partial removal of pancreas 24.03 NA 9.69 3.17 NA 36.88 090 48146 A Pancreatectomy 26.41 NA 11.78 3.49 NA 41.68 090 48148 A Removal of pancreatic duct 17.34 NA 7.48 2.29 NA 27.12 090 48150 A Partial removal of pancreas 48.03 NA 19.10 6.30 NA 73.43 090 48152 A Pancreatectomy 43.77 NA 17.84 5.78 NA 67.39 090 48153 A Pancreatectomy 47.92 NA 19.14 6.29 NA 73.35 090 48154 A Pancreatectomy 44.12 NA 17.89 5.82 NA 67.83 090 48155 A Removal of pancreas 24.65 NA 11.47 3.26 NA 39.38 090 48160 N Pancreas removal/transplant 0.00 0.00 0.00 0.00 0.00 0.00 XXX 48180 A Fuse pancreas and bowel 24.73 NA 10.02 3.27 NA 38.02 090 48400 A Injection, intraop add-on 1.95 NA 0.67 0.15 NA 2.77 ZZZ 48500 A Surgery of pancreatic cyst 15.29 NA 7.24 2.02 NA 24.55 090 48510 A Drain pancreatic pseudocyst 14.32 NA 7.52 1.82 NA 23.66 090 48511 A Drain pancreatic pseudocyst 4.00 21.86 1.37 0.24 26.10 5.61 000 48520 A Fuse pancreas cyst and bowel 15.60 NA 6.62 2.05 NA 24.27 090 48540 A Fuse pancreas cyst and bowel 19.73 NA 7.98 2.60 NA 30.31 090 48545 A Pancreatorrhaphy 18.19 NA 7.86 2.37 NA 28.42 090 48547 A Duodenal exclusion 25.84 NA 10.33 3.41 NA 39.58 090 48551 C Prep donor pancreas 0.00 0.00 0.00 0.00 0.00 0.00 XXX 48552 A Prep donor pancreas/venous 4.31 NA 1.44 0.31 NA 6.06 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 463 and 464: 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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