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 49568 A Hernia repair w/mesh 4.89 NA 1.63 0.64 NA 7.16 ZZZ 49570 A Rpr epigastric hern, reduce 5.69 NA 3.15 0.75 NA 9.59 090 49572 A Rpr epigastric hern, blocked 6.73 NA 3.44 0.88 NA 11.06 090 49580 A Rpr umbil hern, reduc < 5 yr 4.11 NA 2.58 0.54 NA 7.23 090 49582 A Rpr umbil hern, block < 5 yr 6.65 NA 3.45 0.88 NA 10.99 090 49585 A Rpr umbil hern, reduc > 5 yr 6.23 NA 3.28 0.82 NA 10.34 090 49587 A Rpr umbil hern, block > 5 yr 7.57 NA 3.71 0.99 NA 12.27 090 49590 A Repair spigelian hernia 8.55 NA 4.06 1.13 NA 13.73 090 49600 A Repair umbilical lesion 10.96 NA 5.26 1.32 NA 17.54 090 49605 A Repair umbilical lesion 76.04 NA 27.99 9.36 NA 113.39 090 49606 A Repair umbilical lesion 18.61 NA 7.55 2.45 NA 28.60 090 49610 A Repair umbilical lesion 10.50 NA 5.11 1.07 NA 16.68 090 49611 A Repair umbilical lesion 8.93 NA 6.74 0.78 NA 16.45 090 49650 A Laparo hernia repair initial 6.27 NA 3.18 0.93 NA 10.38 090 49651 A Laparo hernia repair recur 8.25 NA 4.03 1.14 NA 13.41 090 49659 C Laparo proc, hernia repair 0.00 0.00 0.00 0.00 0.00 0.00 YYY 49900 A Repair of abdominal wall 12.28 NA 6.21 1.62 NA 20.12 090 49904 A Omental flap, extra-abdom 20.01 NA 14.59 2.69 NA 37.29 090 49905 A Omental flap, intra-abdom 6.55 NA 2.26 0.75 NA 9.57 ZZZ 49906 C Free omental flap, microvasc 0.00 0.00 0.00 0.00 0.00 0.00 090 49999 C Abdomen surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 50010 A Exploration of kidney 10.98 NA 5.82 0.93 NA 17.74 090 50020 A Renal abscess, open drain 14.67 NA 8.25 1.34 NA 24.26 090 50021 A Renal abscess, percut drain 3.38 22.82 1.16 0.20 26.39 4.74 000 50040 A Drainage of kidney 14.95 NA 7.61 1.03 NA 23.59 090 50045 A Exploration of kidney 15.47 NA 7.41 1.24 NA 24.12 090 50060 A Removal of kidney stone 19.31 NA 9.10 1.36 NA 29.76 090 50065 A Incision of kidney 20.80 NA 6.01 1.59 NA 28.40 090 50070 A Incision of kidney 20.33 NA 9.43 1.44 NA 31.20 090 50075 A Removal of kidney stone 25.35 NA 11.47 1.80 NA 38.62 090
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 50080 A Removal of kidney stone 14.72 NA 7.28 1.04 NA 23.04 090 50081 A Removal of kidney stone 21.81 NA 10.27 1.54 NA 33.62 090 50100 A Revise kidney blood vessels 16.10 NA 7.67 2.06 NA 25.83 090 50120 A Exploration of kidney 15.92 NA 7.79 1.21 NA 24.92 090 50125 A Explore and drain kidney 16.53 NA 7.75 1.43 NA 25.71 090 50130 A Removal of kidney stone 17.29 NA 8.29 1.22 NA 26.81 090 50135 A Exploration of kidney 19.19 NA 8.99 1.33 NA 29.51 090 50200 A Biopsy of kidney 2.64 NA 1.32 0.16 NA 4.11 000 50205 A Biopsy of kidney 11.31 NA 5.32 1.30 NA 17.93 090 50220 A Remove kidney, open 17.15 NA 8.12 1.35 NA 26.63 090 50225 A Removal kidney open, complex 20.24 NA 9.34 1.50 NA 31.08 090 50230 A Removal kidney open, radical 22.08 NA 9.88 1.55 NA 33.51 090 50234 A Removal of kidney & ureter 22.41 NA 10.18 1.59 NA 34.19 090 50236 A Removal of kidney & ureter 24.87 NA 11.78 1.76 NA 38.41 090 50240 A Partial removal of kidney 22.01 NA 10.38 1.55 NA 33.94 090 50280 A Removal of kidney lesion 15.68 NA 7.62 1.19 NA 24.49 090 50290 A Removal of kidney lesion 14.74 NA 6.95 1.41 NA 23.10 090 50320 A Remove kidney, living donor 22.22 NA 11.43 2.35 NA 36.00 090 50323 C Prep cadaver renal allograft 0.00 0.00 0.00 0.00 0.00 0.00 XXX 50325 C Prep donor renal graft 0.00 0.00 0.00 0.00 0.00 0.00 XXX 50327 A Prep renal graft/venous 4.01 NA 1.35 0.29 NA 5.65 XXX 50328 A Prep renal graft/arterial 3.51 NA 1.18 0.26 NA 4.95 XXX 50329 A Prep renal graft/ureteral 3.35 NA 1.13 0.25 NA 4.73 XXX 50340 A Removal of kidney 12.15 NA 6.71 1.65 NA 20.51 090 50360 A Transplantation of kidney 31.54 NA 15.94 3.81 NA 51.29 090 50365 A Transplantation of kidney 36.82 NA 18.27 4.42 NA 59.52 090 50370 A Remove transplanted kidney 13.73 NA 7.40 1.67 NA 22.80 090 50380 A Reimplantation of kidney 20.77 NA 12.41 2.50 NA 35.69 090 50390 A Drainage of kidney lesion 1.96 NA 0.68 0.12 NA 2.76 000 50391 A Instll rx agnt into rnal tub 1.96 1.68 0.74 0.14 3.79 2.85 000
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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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