2006 proposed fee schedule - American Society of Clinical Oncology

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January 7, 2004 (69 FR 1084), we stated that the specialty of urology meets the above criteria, along with gynecology and rheumatology (69 FR 1094). Because we are accepting new survey data from the AUA, we are required to exempt, from the budget neutrality adjustment any impacts of accepting these data for purposes of calculating PE RVUs for drug administration services. In addition, Lewin recommended blending the radiation oncology data from this year’s AFROC survey data with last year’s ASTRO survey data to calculate the PE/HR. According to the Lewin Group, the goal of the AFROC survey was to represent the population of freestanding radiation oncology centers only. In order to develop an overall average for the radiation oncology PE pool, the Lewin Group recommended we use the AFROC survey for freestanding radiation oncology centers, and the hospital-based subset of last year's ASTRO survey. We agree that this blending of the AFROC and ASTRO data is a reasonable way to calculate an average PE/HR that fully reflects the practice of radiation oncology in all settings. Therefore, we are proposing to use the new PE/HR calculated in this manner for radiation oncology. We propose to use the following PE/HR figures (deflated to 1995 values to be consistent with the SMS data): 52
TABLE 14--Practice Expense Per Hour Figures Specialty Clinical Admin. Office Medical Medical Other Total Staff Staff Expense Supplies Equipment Radiology 14.8 18.6 16.5 6.5 13.1 26.8 96.3 Cardiology 38.3 34.5 35.7 16.5 12.2 19.1 156.3 Radiation Oncology 35.6 18.9 28.5 4 20.1 21.2 128.3 Urology 18.4 27.9 35.3 16.7 7.5 15.9 121.7 Dermatology 27.9 35.2 49.4 12.4 7.2 20 152.1 Allergy/Immunology 48.2 39.8 47 17.3 4.8 22.4 179.6 Gastroenterology 15.4 23.2 26.8 4.8 3.3 11.5 85 The deadline to submit supplemental PE surveys was March 1, 2005. As discussed in detail below, we are proposing to revise our methodology to calculate direct PE RVUs from the current top-down cost allocation methodology to a bottom-up methodology. Although we would continue to use the SMS data and the incorporated supplemental survey data for indirect PEs, we are not proposing to extend the deadline for submitting supplemental survey data at this time. Instead, we are inviting comment on the most appropriate way to proceed to ensure the indirect PEs per hour are accurate and consistent across specialties. (3) Revisions to the PE Methodology Since 1997, when we first proposed a resource-based PE methodology, we have had several major goals for this payment system. One has been to encourage the maximum input from the medical community regarding our PE data and methodology. We have worked closely with the PEAC, PERC, RUC and the Health Care Professional Advisory Committee (HCPAC) which are all multi-specialty groups that allow the medical community to 53
Page 1 and 2: DEPARTMENT OF HEALTH AND HUMAN SERV
Page 3 and 4: 2. By mail. You may mail written co
Page 5 and 6: Rick Ensor (410) 786-5617 (for issu
Page 7 and 8: service of the U.S. Government Prin
Page 9 and 10: 4. Proposed Revisions to §413.170
Page 11 and 12: AGA American Gastroenterological As
Page 13 and 14: GAO General Accounting Office GPCI
Page 15 and 16: PLI Professional liability insuranc
Page 17 and 18: Initially, only the physician work
Page 19 and 20: This resource-based system was base
Page 21 and 22: effect in 1997, published on Novemb
Page 23 and 24: ● Revised requirements for superv
Page 25 and 26: efinement of work RVUs; and solicit
Page 27 and 28: historical allowed charges. This le
Page 29 and 30: November 1, 2001 (66 FR 55246).) Th
Page 31 and 32: The CPEPs identified specific input
Page 33 and 34: codes that the RUC has not yet revi
Page 35 and 36: procedure: $27,305,408. In this exa
Page 37 and 38: as a whole. Indirect costs include
Page 39 and 40: ● The unscaled indirect expense a
Page 41 and 42: BNF is applied to (multiplied by) t
Page 43 and 44: NPWP Step 2--Calculation of Charge-
Page 45 and 46: In Table 11, the scaled total direc
Page 47 and 48: TABLE 13--Budget Neutrality and Fin
Page 49 and 50: The following discussion outlines t
Page 51: exist, and suggests that the need f
Page 55 and 56: We believe that we have consistentl
Page 57 and 58: Due to the ongoing refinement by th
Page 59 and 60: indirect PE methodology is inaccura
Page 61 and 62: multi-specialty PEAC that were base
Page 63 and 64: the needed survey or other data or
Page 65 and 66: PERC/RUC recommendations for these
Page 67 and 68: eflect the typical number of cast c
Page 69 and 70: on comments received and additional
Page 71 and 72: We have reviewed the PE database an
Page 73 and 74: the ACR. We have accepted the follo
Page 75 and 76: ● Clinical Labor for G-codes Rela
Page 77 and 78: proposed associated prices that we
Page 79 and 80: Supply Code Supply Description Unit
Page 81 and 82: ● Supply and Equipment Items Need
Page 83 and 84: Code 2005 Description Unit Unit Pri
Page 85 and 86: Code 2005 Description Price EQ212 p
Page 87 and 88: Effective January 1, 2006, this pro
Page 89 and 90: challenge the validity of a new loc
Page 91 and 92: ones reconfigured). Yet we also rec
Page 93 and 94: The issue of payment locality desig
Page 95 and 96: specialties listed infrequently as
Page 97 and 98: for premium rating purposes. ISO co
Page 99 and 100: psychology to the nonsurgical risk
Page 101 and 102: 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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2006 proposed fee schedule - American Society of Clinical Oncology

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