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 50392 A Insert kidney drain 3.38 NA 1.61 0.20 NA 5.18 000 50393 A Insert ureteral tube 4.16 NA 1.88 0.25 NA 6.29 000 50394 A Injection for kidney x-ray 0.76 2.72 0.70 0.05 3.53 1.51 000 50395 A Create passage to kidney 3.38 NA 1.61 0.21 NA 5.19 000 50396 A Measure kidney pressure 2.09 NA 1.15 0.13 NA 3.38 000 50398 A Change kidney tube 1.46 16.40 0.55 0.09 17.95 2.10 000 50400 A Revision of kidney/ureter 19.51 NA 9.04 1.38 NA 29.93 090 50405 A Revision of kidney/ureter 23.94 NA 10.26 1.78 NA 35.98 090 50500 A Repair of kidney wound 19.58 NA 8.86 2.01 NA 30.45 090 50520 A Close kidney-skin fistula 17.23 NA 8.35 1.49 NA 27.07 090 50525 A Repair renal-abdomen fistula 22.28 NA 9.57 1.83 NA 33.68 090 50526 A Repair renal-abdomen fistula 24.03 NA 10.40 1.96 NA 36.38 090 50540 A Revision of horseshoe kidney 19.94 NA 8.96 1.36 NA 30.26 090 50541 A Laparo ablate renal cyst 16.01 NA 7.41 1.13 NA 24.55 090 50542 A Laparo ablate renal mass 20.01 NA 9.49 1.39 NA 30.89 090 50543 A Laparo partial nephrectomy 25.51 NA 11.90 1.80 NA 39.21 090 50544 A Laparoscopy, pyeloplasty 22.41 NA 9.75 1.58 NA 33.74 090 50545 A Laparo radical nephrectomy 24.01 NA 10.60 1.70 NA 36.31 090 50546 A Laparoscopic nephrectomy 20.49 NA 9.49 1.57 NA 31.55 090 50547 A Laparo removal donor kidney 25.51 NA 11.70 2.76 NA 39.97 090 50548 A Laparo remove w/ureter 24.41 NA 10.57 1.72 NA 36.70 090 50549 C Laparoscope proc, renal 0.00 0.00 0.00 0.00 0.00 0.00 YYY 50551 A Kidney endoscopy 5.60 4.47 2.34 0.40 10.48 8.35 000 50553 A Kidney endoscopy 5.99 4.72 2.52 0.39 11.11 8.90 000 50555 A Kidney endoscopy & biopsy 6.53 5.03 2.69 0.45 12.01 9.67 000 50557 A Kidney endoscopy & treatment 6.62 5.04 2.73 0.47 12.13 9.82 000 50561 A Kidney endoscopy & treatment 7.60 5.51 3.09 0.54 13.64 11.22 000 50562 A Renal scope w/tumor resect 10.92 NA 4.95 0.73 NA 16.60 090 50570 A Kidney endoscopy 9.55 NA 3.81 0.68 NA 14.04 000 50572 A Kidney endoscopy 10.35 NA 4.07 0.85 NA 15.27 000
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 50574 A Kidney endoscopy & biopsy 11.02 NA 4.37 0.77 NA 16.16 000 50575 A Kidney endoscopy 13.99 NA 5.49 0.99 NA 20.46 000 50576 A Kidney endoscopy & treatment 10.99 NA 4.34 0.78 NA 16.11 000 50580 A Kidney endoscopy & treatment 11.86 NA 4.69 0.83 NA 17.38 000 50590 A Fragmenting of kidney stone 9.10 13.68 4.92 0.65 23.43 14.67 090 50600 A Exploration of ureter 15.85 NA 7.56 1.13 NA 24.54 090 50605 A Insert ureteral support 15.47 NA 7.37 1.45 NA 24.29 090 50610 A Removal of ureter stone 15.93 NA 7.84 1.43 NA 25.20 090 50620 A Removal of ureter stone 15.17 NA 7.35 1.07 NA 23.59 090 50630 A Removal of ureter stone 14.95 NA 7.26 1.09 NA 23.30 090 50650 A Removal of ureter 17.41 NA 8.32 1.23 NA 26.97 090 50660 A Removal of ureter 19.56 NA 9.17 1.38 NA 30.11 090 50684 A Injection for ureter x-ray 0.76 4.95 0.55 0.05 5.76 1.37 000 50686 A Measure ureter pressure 1.51 3.46 0.88 0.11 5.08 2.50 000 50688 A Change of ureter tube 1.17 NA 1.12 0.07 NA 2.37 010 50690 A Injection for ureter x-ray 1.16 1.88 0.78 0.07 3.12 2.02 000 50700 A Revision of ureter 15.22 NA 7.83 1.27 NA 24.32 090 50715 A Release of ureter 18.91 NA 8.92 2.13 NA 29.96 090 50722 A Release of ureter 16.36 NA 7.93 1.90 NA 26.19 090 50725 A Release/revise ureter 18.50 NA 8.71 1.52 NA 28.73 090 50727 A Revise ureter 8.19 NA 4.89 0.61 NA 13.68 090 50728 A Revise ureter 12.02 NA 6.12 1.00 NA 19.15 090 50740 A Fusion of ureter & kidney 18.43 NA 8.33 1.96 NA 28.72 090 50750 A Fusion of ureter & kidney 19.52 NA 9.27 1.38 NA 30.17 090 50760 A Fusion of ureters 18.43 NA 8.59 1.55 NA 28.56 090 50770 A Splicing of ureters 19.52 NA 9.08 1.45 NA 30.05 090 50780 A Reimplant ureter in bladder 18.37 NA 8.59 1.51 NA 28.47 090 50782 A Reimplant ureter in bladder 19.55 NA 9.12 1.61 NA 30.28 090 50783 A Reimplant ureter in bladder 20.56 NA 9.37 1.98 NA 31.91 090 50785 A Reimplant ureter in bladder 20.53 NA 9.44 1.45 NA 31.42 090
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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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