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 52234 A Cystoscopy and treatment 4.63 NA 1.98 0.33 NA 6.94 000 52235 A Cystoscopy and treatment 5.45 NA 2.31 0.39 NA 8.15 000 52240 A Cystoscopy and treatment 9.73 NA 3.93 0.69 NA 14.34 000 52250 A Cystoscopy and radiotracer 4.50 NA 1.98 0.32 NA 6.80 000 52260 A Cystoscopy and treatment 3.92 NA 1.70 0.28 NA 5.89 000 52265 A Cystoscopy and treatment 2.95 12.97 1.33 0.22 16.13 4.49 000 52270 A Cystoscopy & revise urethra 3.37 10.79 1.49 0.24 14.40 5.10 000 52275 A Cystoscopy & revise urethra 4.70 15.22 1.99 0.33 20.24 7.02 000 52276 A Cystoscopy and treatment 5.00 NA 2.13 0.35 NA 7.48 000 52277 A Cystoscopy and treatment 6.17 NA 2.59 0.44 NA 9.20 000 52281 A Cystoscopy and treatment 2.81 7.08 1.30 0.20 10.08 4.31 000 52282 A Cystoscopy, implant stent 6.40 NA 2.66 0.45 NA 9.51 000 52283 A Cystoscopy and treatment 3.74 4.14 1.65 0.26 8.14 5.65 000 52285 A Cystoscopy and treatment 3.61 4.23 1.60 0.26 8.09 5.47 000 52290 A Cystoscopy and treatment 4.59 NA 1.97 0.32 NA 6.88 000 52300 A Cystoscopy and treatment 5.31 NA 2.27 0.38 NA 7.97 000 52301 A Cystoscopy and treatment 5.51 NA 2.03 0.46 NA 8.00 000 52305 A Cystoscopy and treatment 5.31 NA 2.21 0.38 NA 7.90 000 52310 A Cystoscopy and treatment 2.82 4.79 1.23 0.20 7.81 4.25 000 52315 A Cystoscopy and treatment 5.21 8.76 2.18 0.37 14.34 7.76 000 52317 A Remove bladder stone 6.72 28.18 2.71 0.48 35.38 9.91 000 52318 A Remove bladder stone 9.20 NA 3.67 0.65 NA 13.52 000 52320 A Cystoscopy and treatment 4.70 NA 1.94 0.33 NA 6.97 000 52325 A Cystoscopy, stone removal 6.16 NA 2.52 0.44 NA 9.12 000 52327 A Cystoscopy, inject material 5.19 30.65 2.14 0.37 36.21 7.70 000 52330 A Cystoscopy and treatment 5.04 37.29 2.08 0.36 42.69 7.48 000 52332 A Cystoscopy and treatment 2.84 5.70 1.26 0.21 8.75 4.31 000 52334 A Create passage to kidney 4.83 NA 2.05 0.35 NA 7.23 000 52341 A Cysto w/ureter stricture tx 6.00 NA 2.62 0.43 NA 9.05 000 52342 A Cysto w/up stricture tx 6.50 NA 2.79 0.46 NA 9.75 000
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 52343 A Cysto w/renal stricture tx 7.20 NA 3.06 0.51 NA 10.77 000 52344 A Cysto/uretero, stricture tx 7.71 NA 3.34 0.55 NA 11.59 000 52345 A Cysto/uretero w/up stricture 8.21 NA 3.53 0.58 NA 12.31 000 52346 A Cystouretero w/renal strict 9.24 NA 3.92 0.65 NA 13.81 000 52351 A Cystouretero & or pyeloscope 5.86 NA 2.56 0.41 NA 8.83 000 52352 A Cystouretero w/stone remove 6.88 NA 2.99 0.49 NA 10.37 000 52353 A Cystouretero w/lithotripsy 7.98 NA 3.40 0.57 NA 11.95 000 52354 A Cystouretero w/biopsy 7.34 NA 3.16 0.52 NA 11.03 000 52355 A Cystouretero w/excise tumor 8.83 NA 3.73 0.63 NA 13.19 000 52400 A Cystouretero w/congen repr 9.69 NA 4.48 0.68 NA 14.85 090 52402 A Cystourethro cut ejacul duct 5.28 NA 2.02 0.40 NA 7.70 000 52450 A Incision of prostate 7.65 NA 4.40 0.54 NA 12.58 090 52500 A Revision of bladder neck 8.48 NA 4.70 0.60 NA 13.78 090 52510 A Dilation prostatic urethra 6.72 NA 3.71 0.48 NA 10.91 090 52601 A Prostatectomy (TURP) 12.37 NA 6.08 0.87 NA 19.33 090 52606 A Control postop bleeding 8.14 NA 4.23 0.57 NA 12.93 090 52612 A Prostatectomy, first stage 7.99 NA 4.40 0.56 NA 12.95 090 52614 A Prostatectomy, second stage 6.84 NA 4.00 0.48 NA 11.33 090 52620 A Remove residual prostate 6.61 NA 3.57 0.47 NA 10.65 090 52630 A Remove prostate regrowth 7.26 NA 3.82 0.51 NA 11.59 090 52640 A Relieve bladder contracture 6.62 NA 3.53 0.47 NA 10.63 090 52647 A Laser surgery of prostate 10.36 70.90 5.42 0.73 81.99 16.51 090 52648 A Laser surgery of prostate 11.21 NA 5.70 0.79 NA 17.70 090 52700 A Drainage of prostate abscess 6.80 NA 3.78 0.48 NA 11.06 090 53000 A Incision of urethra 2.28 NA 1.67 0.16 NA 4.11 010 53010 A Incision of urethra 3.64 NA 3.21 0.24 NA 7.09 090 53020 A Incision of urethra 1.77 NA 0.80 0.13 NA 2.70 000 53025 A Incision of urethra 1.13 NA 0.63 0.08 NA 1.84 000 53040 A Drainage of urethra abscess 6.40 NA 3.88 0.45 NA 10.73 090 53060 A Drainage of urethra abscess 2.64 2.08 1.50 0.28 4.99 4.42 010
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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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