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 53080 A Drainage of urinary leakage 6.29 NA 6.21 0.52 NA 13.02 090 53085 A Drainage of urinary leakage 10.27 NA 7.86 0.92 NA 19.05 090 53200 A Biopsy of urethra 2.60 1.46 1.15 0.20 4.25 3.95 000 53210 A Removal of urethra 12.58 NA 6.55 0.89 NA 20.01 090 53215 A Removal of urethra 15.59 NA 7.67 1.10 NA 24.36 090 53220 A Treatment of urethra lesion 7.00 NA 4.21 0.49 NA 11.70 090 53230 A Removal of urethra lesion 9.59 NA 5.39 0.73 NA 15.71 090 53235 A Removal of urethra lesion 10.14 NA 5.61 0.72 NA 16.47 090 53240 A Surgery for urethra pouch 6.45 NA 3.96 0.52 NA 10.93 090 53250 A Removal of urethra gland 5.89 NA 3.64 0.49 NA 10.02 090 53260 A Treatment of urethra lesion 2.99 2.27 1.63 0.25 5.51 4.87 010 53265 A Treatment of urethra lesion 3.13 2.83 1.67 0.24 6.19 5.04 010 53270 A Removal of urethra gland 3.10 2.30 1.69 0.30 5.70 5.09 010 53275 A Repair of urethra defect 4.53 NA 2.55 0.32 NA 7.39 010 53400 A Revise urethra, stage 1 12.78 NA 6.83 0.98 NA 20.58 090 53405 A Revise urethra, stage 2 14.49 NA 7.31 1.10 NA 22.90 090 53410 A Reconstruction of urethra 16.45 NA 8.18 1.16 NA 25.80 090 53415 A Reconstruction of urethra 19.42 NA 8.22 1.37 NA 29.01 090 53420 A Reconstruct urethra, stage 1 14.09 NA 6.54 0.96 NA 21.59 090 53425 A Reconstruct urethra, stage 2 15.99 NA 7.86 1.13 NA 24.99 090 53430 A Reconstruction of urethra 16.35 NA 7.95 1.15 NA 25.45 090 53431 A Reconstruct urethra/bladder 19.90 NA 9.43 1.41 NA 30.74 090 53440 A Male sling procedure 13.63 NA 6.96 0.96 NA 21.55 090 53442 A Remove/revise male sling 11.57 NA 6.10 0.82 NA 18.50 090 53444 A Insert tandem cuff 13.41 NA 6.75 0.94 NA 21.10 090 53445 A Insert uro/ves nck sphincter 14.07 NA 8.00 0.99 NA 23.06 090 53446 A Remove uro sphincter 10.23 NA 5.98 0.72 NA 16.93 090 53447 A Remove/replace ur sphincter 13.50 NA 7.35 0.95 NA 21.80 090 53448 A Remov/replc ur sphinctr comp 21.16 NA 10.38 1.50 NA 33.04 090 53449 A Repair uro sphincter 9.71 NA 5.49 0.68 NA 15.88 090
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 53450 A Revision of urethra 6.14 NA 3.83 0.43 NA 10.40 090 53460 A Revision of urethra 7.12 NA 4.26 0.50 NA 11.88 090 53500 A Urethrlys, transvag w/ scope 12.21 NA 6.83 0.90 NA 19.95 090 53502 A Repair of urethra injury 7.64 NA 4.47 0.62 NA 12.73 090 53505 A Repair of urethra injury 7.64 NA 4.46 0.54 NA 12.63 090 53510 A Repair of urethra injury 10.11 NA 5.77 0.74 NA 16.62 090 53515 A Repair of urethra injury 13.32 NA 6.71 1.05 NA 21.08 090 53520 A Repair of urethra defect 8.69 NA 5.13 0.61 NA 14.43 090 53600 A Dilate urethra stricture 1.21 1.21 0.50 0.09 2.51 1.81 000 53601 A Dilate urethra stricture 0.98 1.34 0.44 0.07 2.39 1.49 000 53605 A Dilate urethra stricture 1.28 NA 0.48 0.09 NA 1.85 000 53620 A Dilate urethra stricture 1.62 2.05 0.71 0.11 3.78 2.44 000 53621 A Dilate urethra stricture 1.35 2.13 0.58 0.10 3.58 2.04 000 53660 A Dilation of urethra 0.71 1.36 0.37 0.05 2.12 1.13 000 53661 A Dilation of urethra 0.72 1.35 0.35 0.05 2.12 1.12 000 53665 A Dilation of urethra 0.76 NA 0.28 0.06 NA 1.10 000 53850 A Prostatic microwave thermotx 9.46 88.85 4.72 0.67 98.98 14.85 090 53852 A Prostatic rf thermotx 9.89 84.87 5.22 0.70 95.46 15.81 090 53853 A Prostatic water thermother 5.24 53.22 3.35 0.37 58.83 8.96 090 53899 C Urology surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 54000 A Slitting of prepuce 1.54 2.98 1.12 0.11 4.63 2.77 010 54001 A Slitting of prepuce 2.19 3.29 1.32 0.15 5.63 3.66 010 54015 A Drain penis lesion 5.32 NA 2.90 0.38 NA 8.60 010 54050 A Destruction, penis lesion(s) 1.24 1.81 1.15 0.08 3.13 2.48 010 54055 A Destruction, penis lesion(s) 1.22 1.72 0.92 0.08 3.02 2.22 010 54056 A Cryosurgery, penis lesion(s) 1.24 1.88 1.23 0.06 3.18 2.53 010 54057 A Laser surg, penis lesion(s) 1.24 2.38 1.00 0.09 3.71 2.33 010 54060 A Excision of penis lesion(s) 1.93 3.23 1.25 0.13 5.29 3.32 010 54065 A Destruction, penis lesion(s) 2.42 2.90 1.43 0.13 5.45 3.99 010 54100 A Biopsy of penis 1.90 3.02 0.99 0.10 5.02 2.99 000
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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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