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 54105 A Biopsy of penis 3.50 4.45 2.18 0.25 8.20 5.93 010 54110 A Treatment of penis lesion 10.13 NA 5.51 0.72 NA 16.36 090 54111 A Treat penis lesion, graft 13.58 NA 6.75 0.96 NA 21.29 090 54112 A Treat penis lesion, graft 15.87 NA 7.86 1.11 NA 24.84 090 54115 A Treatment of penis lesion 6.15 4.90 3.98 0.43 11.48 10.56 090 54120 A Partial removal of penis 9.98 NA 5.45 0.68 NA 16.11 090 54125 A Removal of penis 13.54 NA 6.79 0.95 NA 21.28 090 54130 A Remove penis & nodes 20.15 NA 9.51 1.52 NA 31.18 090 54135 A Remove penis & nodes 26.37 NA 11.79 1.87 NA 40.03 090 54150 A Circumcision 1.81 4.16 0.70 0.16 6.13 2.67 XXX 54152 A Circumcision 2.31 NA 1.36 0.19 NA 3.86 010 54160 A Circumcision 2.48 4.20 1.25 0.19 6.88 3.92 010 54161 A Circumcision 3.28 NA 1.83 0.23 NA 5.34 010 54162 A Lysis penil circumic lesion 3.01 4.74 1.72 0.21 7.96 4.94 010 54163 A Repair of circumcision 3.01 NA 2.30 0.21 NA 5.52 010 54164 A Frenulotomy of penis 2.51 NA 2.10 0.18 NA 4.78 010 54200 A Treatment of penis lesion 1.06 1.90 1.02 0.08 3.04 2.16 010 54205 A Treatment of penis lesion 7.94 NA 5.26 0.56 NA 13.76 090 54220 A Treatment of penis lesion 2.42 3.90 1.14 0.17 6.49 3.73 000 54230 A Prepare penis study 1.34 1.21 0.75 0.09 2.65 2.18 000 54231 A Dynamic cavernosometry 2.04 1.48 1.02 0.16 3.68 3.23 000 54235 A Penile injection 1.19 1.09 0.70 0.08 2.36 1.97 000 54240 A Penis study 1.31 1.12 NA 0.17 2.60 NA 000 54240 26 A Penis study 1.31 0.47 0.47 0.11 1.90 1.90 000 54240 TC A Penis study 0.00 0.64 NA 0.06 0.70 NA 000 54250 A Penis study 2.22 0.98 NA 0.02 3.23 NA 000 54250 26 A Penis study 2.22 0.82 0.82 0.16 3.20 3.20 000 54250 TC A Penis study 0.00 0.17 NA 0.02 0.19 NA 000 54300 A Revision of penis 10.41 NA 6.23 0.76 NA 17.40 090 54304 A Revision of penis 12.49 NA 7.09 0.88 NA 20.47 090
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 54308 A Reconstruction of urethra 11.83 NA 6.69 0.84 NA 19.36 090 54312 A Reconstruction of urethra 13.58 NA 7.82 1.24 NA 22.63 090 54316 A Reconstruction of urethra 16.82 NA 8.81 1.21 NA 26.84 090 54318 A Reconstruction of urethra 11.25 NA 6.34 1.39 NA 18.98 090 54322 A Reconstruction of urethra 13.02 NA 7.28 0.92 NA 21.22 090 54324 A Reconstruction of urethra 16.32 NA 8.87 1.14 NA 26.34 090 54326 A Reconstruction of urethra 15.73 NA 8.66 1.11 NA 25.51 090 54328 A Revise penis/urethra 15.66 NA 8.24 0.98 NA 24.88 090 54332 A Revise penis/urethra 17.08 NA 8.69 1.21 NA 26.98 090 54336 A Revise penis/urethra 20.05 NA 11.00 2.20 NA 33.25 090 54340 A Secondary urethral surgery 8.92 NA 5.40 0.63 NA 14.95 090 54344 A Secondary urethral surgery 15.95 NA 8.70 1.54 NA 26.19 090 54348 A Secondary urethral surgery 17.15 NA 9.18 1.23 NA 27.57 090 54352 A Reconstruct urethra/penis 24.75 NA 12.36 2.24 NA 39.35 090 54360 A Penis plastic surgery 11.93 NA 6.83 0.84 NA 19.60 090 54380 A Repair penis 13.19 NA 7.19 0.93 NA 21.31 090 54385 A Repair penis 15.40 NA 9.36 0.86 NA 25.62 090 54390 A Repair penis and bladder 21.62 NA 10.88 1.54 NA 34.04 090 54400 A Insert semi-rigid prosthesis 9.00 NA 5.00 0.64 NA 14.64 090 54401 A Insert self-contd prosthesis 10.28 NA 6.69 0.73 NA 17.70 090 54405 A Insert multi-comp penis pros 13.44 NA 6.85 0.95 NA 21.24 090 54406 A Remove muti-comp penis pros 12.10 NA 6.33 0.86 NA 19.30 090 54408 A Repair multi-comp penis pros 12.76 NA 6.73 0.90 NA 20.39 090 54410 A Remove/replace penis prosth 15.51 NA 7.78 1.10 NA 24.39 090 54411 A Remov/replc penis pros, comp 16.01 NA 8.24 1.13 NA 25.38 090 54415 A Remove self-contd penis pros 8.21 NA 4.88 0.58 NA 13.66 090 54416 A Remv/repl penis contain pros 10.87 NA 6.30 0.77 NA 17.94 090 54417 A Remv/replc penis pros, compl 14.20 NA 7.28 1.00 NA 22.48 090 54420 A Revision of penis 11.42 NA 6.21 0.81 NA 18.45 090 54430 A Revision of penis 10.15 NA 5.85 0.72 NA 16.72 090
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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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