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 54435 A Revision of penis 6.12 NA 4.09 0.43 NA 10.64 090 54440 C Repair of penis 0.00 0.00 0.00 0.00 0.00 0.00 090 54450 A Preputial stretching 1.12 0.99 0.50 0.08 2.20 1.70 000 54500 A Biopsy of testis 1.31 NA 0.65 0.10 NA 2.06 000 54505 A Biopsy of testis 3.46 NA 2.15 0.27 NA 5.88 010 54512 A Excise lesion testis 8.59 NA 4.70 0.67 NA 13.96 090 54520 A Removal of testis 5.23 NA 3.16 0.50 NA 8.89 090 54522 A Orchiectomy, partial 9.51 NA 5.36 0.89 NA 15.76 090 54530 A Removal of testis 8.59 NA 4.87 0.66 NA 14.11 090 54535 A Extensive testis surgery 12.16 NA 6.19 0.95 NA 19.30 090 54550 A Exploration for testis 7.79 NA 4.31 0.59 NA 12.68 090 54560 A Exploration for testis 11.13 NA 5.74 0.90 NA 17.77 090 54600 A Reduce testis torsion 7.01 NA 4.05 0.51 NA 11.57 090 54620 A Suspension of testis 4.90 NA 2.78 0.37 NA 8.05 010 54640 A Suspension of testis 6.90 NA 4.20 0.62 NA 11.72 090 54650 A Orchiopexy (Fowler-Stephens) 11.45 NA 6.03 1.16 NA 18.64 090 54660 A Revision of testis 5.11 NA 3.39 0.44 NA 8.94 090 54670 A Repair testis injury 6.41 NA 3.95 0.47 NA 10.83 090 54680 A Relocation of testis(es) 12.66 NA 6.67 1.16 NA 20.48 090 54690 A Laparoscopy, orchiectomy 10.96 NA 5.61 1.02 NA 17.59 090 54692 A Laparoscopy, orchiopexy 12.89 NA 6.14 1.30 NA 20.33 090 54699 C Laparoscope proc, testis 0.00 0.00 0.00 0.00 0.00 0.00 YYY 54700 A Drainage of scrotum 3.43 NA 2.13 0.28 NA 5.84 010 54800 A Biopsy of epididymis 2.33 NA 1.03 0.23 NA 3.60 000 54820 A Exploration of epididymis 5.14 NA 3.32 0.40 NA 8.86 090 54830 A Remove epididymis lesion 5.38 NA 3.45 0.41 NA 9.25 090 54840 A Remove epididymis lesion 5.20 NA 3.19 0.37 NA 8.76 090 54860 A Removal of epididymis 6.32 NA 3.85 0.45 NA 10.62 090 54861 A Removal of epididymis 8.91 NA 5.03 0.63 NA 14.57 090 54900 A Fusion of spermatic ducts 13.21 NA 6.74 0.93 NA 20.87 090
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 54901 A Fusion of spermatic ducts 17.95 NA 8.13 1.82 NA 27.89 090 55000 A Drainage of hydrocele 1.43 2.08 0.74 0.11 3.63 2.28 000 55040 A Removal of hydrocele 5.36 NA 3.26 0.43 NA 9.05 090 55041 A Removal of hydroceles 7.75 NA 4.52 0.60 NA 12.86 090 55060 A Repair of hydrocele 5.52 NA 3.45 0.46 NA 9.43 090 55100 A Drainage of scrotum abscess 2.13 3.74 1.72 0.17 6.04 4.02 010 55110 A Explore scrotum 5.70 NA 3.58 0.43 NA 9.71 090 55120 A Removal of scrotum lesion 5.09 NA 3.35 0.39 NA 8.83 090 55150 A Removal of scrotum 7.22 NA 4.36 0.56 NA 12.15 090 55175 A Revision of scrotum 5.24 NA 3.45 0.37 NA 9.06 090 55180 A Revision of scrotum 10.72 NA 6.05 0.90 NA 17.67 090 55200 A Incision of sperm duct 4.24 12.12 2.67 0.33 16.69 7.23 090 55250 A Removal of sperm duct(s) 3.30 11.22 2.51 0.25 14.77 6.05 090 55300 A Prepare, sperm duct x-ray 3.51 NA 1.53 0.25 NA 5.28 000 55400 A Repair of sperm duct 8.50 NA 4.68 0.64 NA 13.81 090 55450 A Ligation of sperm duct 4.12 7.06 2.20 0.29 11.47 6.61 010 55500 A Removal of hydrocele 5.59 NA 3.35 0.55 NA 9.49 090 55520 A Removal of sperm cord lesion 6.03 NA 3.31 0.75 NA 10.09 090 55530 A Revise spermatic cord veins 5.66 NA 3.41 0.45 NA 9.52 090 55535 A Revise spermatic cord veins 6.56 NA 3.89 0.47 NA 10.92 090 55540 A Revise hernia & sperm veins 7.68 NA 3.86 0.94 NA 12.47 090 55550 A Laparo ligate spermatic vein 6.57 NA 3.59 0.57 NA 10.74 090 55559 C Laparo proc, spermatic cord 0.00 0.00 0.00 0.00 0.00 0.00 YYY 55600 A Incise sperm duct pouch 6.38 NA 3.89 0.62 NA 10.89 090 55605 A Incise sperm duct pouch 7.97 NA 4.86 0.64 NA 13.46 090 55650 A Remove sperm duct pouch 11.80 NA 6.12 0.92 NA 18.84 090 55680 A Remove sperm pouch lesion 5.19 NA 3.39 0.47 NA 9.05 090 55700 A Biopsy of prostate 1.57 4.22 0.76 0.11 5.90 2.45 000 55705 A Biopsy of prostate 4.57 NA 2.60 0.32 NA 7.49 010 55720 A Drainage of prostate abscess 7.65 NA 4.35 0.95 NA 12.94 090
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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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