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 55725 A Drainage of prostate abscess 8.69 NA 5.02 0.70 NA 14.40 090 55801 A Removal of prostate 17.81 NA 8.72 1.34 NA 27.86 090 55810 A Extensive prostate surgery 22.60 NA 10.31 1.60 NA 34.51 090 55812 A Extensive prostate surgery 27.52 NA 12.47 2.04 NA 42.03 090 55815 A Extensive prostate surgery 30.47 NA 13.65 2.16 NA 46.28 090 55821 A Removal of prostate 14.26 NA 7.15 1.01 NA 22.42 090 55831 A Removal of prostate 15.63 NA 7.67 1.10 NA 24.40 090 55840 A Extensive prostate surgery 22.71 NA 10.68 1.61 NA 35.00 090 55842 A Extensive prostate surgery 24.39 NA 11.28 1.72 NA 37.39 090 55845 A Extensive prostate surgery 28.57 NA 12.67 2.02 NA 43.25 090 55859 A Percut/needle insert, pros 12.53 NA 6.72 0.89 NA 20.13 090 55860 A Surgical exposure, prostate 14.46 NA 7.23 1.02 NA 22.71 090 55862 A Extensive prostate surgery 18.40 NA 8.62 1.49 NA 28.51 090 55865 A Extensive prostate surgery 22.89 NA 10.64 1.63 NA 35.16 090 55866 A Laparo radical prostatectomy 30.75 NA 13.70 2.16 NA 46.62 090 55870 A Electroejaculation 2.59 1.83 1.25 0.16 4.57 3.99 000 55873 A Cryoablate prostate 19.48 NA 10.16 1.38 NA 31.02 090 55899 C Genital surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 55970 N Sex transformation, M to F 0.00 0.00 0.00 0.00 0.00 0.00 XXX 55980 N Sex transformation, F to M 0.00 0.00 0.00 0.00 0.00 0.00 XXX 56405 A I & D of vulva/perineum 1.44 1.31 1.14 0.17 2.92 2.75 010 56420 A Drainage of gland abscess 1.39 2.14 0.98 0.16 3.69 2.53 010 56440 A Surgery for vulva lesion 2.85 NA 1.70 0.34 NA 4.88 010 56441 A Lysis of labial lesion(s) 1.97 1.82 1.48 0.20 4.00 3.65 010 56501 A Destroy, vulva lesions, sim 1.53 1.76 1.24 0.18 3.48 2.95 010 56515 A Destroy vulva lesion/s compl 2.77 2.55 1.79 0.33 5.64 4.89 010 56605 A Biopsy of vulva/perineum 1.10 1.05 0.45 0.13 2.28 1.68 000 56606 A Biopsy of vulva/perineum 0.55 0.47 0.22 0.07 1.09 0.84 ZZZ 56620 A Partial removal of vulva 7.47 NA 4.72 0.90 NA 13.09 090 56625 A Complete removal of vulva 8.41 NA 5.22 1.02 NA 14.64 090
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 56630 A Extensive vulva surgery 12.36 NA 6.69 1.49 NA 20.55 090 56631 A Extensive vulva surgery 16.21 NA 8.62 1.95 NA 26.78 090 56632 A Extensive vulva surgery 20.30 NA 9.30 2.38 NA 31.98 090 56633 A Extensive vulva surgery 16.48 NA 8.40 1.97 NA 26.86 090 56634 A Extensive vulva surgery 17.89 NA 9.22 2.16 NA 29.26 090 56637 A Extensive vulva surgery 21.98 NA 10.81 2.60 NA 35.39 090 56640 A Extensive vulva surgery 22.18 NA 10.38 2.88 NA 35.44 090 56700 A Partial removal of hymen 2.53 NA 1.84 0.30 NA 4.67 010 56720 A Incision of hymen 0.68 NA 0.51 0.08 NA 1.27 000 56740 A Remove vagina gland lesion 4.57 NA 2.53 0.56 NA 7.66 010 56800 A Repair of vagina 3.89 NA 2.21 0.44 NA 6.54 010 56805 A Repair clitoris 18.87 NA 9.45 2.14 NA 30.46 090 56810 A Repair of perineum 4.13 NA 2.27 0.49 NA 6.89 010 56820 A Exam of vulva w/scope 1.50 1.30 0.66 0.18 2.98 2.34 000 56821 A Exam/biopsy of vulva w/scope 2.05 1.72 0.89 0.25 4.03 3.20 000 57000 A Exploration of vagina 2.98 NA 1.78 0.31 NA 5.06 010 57010 A Drainage of pelvic abscess 6.03 NA 3.81 0.71 NA 10.55 090 57020 A Drainage of pelvic fluid 1.50 0.92 0.58 0.18 2.60 2.26 000 57022 A I & d vaginal hematoma, pp 2.57 NA 1.49 0.26 NA 4.32 010 57023 A I & d vag hematoma, non-ob 4.75 NA 2.57 0.58 NA 7.90 010 57061 A Destroy vag lesions, simple 1.25 1.63 1.13 0.15 3.03 2.53 010 57065 A Destroy vag lesions, complex 2.62 2.26 1.66 0.31 5.19 4.58 010 57100 A Biopsy of vagina 1.20 1.06 0.48 0.14 2.40 1.82 000 57105 A Biopsy of vagina 1.69 1.76 1.42 0.20 3.65 3.31 010 57106 A Remove vagina wall, partial 6.36 NA 4.16 0.73 NA 11.25 090 57107 A Remove vagina tissue, part 23.02 NA 10.42 2.71 NA 36.14 090 57109 A Vaginectomy partial w/nodes 27.01 NA 12.16 3.21 NA 42.39 090 57110 A Remove vagina wall, complete 14.30 NA 7.17 1.73 NA 23.20 090 57111 A Remove vagina tissue, compl 27.01 NA 12.41 3.17 NA 42.60 090 57112 A Vaginectomy w/nodes, compl 29.02 NA 12.99 3.07 NA 45.08 090
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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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Page 483 and 484: 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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