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 57550 A Removal of residual cervix 5.53 NA 3.79 0.67 NA 9.99 090 57555 A Remove cervix/repair vagina 8.96 NA 5.03 1.09 NA 15.08 090 57556 A Remove cervix, repair bowel 8.38 NA 4.85 0.92 NA 14.15 090 57700 A Revision of cervix 3.55 NA 3.14 0.41 NA 7.10 090 57720 A Revision of cervix 4.13 NA 3.09 0.49 NA 7.71 090 57800 A Dilation of cervical canal 0.77 0.75 0.47 0.09 1.62 1.33 000 57820 A D & c of residual cervix 1.67 1.46 1.13 0.20 3.33 3.00 010 58100 A Biopsy of uterus lining 1.53 1.30 0.71 0.18 3.01 2.42 000 58120 A Dilation and curettage 3.28 2.27 1.85 0.39 5.94 5.51 010 58140 A Myomectomy abdom method 14.61 NA 6.99 1.81 NA 23.41 090 58145 A Myomectomy vag method 8.05 NA 4.74 0.97 NA 13.75 090 58146 A Myomectomy abdom complex 19.01 NA 8.83 2.32 NA 30.16 090 58150 A Total hysterectomy 15.25 NA 7.36 1.84 NA 24.45 090 58152 A Total hysterectomy 20.61 NA 9.68 2.47 NA 32.76 090 58180 A Partial hysterectomy 15.30 NA 7.32 1.64 NA 24.27 090 58200 A Extensive hysterectomy 21.60 NA 9.79 2.54 NA 33.93 090 58210 A Extensive hysterectomy 28.87 NA 12.91 3.37 NA 45.14 090 58240 A Removal of pelvis contents 38.41 NA 17.43 4.22 NA 60.06 090 58260 A Vaginal hysterectomy 12.99 NA 6.61 1.57 NA 21.16 090 58262 A Vag hyst including t/o 14.78 NA 7.28 1.79 NA 23.85 090 58263 A Vag hyst w/t/o & vag repair 16.07 NA 7.77 1.94 NA 25.78 090 58267 A Vag hyst w/urinary repair 17.04 NA 8.25 2.06 NA 27.35 090 58270 A Vag hyst w/enterocele repair 14.27 NA 6.96 1.73 NA 22.96 090 58275 A Hysterectomy/revise vagina 15.77 NA 7.66 1.91 NA 25.34 090 58280 A Hysterectomy/revise vagina 17.01 NA 8.15 2.06 NA 27.23 090 58285 A Extensive hysterectomy 22.27 NA 9.74 2.70 NA 34.72 090 58290 A Vag hyst complex 19.01 NA 8.96 2.29 NA 30.26 090 58291 A Vag hyst incl t/o, complex 20.80 NA 9.69 2.52 NA 33.01 090 58292 A Vag hyst t/o & repair, compl 22.09 NA 10.16 2.67 NA 34.93 090 58293 A Vag hyst w/uro repair, compl 23.08 NA 10.44 2.78 NA 36.29 090
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 58294 A Vag hyst w/enterocele, compl 20.29 NA 9.37 2.39 NA 32.05 090 58300 N Insert intrauterine device 1.01 1.33 0.38 0.12 2.46 1.51 XXX 58301 A Remove intrauterine device 1.27 1.28 0.47 0.15 2.70 1.89 000 58321 A Artificial insemination 0.92 1.12 0.36 0.10 2.14 1.38 000 58322 A Artificial insemination 1.10 1.18 0.41 0.13 2.41 1.64 000 58323 A Sperm washing 0.23 0.47 0.09 0.03 0.73 0.35 000 58340 A Catheter for hysterography 0.88 3.02 0.68 0.09 3.99 1.65 000 58345 A Reopen fallopian tube 4.66 NA 2.48 0.41 NA 7.55 010 58346 A Insert heyman uteri capsule 6.75 NA 3.93 0.56 NA 11.24 090 58350 A Reopen fallopian tube 1.01 1.50 0.92 0.12 2.64 2.05 010 58353 A Endometr ablate, thermal 3.56 33.29 2.02 0.43 37.28 6.01 010 58356 A Endometrial cryoablation 6.37 6.85 2.59 0.82 14.05 9.78 010 58400 A Suspension of uterus 6.36 NA 3.91 0.75 NA 11.03 090 58410 A Suspension of uterus 12.74 NA 6.33 1.45 NA 20.51 090 58520 A Repair of ruptured uterus 11.92 NA 5.92 1.47 NA 19.31 090 58540 A Revision of uterus 14.65 NA 6.85 1.78 NA 23.28 090 58545 A Laparoscopic myomectomy 14.61 NA 7.06 1.77 NA 23.44 090 58546 A Laparo-myomectomy, complex 19.01 NA 8.75 2.30 NA 30.06 090 58550 A Laparo-asst vag hysterectomy 14.20 NA 7.18 1.72 NA 23.10 090 58552 A Laparo-vag hyst incl t/o 16.01 NA 7.88 1.72 NA 25.62 090 58553 A Laparo-vag hyst, complex 19.01 NA 8.78 2.30 NA 30.09 090 58554 A Laparo-vag hyst w/t/o, compl 22.01 NA 10.24 2.27 NA 34.52 090 58555 A Hysteroscopy, dx, sep proc 3.34 2.16 1.52 0.40 5.90 5.26 000 58558 A Hysteroscopy, biopsy 4.75 NA 2.13 0.57 NA 7.45 000 58559 A Hysteroscopy, lysis 6.17 NA 2.68 0.74 NA 9.60 000 58560 A Hysteroscopy, resect septum 7.00 NA 3.02 0.84 NA 10.86 000 58561 A Hysteroscopy, remove myoma 10.01 NA 4.19 1.21 NA 15.41 000 58562 A Hysteroscopy, remove fb 5.21 NA 2.30 0.63 NA 8.14 000 58563 A Hysteroscopy, ablation 6.17 52.70 2.70 0.74 59.62 9.61 000 58565 A Hysteroscopy, sterilization 7.03 46.78 3.88 1.19 55.01 12.11 090
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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 487 and 488: 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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