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 58578 C Laparo proc, uterus 0.00 0.00 0.00 0.00 0.00 0.00 YYY 58579 C Hysteroscope procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 58600 A Division of fallopian tube 5.60 NA 3.29 0.66 NA 9.55 090 58605 A Division of fallopian tube 5.00 NA 3.06 0.59 NA 8.65 090 58611 A Ligate oviduct(s) add-on 1.45 NA 0.56 0.18 NA 2.19 ZZZ 58615 A Occlude fallopian tube(s) 3.90 NA 2.62 0.47 NA 6.98 010 58660 A Laparoscopy, lysis 11.29 NA 5.17 1.40 NA 17.87 090 58661 A Laparoscopy, remove adnexa 11.05 NA 5.02 1.34 NA 17.41 010 58662 A Laparoscopy, excise lesions 11.79 NA 5.68 1.43 NA 18.90 090 58670 A Laparoscopy, tubal cautery 5.60 NA 3.23 0.67 NA 9.50 090 58671 A Laparoscopy, tubal block 5.60 NA 3.23 0.68 NA 9.51 090 58672 A Laparoscopy, fimbrioplasty 12.89 NA 6.06 1.60 NA 20.55 090 58673 A Laparoscopy, salpingostomy 13.75 NA 6.45 1.69 NA 21.88 090 58679 C Laparo proc, oviduct-ovary 0.00 0.00 0.00 0.00 0.00 0.00 YYY 58700 A Removal of fallopian tube 12.05 NA 5.91 1.51 NA 19.48 090 58720 A Removal of ovary/tube(s) 11.36 NA 5.69 1.39 NA 18.44 090 58740 A Revise fallopian tube(s) 14.01 NA 7.03 1.71 NA 22.74 090 58750 A Repair oviduct 14.85 NA 7.22 1.84 NA 23.91 090 58752 A Revise ovarian tube(s) 14.85 NA 6.79 1.80 NA 23.44 090 58760 A Remove tubal obstruction 13.14 NA 6.62 1.79 NA 21.54 090 58770 A Create new tubal opening 13.98 NA 6.78 1.73 NA 22.49 090 58800 A Drainage of ovarian cyst(s) 4.14 3.56 2.93 0.43 8.13 7.50 090 58805 A Drainage of ovarian cyst(s) 5.88 NA 3.49 0.69 NA 10.06 090 58820 A Drain ovary abscess, open 4.22 NA 3.35 0.52 NA 8.09 090 58822 A Drain ovary abscess, percut 10.13 NA 5.19 1.16 NA 16.48 090 58823 A Drain pelvic abscess, percut 3.38 21.63 1.16 0.24 25.24 4.77 000 58825 A Transposition, ovary(s) 10.98 NA 5.69 1.32 NA 17.99 090 58900 A Biopsy of ovary(s) 5.99 NA 3.57 0.69 NA 10.25 090 58920 A Partial removal of ovary(s) 11.36 NA 5.49 1.43 NA 18.28 090 58925 A Removal of ovarian cyst(s) 11.36 NA 5.62 1.41 NA 18.39 090
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 58940 A Removal of ovary(s) 7.29 NA 4.08 0.91 NA 12.29 090 58943 A Removal of ovary(s) 18.44 NA 8.48 2.22 NA 29.13 090 58950 A Resect ovarian malignancy 16.93 NA 8.24 2.04 NA 27.22 090 58951 A Resect ovarian malignancy 22.39 NA 10.22 2.63 NA 35.24 090 58952 A Resect ovarian malignancy 25.02 NA 11.50 3.02 NA 39.54 090 58953 A Tah, rad dissect for debulk 32.01 NA 14.24 3.83 NA 50.08 090 58954 A Tah rad debulk/lymph remove 35.02 NA 15.44 4.17 NA 54.63 090 58956 A Bso, omentectomy w/tah 20.82 NA 10.08 4.00 NA 34.90 090 58960 A Exploration of abdomen 14.66 NA 7.21 1.79 NA 23.66 090 58970 A Retrieval of oocyte 3.53 2.27 1.46 0.43 6.23 5.42 000 58974 C Transfer of embryo 0.00 0.00 0.00 0.00 0.00 0.00 000 58976 A Transfer of embryo 3.83 2.63 1.79 0.47 6.93 6.09 000 58999 C Genital surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 59000 A Amniocentesis, diagnostic 1.30 2.01 0.66 0.31 3.63 2.27 000 59001 A Amniocentesis, therapeutic 3.01 NA 1.39 0.71 NA 5.10 000 59012 A Fetal cord puncture,prenatal 3.45 NA 1.51 0.82 NA 5.77 000 59015 A Chorion biopsy 2.20 1.54 1.02 0.52 4.26 3.75 000 59020 A Fetal contract stress test 0.66 0.83 NA 0.26 1.76 NA 000 59020 26 A Fetal contract stress test 0.66 0.26 0.26 0.16 1.08 1.08 000 59020 TC A Fetal contract stress test 0.00 0.58 NA 0.10 0.68 NA 000 59025 A Fetal non-stress test 0.53 0.48 NA 0.15 1.16 NA 000 59025 26 A Fetal non-stress test 0.53 0.21 0.21 0.13 0.87 0.87 000 59025 TC A Fetal non-stress test 0.00 0.27 NA 0.02 0.29 NA 000 59030 A Fetal scalp blood sample 1.99 NA 0.75 0.47 NA 3.22 000 59050 A Fetal monitor w/report 0.89 NA 0.34 0.21 NA 1.44 XXX 59051 A Fetal monitor/interpret only 0.74 NA 0.28 0.17 NA 1.19 XXX 59070 A Transabdom amnioinfus w/us 5.25 5.16 2.29 0.28 10.69 7.82 000 59072 A Umbilical cord occlud w/us 9.01 NA 3.56 0.16 NA 12.73 000 59074 A Fetal fluid drainage w/us 5.25 4.51 2.29 0.28 10.04 7.82 000 59076 A Fetal shunt placement, w/us 9.01 NA 3.56 0.16 NA 12.73 000
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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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Page 489 and 490: 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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