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 59100 A Remove uterus lesion 12.35 NA 6.36 2.94 NA 21.65 090 59120 A Treat ectopic pregnancy 11.49 NA 6.14 2.72 NA 20.35 090 59121 A Treat ectopic pregnancy 11.67 NA 6.21 2.78 NA 20.67 090 59130 A Treat ectopic pregnancy 14.23 NA 4.59 3.38 NA 22.20 090 59135 A Treat ectopic pregnancy 13.89 NA 7.09 3.30 NA 24.28 090 59136 A Treat ectopic pregnancy 13.19 NA 6.48 3.13 NA 22.80 090 59140 A Treat ectopic pregnancy 5.46 NA 2.49 1.29 NA 9.24 090 59150 A Treat ectopic pregnancy 11.67 NA 5.90 2.78 NA 20.35 090 59151 A Treat ectopic pregnancy 11.49 NA 5.95 2.73 NA 20.17 090 59160 A D & c after delivery 2.72 3.09 1.99 0.64 6.44 5.35 010 59200 A Insert cervical dilator 0.79 1.15 0.30 0.19 2.13 1.28 000 59300 A Episiotomy or vaginal repair 2.41 2.34 1.02 0.57 5.33 4.01 000 59320 A Revision of cervix 2.48 NA 1.22 0.59 NA 4.30 000 59325 A Revision of cervix 4.07 NA 1.86 0.88 NA 6.80 000 59350 A Repair of uterus 4.95 NA 1.84 1.17 NA 7.96 000 59400 A Obstetrical care 23.08 NA 15.13 5.48 NA 43.68 MMM 59409 A Obstetrical care 13.51 NA 5.17 3.21 NA 21.89 MMM 59410 A Obstetrical care 14.79 NA 6.16 3.51 NA 24.46 MMM 59412 A Antepartum manipulation 1.71 NA 0.80 0.40 NA 2.91 MMM 59414 A Deliver placenta 1.61 NA 0.62 0.38 NA 2.62 MMM 59425 A Antepartum care only 4.81 4.16 1.80 1.14 10.11 7.75 MMM 59426 A Antepartum care only 8.29 7.48 3.14 1.97 17.74 13.40 MMM 59430 A Care after delivery 2.13 1.21 0.91 0.50 3.84 3.55 MMM 59510 A Cesarean delivery 26.23 NA 17.03 6.23 NA 49.50 MMM 59514 A Cesarean delivery only 15.98 NA 6.06 3.79 NA 25.83 MMM 59515 A Cesarean delivery 17.37 NA 7.67 4.12 NA 29.16 MMM 59525 A Remove uterus after cesarean 8.55 NA 3.22 1.94 NA 13.71 ZZZ 59610 A Vbac delivery 24.63 NA 15.63 5.85 NA 46.11 MMM 59612 A Vbac delivery only 15.07 NA 5.90 3.58 NA 24.55 MMM 59614 A Vbac care after delivery 16.35 NA 6.77 3.88 NA 27.00 MMM
ADDENDUM B: RELATIVE VALUE UNITS (RVUs) AND RELATED INFORMATION Physician work Facility PE 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. Mal- practice Nonfacility CPT 1 / HCPCS 2 Mod Status Description RVUs 3 Non-facility Facility PE RVUs RVUs RVUs Total Total Global 59618 A Attempted vbac delivery 27.80 NA 17.88 6.59 NA 52.26 MMM 59620 A Attempted vbac delivery only 17.54 NA 6.59 4.16 NA 28.28 MMM 59622 A Attempted vbac after care 18.94 NA 8.59 4.49 NA 32.02 MMM 59812 A Treatment of miscarriage 4.01 NA 2.50 0.95 NA 7.46 090 59820 A Care of miscarriage 4.01 4.34 3.53 0.95 9.30 8.49 090 59821 A Treatment of miscarriage 4.47 4.20 3.36 1.06 9.72 8.89 090 59830 A Treat uterus infection 6.11 NA 3.91 1.44 NA 11.46 090 59840 R Abortion 3.02 NA 2.09 0.71 NA 5.81 010 59841 R Abortion 5.24 NA 2.93 1.24 NA 9.41 010 59850 R Abortion 5.91 NA 3.22 1.28 NA 10.41 090 59851 R Abortion 5.93 NA 3.70 1.28 NA 10.91 090 59852 R Abortion 8.25 NA 4.94 1.80 NA 14.99 090 59855 R Abortion 6.12 NA 3.48 1.45 NA 11.05 090 59856 R Abortion 7.48 NA 4.00 1.78 NA 13.26 090 59857 R Abortion 9.30 NA 4.63 2.01 NA 15.94 090 59866 R Abortion (mpr) 4.00 NA 1.86 0.87 NA 6.73 000 59870 A Evacuate mole of uterus 6.01 NA 4.43 1.42 NA 11.87 090 59871 A Remove cerclage suture 2.13 NA 1.11 0.50 NA 3.75 000 59897 C Fetal invas px w/us 0.00 0.00 0.00 0.00 0.00 0.00 YYY 59898 C Laparo proc, ob care/deliver 0.00 0.00 0.00 0.00 0.00 0.00 YYY 59899 C Maternity care procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 60000 A Drain thyroid/tongue cyst 1.76 1.94 1.73 0.15 3.85 3.64 010 60001 A Aspirate/inject thyriod cyst 0.97 1.57 0.33 0.07 2.61 1.38 000 60100 A Biopsy of thyroid 1.56 1.38 0.55 0.10 3.05 2.21 000 60200 A Remove thyroid lesion 9.56 NA 5.87 1.01 NA 16.44 090 60210 A Partial thyroid excision 10.88 NA 5.53 1.23 NA 17.65 090 60212 A Partial thyroid excision 16.04 NA 7.54 1.94 NA 25.52 090 60220 A Partial removal of thyroid 11.90 NA 6.03 1.32 NA 19.25 090 60225 A Partial removal of thyroid 14.20 NA 7.28 1.64 NA 23.12 090 60240 A Removal of thyroid 16.07 NA 7.41 1.85 NA 25.33 090 60252 A Removal of thyroid 20.58 NA 9.87 2.29 NA 32.75 090
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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 491 and 492: 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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