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 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 61470 A Incise skull for surgery 26.07 NA 13.55 5.88 NA 45.51 090 61480 A Incise skull for surgery 26.50 NA 14.94 6.71 NA 48.16 090 61490 A Incise skull for surgery 25.67 NA 14.02 6.90 NA 46.59 090 61500 A Removal of skull lesion 17.93 NA 10.58 4.10 NA 32.60 090 61501 A Remove infected skull bone 14.85 NA 9.06 3.21 NA 27.12 090 61510 A Removal of brain lesion 28.47 NA 16.35 7.33 NA 52.15 090 61512 A Remove brain lining lesion 35.11 NA 19.25 9.05 NA 63.41 090 61514 A Removal of brain abscess 25.27 NA 14.13 6.52 NA 45.92 090 61516 A Removal of brain lesion 24.62 NA 13.97 6.33 NA 44.91 090 61517 A Implt brain chemotx add-on 1.38 NA 0.62 0.35 NA 2.36 ZZZ 61518 A Removal of brain lesion 37.33 NA 20.64 9.62 NA 67.60 090 61519 A Remove brain lining lesion 41.41 NA 22.14 10.60 NA 74.15 090 61520 A Removal of brain lesion 54.87 NA 29.56 11.18 NA 95.61 090 61521 A Removal of brain lesion 44.50 NA 23.66 11.36 NA 79.52 090 61522 A Removal of brain abscess 29.47 NA 16.06 7.60 NA 53.13 090 61524 A Removal of brain lesion 27.88 NA 15.32 7.14 NA 50.34 090 61526 A Removal of brain lesion 52.19 NA 28.57 7.05 NA 87.82 090 61530 A Removal of brain lesion 43.88 NA 24.30 6.13 NA 74.31 090 61531 A Implant brain electrodes 14.64 NA 8.96 3.78 NA 27.37 090 61533 A Implant brain electrodes 19.72 NA 11.30 5.10 NA 36.12 090 61534 A Removal of brain lesion 20.98 NA 11.83 5.42 NA 38.24 090 61535 A Remove brain electrodes 11.63 NA 7.29 3.01 NA 21.93 090 61536 A Removal of brain lesion 35.54 NA 19.34 9.18 NA 64.06 090 61537 A Removal of brain tissue 25.01 NA 14.46 6.92 NA 46.39 090 61538 A Removal of brain tissue 26.82 NA 14.99 6.92 NA 48.73 090 61539 A Removal of brain tissue 32.09 NA 17.37 8.30 NA 57.76 090 61540 A Removal of brain tissue 30.02 NA 16.93 8.30 NA 55.25 090 61541 A Incision of brain tissue 28.87 NA 15.84 6.58 NA 51.29 090 61542 A Removal of brain tissue 31.03 NA 17.43 8.01 NA 56.47 090 61543 A Removal of brain tissue 29.24 NA 16.02 7.54 NA 52.80 090 61544 A Remove & treat brain lesion 25.51 NA 13.50 5.95 NA 44.96 090
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 61545 A Excision of brain tumor 43.82 NA 23.67 10.60 NA 78.09 090 61546 A Removal of pituitary gland 31.31 NA 17.12 7.65 NA 56.08 090 61548 A Removal of pituitary gland 21.54 NA 12.46 3.42 NA 37.43 090 61550 A Release of skull seams 14.66 NA 6.92 0.98 NA 22.56 090 61552 A Release of skull seams 19.57 NA 9.46 1.06 NA 30.09 090 61556 A Incise skull/sutures 22.27 NA 11.14 4.64 NA 38.05 090 61557 A Incise skull/sutures 22.39 NA 13.35 5.78 NA 41.52 090 61558 A Excision of skull/sutures 25.59 NA 13.91 1.36 NA 40.86 090 61559 A Excision of skull/sutures 32.81 NA 18.91 8.48 NA 60.19 090 61563 A Excision of skull tumor 26.84 NA 14.87 5.15 NA 46.87 090 61564 A Excision of skull tumor 33.85 NA 17.88 8.75 NA 60.48 090 61566 A Removal of brain tissue 31.01 NA 17.43 6.92 NA 55.36 090 61567 A Incision of brain tissue 35.52 NA 20.22 6.52 NA 62.26 090 61570 A Remove foreign body, brain 24.61 NA 13.62 5.86 NA 44.09 090 61571 A Incise skull for brain wound 26.40 NA 14.81 6.77 NA 47.98 090 61575 A Skull base/brainstem surgery 34.38 NA 19.10 5.32 NA 58.80 090 61576 A Skull base/brainstem surgery 52.45 NA 33.91 5.56 NA 91.92 090 61580 A Craniofacial approach, skull 30.36 NA 24.92 3.36 NA 58.65 090 61581 A Craniofacial approach, skull 34.62 NA 22.74 3.91 NA 61.27 090 61582 A Craniofacial approach, skull 31.67 NA 26.53 7.19 NA 65.39 090 61583 A Craniofacial approach, skull 36.23 NA 24.49 9.18 NA 69.90 090 61584 A Orbitocranial approach/skull 34.67 NA 23.90 8.16 NA 66.72 090 61585 A Orbitocranial approach/skull 38.63 NA 25.74 7.01 NA 71.37 090 61586 A Resect nasopharynx, skull 25.11 NA 21.90 4.36 NA 51.37 090 61590 A Infratemporal approach/skull 41.80 NA 27.92 5.29 NA 75.01 090 61591 A Infratemporal approach/skull 43.70 NA 28.74 5.64 NA 78.08 090 61592 A Orbitocranial approach/skull 39.66 NA 25.87 10.04 NA 75.57 090 61595 A Transtemporal approach/skull 29.59 NA 21.85 3.97 NA 55.41 090 61596 A Transcochlear approach/skull 35.65 NA 23.83 3.39 NA 62.87 090 61597 A Transcondylar approach/skull 37.98 NA 22.44 8.81 NA 69.23 090 61598 A Transpetrosal approach/skull 33.43 NA 22.65 5.68 NA 61.75 090
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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 495 and 496: 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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