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 63005 A Removal of spinal lamina 14.93 NA 9.73 3.34 NA 28.00 090 63011 A Removal of spinal lamina 14.53 NA 8.08 3.37 NA 25.98 090 63012 A Removal of spinal lamina 15.41 NA 9.87 3.48 NA 28.76 090 63015 A Removal of spinal lamina 19.36 NA 11.62 4.75 NA 35.73 090 63016 A Removal of spinal lamina 19.21 NA 11.52 4.58 NA 35.30 090 63017 A Removal of spinal lamina 15.95 NA 10.15 3.63 NA 29.73 090 63020 A Neck spine disk surgery 14.82 NA 9.47 3.71 NA 28.00 090 63030 A Low back disk surgery 12.00 NA 8.23 3.00 NA 23.24 090 63035 A Spinal disk surgery add-on 3.16 NA 1.55 0.79 NA 5.49 ZZZ 63040 A Laminotomy, single cervical 18.82 NA 11.23 4.67 NA 34.72 090 63042 A Laminotomy, single lumbar 17.47 NA 11.06 4.25 NA 32.78 090 63043 C Laminotomy, addªl cervical 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 63044 C Laminotomy, addªl lumbar 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 63045 A Removal of spinal lamina 16.51 NA 10.13 3.98 NA 30.62 090 63046 A Removal of spinal lamina 15.81 NA 9.94 3.55 NA 29.30 090 63047 A Removal of spinal lamina 14.62 NA 9.65 3.23 NA 27.50 090 63048 A Remove spinal lamina add-on 3.27 NA 1.62 0.72 NA 5.60 ZZZ 63050 A Cervical laminoplasty 20.79 NA 11.41 4.66 NA 36.86 090 63051 A C-laminoplasty w/graft/plate 24.30 NA 12.97 4.66 NA 41.93 090 63055 A Decompress spinal cord 22.00 NA 12.84 5.27 NA 40.11 090 63056 A Decompress spinal cord 20.37 NA 12.25 4.75 NA 37.37 090 63057 A Decompress spine cord add-on 5.26 NA 2.56 1.22 NA 9.04 ZZZ 63064 A Decompress spinal cord 24.62 NA 14.08 5.69 NA 44.39 090 63066 A Decompress spine cord add-on 3.27 NA 1.62 0.69 NA 5.57 ZZZ 63075 A Neck spine disk surgery 19.42 NA 11.81 4.62 NA 35.85 090 63076 A Neck spine disk surgery 4.05 NA 2.00 0.96 NA 7.00 ZZZ 63077 A Spine disk surgery, thorax 21.45 NA 12.43 3.98 NA 37.87 090 63078 A Spine disk surgery, thorax 3.29 NA 1.59 0.66 NA 5.54 ZZZ 63081 A Removal of vertebral body 23.74 NA 13.98 5.54 NA 43.26 090 63082 A Remove vertebral body add-on 4.37 NA 2.16 1.02 NA 7.55 ZZZ 63085 A Removal of vertebral body 26.93 NA 15.05 4.48 NA 46.47 090
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 63086 A Remove vertebral body add-on 3.20 NA 1.55 0.59 NA 5.33 ZZZ 63087 A Removal of vertebral body 35.59 NA 18.93 6.20 NA 60.72 090 63088 A Remove vertebral body add-on 4.33 NA 2.11 0.82 NA 7.26 ZZZ 63090 A Removal of vertebral body 28.18 NA 15.60 4.21 NA 47.99 090 63091 A Remove vertebral body add-on 3.04 NA 1.42 0.48 NA 4.93 ZZZ 63101 A Removal of vertebral body 32.01 NA 18.84 5.69 NA 56.54 090 63102 A Removal of vertebral body 32.01 NA 18.78 5.69 NA 56.48 090 63103 A Remove vertebral body add-on 4.83 NA 2.41 0.69 NA 7.93 ZZZ 63170 A Incise spinal cord tract(s) 19.84 NA 11.62 4.86 NA 36.32 090 63172 A Drainage of spinal cyst 17.67 NA 10.42 4.48 NA 32.57 090 63173 A Drainage of spinal cyst 22.00 NA 12.54 5.68 NA 40.22 090 63180 A Revise spinal cord ligaments 18.28 NA 10.77 3.95 NA 33.00 090 63182 A Revise spinal cord ligaments 20.51 NA 10.76 5.30 NA 36.57 090 63185 A Incise spinal column/nerves 15.05 NA 7.93 2.79 NA 25.77 090 63190 A Incise spinal column/nerves 17.45 NA 9.90 3.24 NA 30.59 090 63191 A Incise spinal column/nerves 17.55 NA 10.21 6.34 NA 34.10 090 63194 A Incise spinal column & cord 19.20 NA 11.48 3.26 NA 33.94 090 63195 A Incise spinal column & cord 18.85 NA 10.81 4.87 NA 34.53 090 63196 A Incise spinal column & cord 22.31 NA 13.11 5.76 NA 41.18 090 63197 A Incise spinal column & cord 21.12 NA 11.95 5.36 NA 38.44 090 63198 A Incise spinal column & cord 25.39 NA 8.28 6.43 NA 40.10 090 63199 A Incise spinal column & cord 26.90 NA 14.73 1.40 NA 43.04 090 63200 A Release of spinal cord 19.19 NA 11.10 4.96 NA 35.25 090 63250 A Revise spinal cord vessels 40.78 NA 19.47 9.01 NA 69.26 090 63251 A Revise spinal cord vessels 41.22 NA 22.08 10.41 NA 73.72 090 63252 A Revise spinal cord vessels 41.21 NA 21.75 10.64 NA 73.60 090 63265 A Excise intraspinal lesion 21.57 NA 12.49 5.43 NA 39.49 090 63266 A Excise intraspinal lesion 22.31 NA 12.89 5.54 NA 40.74 090 63267 A Excise intraspinal lesion 17.96 NA 10.83 4.37 NA 33.16 090 63268 A Excise intraspinal lesion 18.53 NA 10.13 3.69 NA 32.35 090 63270 A Excise intraspinal lesion 26.81 NA 15.13 6.82 NA 48.76 090
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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 501 and 502: 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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