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 63271 A Excise intraspinal lesion 26.93 NA 15.23 6.90 NA 49.06 090 63272 A Excise intraspinal lesion 25.33 NA 14.36 6.18 NA 45.87 090 63273 A Excise intraspinal lesion 24.30 NA 14.03 5.74 NA 44.06 090 63275 A Biopsy/excise spinal tumor 23.69 NA 13.47 5.80 NA 42.95 090 63276 A Biopsy/excise spinal tumor 23.46 NA 13.38 5.83 NA 42.66 090 63277 A Biopsy/excise spinal tumor 20.84 NA 12.24 5.01 NA 38.09 090 63278 A Biopsy/excise spinal tumor 20.57 NA 12.10 4.55 NA 37.22 090 63280 A Biopsy/excise spinal tumor 28.37 NA 15.96 7.27 NA 51.59 090 63281 A Biopsy/excise spinal tumor 28.07 NA 15.82 7.17 NA 51.06 090 63282 A Biopsy/excise spinal tumor 26.40 NA 15.00 6.76 NA 48.17 090 63283 A Biopsy/excise spinal tumor 25.01 NA 14.34 6.26 NA 45.61 090 63285 A Biopsy/excise spinal tumor 36.02 NA 19.49 9.18 NA 64.69 090 63286 A Biopsy/excise spinal tumor 35.65 NA 19.46 9.21 NA 64.32 090 63287 A Biopsy/excise spinal tumor 36.71 NA 19.96 9.39 NA 66.06 090 63290 A Biopsy/excise spinal tumor 37.39 NA 20.12 9.02 NA 66.54 090 63295 A Repair of laminectomy defect 5.26 NA 2.07 1.03 NA 8.36 ZZZ 63300 A Removal of vertebral body 24.44 NA 13.97 5.97 NA 44.37 090 63301 A Removal of vertebral body 27.62 NA 15.16 5.39 NA 48.17 090 63302 A Removal of vertebral body 27.83 NA 15.47 5.53 NA 48.82 090 63303 A Removal of vertebral body 30.51 NA 16.47 4.68 NA 51.66 090 63304 A Removal of vertebral body 30.34 NA 16.88 6.41 NA 53.63 090 63305 A Removal of vertebral body 32.04 NA 17.60 5.71 NA 55.35 090 63306 A Removal of vertebral body 32.23 NA 17.37 8.33 NA 57.93 090 63307 A Removal of vertebral body 31.64 NA 16.65 4.46 NA 52.75 090 63308 A Remove vertebral body add-on 5.25 NA 2.53 1.29 NA 9.07 ZZZ 63600 A Remove spinal cord lesion 14.03 NA 5.29 1.52 NA 20.83 090 63610 A Stimulation of spinal cord 8.74 53.74 2.21 0.86 63.34 11.80 000 63615 A Remove lesion of spinal cord 16.29 NA 9.07 2.84 NA 28.20 090 63650 A Implant neuroelectrodes 6.74 NA 3.09 0.53 NA 10.36 090 63655 A Implant neuroelectrodes 10.29 NA 6.75 2.43 NA 19.47 090 63660 A Revise/remove neuroelectrode 6.16 NA 3.53 0.78 NA 10.47 090
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 63685 A Insrt/redo spine n generator 7.04 NA 4.05 1.05 NA 12.14 090 63688 A Revise/remove neuroreceiver 5.39 NA 3.47 0.89 NA 9.76 090 63700 A Repair of spinal herniation 16.54 NA 10.06 3.52 NA 30.12 090 63702 A Repair of spinal herniation 18.49 NA 10.87 4.12 NA 33.48 090 63704 A Repair of spinal herniation 21.19 NA 12.61 4.57 NA 38.37 090 63706 A Repair of spinal herniation 24.12 NA 13.24 6.23 NA 43.58 090 63707 A Repair spinal fluid leakage 11.26 NA 7.53 2.51 NA 21.30 090 63709 A Repair spinal fluid leakage 14.33 NA 9.16 3.09 NA 26.58 090 63710 A Graft repair of spine defect 14.08 NA 8.84 3.40 NA 26.32 090 63740 A Install spinal shunt 11.36 NA 7.22 2.93 NA 21.51 090 63741 A Install spinal shunt 8.26 NA 4.68 1.66 NA 14.60 090 63744 A Revision of spinal shunt 8.11 NA 5.16 1.89 NA 15.16 090 63746 A Removal of spinal shunt 6.43 NA 3.70 1.53 NA 11.66 090 64400 A N block inj, trigeminal 1.11 1.83 0.42 0.07 3.01 1.60 000 64402 A N block inj, facial 1.25 1.59 0.59 0.09 2.93 1.93 000 64405 A N block inj, occipital 1.32 1.42 0.45 0.08 2.82 1.85 000 64408 A N block inj, vagus 1.41 1.57 0.83 0.10 3.08 2.34 000 64410 A N block inj, phrenic 1.43 2.36 0.45 0.09 3.89 1.97 000 64412 A N block inj, spinal accessor 1.18 2.49 0.42 0.08 3.75 1.68 000 64413 A N block inj, cervical plexus 1.40 1.77 0.49 0.08 3.25 1.97 000 64415 A N block inj, brachial plexus 1.48 2.66 0.45 0.09 4.23 2.02 000 64416 A N block cont infuse, b plex 3.50 NA 0.77 0.31 NA 4.58 010 64417 A N block inj, axillary 1.44 2.84 0.48 0.11 4.40 2.03 000 64418 A N block inj, suprascapular 1.32 2.49 0.43 0.07 3.89 1.82 000 64420 A N block inj, intercost, sng 1.18 3.62 0.41 0.08 4.89 1.67 000 64421 A N block inj, intercost, mlt 1.68 5.65 0.51 0.11 7.44 2.30 000 64425 A N block inj, ilio-ing/hypogi 1.75 1.62 0.53 0.13 3.51 2.41 000 64430 A N block inj, pudendal 1.46 2.47 0.56 0.10 4.03 2.12 000 64435 A N block inj, paracervical 1.45 2.42 0.68 0.16 4.03 2.29 000 64445 A N block inj, sciatic, sng 1.48 2.52 0.49 0.10 4.11 2.07 000 64446 A N blk inj, sciatic, cont inf 3.26 NA 0.97 0.20 NA 4.43 010
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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 503 and 504: 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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