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 64447 A N block inj fem, single 1.50 NA 0.42 0.09 NA 2.01 000 64448 A N block inj fem, cont inf 3.01 NA 0.79 0.18 NA 3.98 010 64449 A N block inj, lumbar plexus 3.01 NA 0.91 0.15 NA 4.07 010 64450 A N block, other peripheral 1.27 1.25 0.47 0.13 2.65 1.87 000 64470 A Inj paravertebral c/t 1.85 6.70 0.69 0.11 8.66 2.66 000 64472 A Inj paravertebral c/t add-on 1.29 2.16 0.33 0.08 3.53 1.71 ZZZ 64475 A Inj paravertebral l/s 1.41 6.37 0.62 0.10 7.89 2.13 000 64476 A Inj paravertebral l/s add-on 0.98 1.95 0.24 0.07 3.00 1.29 ZZZ 64479 A Inj foramen epidural c/t 2.20 6.90 0.87 0.12 9.22 3.19 000 64480 A Inj foramen epidural add-on 1.54 2.62 0.46 0.10 4.26 2.10 ZZZ 64483 A Inj foramen epidural l/s 1.90 7.23 0.81 0.11 9.25 2.82 000 64484 A Inj foramen epidural add-on 1.33 3.01 0.36 0.08 4.42 1.77 ZZZ 64505 A N block, spenopalatine gangl 1.36 1.21 0.64 0.10 2.68 2.10 000 64508 A N block, carotid sinus s/p 1.12 3.15 0.76 0.07 4.35 1.95 000 64510 A N block, stellate ganglion 1.22 3.19 0.50 0.07 4.49 1.79 000 64517 A N block inj, hypogas plxs 2.20 2.65 0.87 0.11 4.96 3.19 000 64520 A N block, lumbar/thoracic 1.35 4.76 0.54 0.08 6.19 1.97 000 64530 A N block inj, celiac pelus 1.58 4.14 0.64 0.10 5.82 2.32 000 64550 A Apply neurostimulator 0.18 0.27 0.05 0.01 0.46 0.24 000 64553 A Implant neuroelectrodes 2.31 2.70 1.81 0.18 5.20 4.31 010 64555 A Implant neuroelectrodes 2.27 2.98 1.26 0.19 5.44 3.73 010 64560 A Implant neuroelectrodes 2.36 2.54 1.25 0.22 5.12 3.84 010 64561 A Implant neuroelectrodes 6.74 29.47 3.21 0.51 36.73 10.46 010 64565 A Implant neuroelectrodes 1.76 3.12 1.24 0.13 5.01 3.14 010 64573 A Implant neuroelectrodes 7.50 NA 5.15 1.60 NA 14.25 090 64575 A Implant neuroelectrodes 4.35 NA 2.84 0.61 NA 7.80 090 64577 A Implant neuroelectrodes 4.62 NA 3.20 1.04 NA 8.86 090 64580 A Implant neuroelectrodes 4.12 NA 3.44 0.36 NA 7.92 090 64581 A Implant neuroelectrodes 13.51 NA 6.11 1.05 NA 20.67 090 64585 A Revise/remove neuroelectrode 2.06 10.39 2.13 0.20 12.65 4.39 010 64590 A Insrt/redo perph n generator 2.40 6.92 2.33 0.19 9.51 4.92 010
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 64595 A Revise/remove neuroreceiver 1.73 9.61 1.90 0.19 11.54 3.83 010 64600 A Injection treatment of nerve 3.45 8.75 1.62 0.34 12.54 5.40 010 64605 A Injection treatment of nerve 5.61 8.92 2.13 0.79 15.32 8.53 010 64610 A Injection treatment of nerve 7.16 8.48 3.64 1.58 17.22 12.38 010 64612 A Destroy nerve, face muscle 1.96 2.41 1.30 0.11 4.48 3.38 010 64613 A Destroy nerve, spine muscle 1.96 2.86 1.20 0.11 4.93 3.28 010 64614 A Destroy nerve, extrem musc 2.20 3.07 1.28 0.10 5.37 3.58 010 64620 A Injection treatment of nerve 2.85 4.75 1.29 0.20 7.80 4.33 010 64622 A Destr paravertebrl nerve l/s 3.01 7.17 1.33 0.18 10.35 4.52 010 64623 A Destr paravertebral n add-on 0.99 2.74 0.22 0.06 3.79 1.27 ZZZ 64626 A Destr paravertebrl nerve c/t 3.29 7.26 1.90 0.20 10.75 5.39 010 64627 A Destr paravertebral n add-on 1.16 4.18 0.26 0.07 5.41 1.50 ZZZ 64630 A Injection treatment of nerve 3.01 2.69 1.42 0.22 5.92 4.65 010 64640 A Injection treatment of nerve 2.77 3.94 1.78 0.29 7.00 4.84 010 64680 A Injection treatment of nerve 2.63 6.22 1.40 0.18 9.03 4.20 010 64681 A Injection treatment of nerve 3.55 8.67 2.01 0.28 12.50 5.84 010 64702 A Revise finger/toe nerve 4.23 NA 3.76 0.61 NA 8.60 090 64704 A Revise hand/foot nerve 4.57 NA 3.29 0.61 NA 8.47 090 64708 A Revise arm/leg nerve 6.12 NA 4.73 0.96 NA 11.81 090 64712 A Revision of sciatic nerve 7.76 NA 4.79 0.95 NA 13.49 090 64713 A Revision of arm nerve(s) 11.00 NA 5.70 1.82 NA 18.52 090 64714 A Revise low back nerve(s) 10.33 NA 4.09 1.19 NA 15.61 090 64716 A Revision of cranial nerve 6.31 NA 5.84 0.63 NA 12.78 090 64718 A Revise ulnar nerve at elbow 5.99 NA 5.84 1.05 NA 12.88 090 64719 A Revise ulnar nerve at wrist 4.85 NA 4.39 0.77 NA 10.01 090 64721 A Carpal tunnel surgery 4.29 0.00 5.17 0.73 5.02 10.19 090 64722 A Relieve pressure on nerve(s) 4.70 NA 2.96 0.48 NA 8.14 090 64726 A Release foot/toe nerve 4.18 NA 2.77 0.54 NA 7.49 090 64727 A Internal nerve revision 3.11 NA 1.46 0.48 NA 5.04 ZZZ 64732 A Incision of brow nerve 4.41 NA 3.45 0.98 NA 8.84 090 64734 A Incision of cheek nerve 4.92 NA 3.99 0.89 NA 9.80 090
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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 505 and 506: 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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