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 64736 A Incision of chin nerve 4.60 NA 3.98 0.52 NA 9.10 090 64738 A Incision of jaw nerve 5.73 NA 4.54 1.08 NA 11.36 090 64740 A Incision of tongue nerve 5.59 NA 5.06 0.69 NA 11.34 090 64742 A Incision of facial nerve 6.22 NA 4.61 0.73 NA 11.56 090 64744 A Incise nerve, back of head 5.24 NA 3.71 1.16 NA 10.11 090 64746 A Incise diaphragm nerve 5.93 NA 4.29 0.82 NA 11.04 090 64752 A Incision of vagus nerve 7.06 NA 4.18 0.93 NA 12.17 090 64755 A Incision of stomach nerves 13.53 NA 5.57 1.83 NA 20.93 090 64760 A Incision of vagus nerve 6.96 NA 3.41 0.81 NA 11.19 090 64761 A Incision of pelvis nerve 6.41 NA 3.50 0.53 NA 10.44 090 64763 A Incise hip/thigh nerve 6.93 NA 5.06 0.94 NA 12.93 090 64766 A Incise hip/thigh nerve 8.68 NA 5.25 1.06 NA 14.99 090 64771 A Sever cranial nerve 7.35 NA 5.45 1.23 NA 14.03 090 64772 A Incision of spinal nerve 7.21 NA 4.83 1.40 NA 13.45 090 64774 A Remove skin nerve lesion 5.17 NA 3.77 0.74 NA 9.68 090 64776 A Remove digit nerve lesion 5.12 NA 3.61 0.76 NA 9.49 090 64778 A Digit nerve surgery add-on 3.12 NA 1.46 0.46 NA 5.03 ZZZ 64782 A Remove limb nerve lesion 6.23 NA 3.76 0.86 NA 10.85 090 64783 A Limb nerve surgery add-on 3.72 NA 1.78 0.51 NA 6.01 ZZZ 64784 A Remove nerve lesion 9.83 NA 6.43 1.38 NA 17.64 090 64786 A Remove sciatic nerve lesion 15.47 NA 9.57 2.60 NA 27.64 090 64787 A Implant nerve end 4.30 NA 2.06 0.58 NA 6.94 ZZZ 64788 A Remove skin nerve lesion 4.61 NA 3.43 0.73 NA 8.77 090 64790 A Removal of nerve lesion 11.31 NA 7.05 2.10 NA 20.46 090 64792 A Removal of nerve lesion 14.93 NA 8.63 2.48 NA 26.04 090 64795 A Biopsy of nerve 3.02 NA 1.53 0.52 NA 5.07 000 64802 A Remove sympathetic nerves 9.16 NA 4.96 1.29 NA 15.41 090 64804 A Remove sympathetic nerves 14.65 NA 6.92 2.14 NA 23.71 090 64809 A Remove sympathetic nerves 13.68 NA 5.58 1.50 NA 20.76 090 64818 A Remove sympathetic nerves 10.30 NA 5.10 1.33 NA 16.73 090 64820 A Remove sympathetic nerves 10.37 NA 6.92 1.49 NA 18.78 090
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 64821 A Remove sympathetic nerves 8.76 NA 7.13 1.24 NA 17.13 090 64822 A Remove sympathetic nerves 8.76 NA 7.03 1.30 NA 17.09 090 64823 A Remove sympathetic nerves 10.37 NA 7.91 1.57 NA 19.85 090 64831 A Repair of digit nerve 9.45 NA 6.88 1.41 NA 17.74 090 64832 A Repair nerve add-on 5.66 NA 2.85 0.85 NA 9.36 ZZZ 64834 A Repair of hand or foot nerve 10.19 NA 6.90 1.54 NA 18.63 090 64835 A Repair of hand or foot nerve 10.94 NA 7.48 1.73 NA 20.15 090 64836 A Repair of hand or foot nerve 10.94 NA 7.45 1.67 NA 20.07 090 64837 A Repair nerve add-on 6.26 NA 3.14 0.97 NA 10.37 ZZZ 64840 A Repair of leg nerve 13.03 NA 8.05 1.37 NA 22.44 090 64856 A Repair/transpose nerve 13.81 NA 8.93 2.12 NA 24.86 090 64857 A Repair arm/leg nerve 14.50 NA 9.37 2.21 NA 26.08 090 64858 A Repair sciatic nerve 16.50 NA 10.48 3.33 NA 30.31 090 64859 A Nerve surgery 4.26 NA 2.13 0.67 NA 7.06 ZZZ 64861 A Repair of arm nerves 19.25 NA 11.42 4.08 NA 34.75 090 64862 A Repair of low back nerves 19.45 NA 11.75 4.31 NA 35.50 090 64864 A Repair of facial nerve 12.56 NA 8.49 1.26 NA 22.31 090 64865 A Repair of facial nerve 15.25 NA 13.11 1.50 NA 29.86 090 64866 A Fusion of facial/other nerve 15.75 NA 12.78 2.04 NA 30.57 090 64868 A Fusion of facial/other nerve 14.05 NA 11.16 1.43 NA 26.64 090 64870 A Fusion of facial/other nerve 16.00 NA 8.55 1.30 NA 25.85 090 64872 A Subsequent repair of nerve 1.99 NA 1.05 0.29 NA 3.33 ZZZ 64874 A Repair & revise nerve add-on 2.99 NA 1.48 0.42 NA 4.89 ZZZ 64876 A Repair nerve/shorten bone 3.38 NA 1.70 0.47 NA 5.54 ZZZ 64885 A Nerve graft, head or neck 17.54 NA 11.26 1.63 NA 30.42 090 64886 A Nerve graft, head or neck 20.76 NA 13.11 2.08 NA 35.96 090 64890 A Nerve graft, hand or foot 15.16 NA 9.71 2.29 NA 27.16 090 64891 A Nerve graft, hand or foot 16.15 NA 7.41 1.63 NA 25.19 090 64892 A Nerve graft, arm or leg 14.66 NA 8.65 2.47 NA 25.78 090 64893 A Nerve graft, arm or leg 15.61 NA 9.60 2.61 NA 27.82 090 64895 A Nerve graft, hand or foot 19.26 NA 9.45 2.57 NA 31.27 090
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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 507 and 508: 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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