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 65805 A Drainage of eye 1.91 2.09 1.17 0.09 4.10 3.17 000 65810 A Drainage of eye 4.87 NA 4.60 0.24 NA 9.71 090 65815 A Drainage of eye 5.05 9.56 4.71 0.25 14.86 10.01 090 65820 A Relieve inner eye pressure 8.14 NA 8.75 0.40 NA 17.29 090 65850 A Incision of eye 10.52 NA 8.21 0.52 NA 19.25 090 65855 A Laser surgery of eye 3.85 4.18 3.03 0.19 8.21 7.07 010 65860 A Incise inner eye adhesions 3.55 3.92 2.45 0.18 7.64 6.17 090 65865 A Incise inner eye adhesions 5.60 NA 5.47 0.28 NA 11.35 090 65870 A Incise inner eye adhesions 6.27 NA 6.24 0.31 NA 12.82 090 65875 A Incise inner eye adhesions 6.54 NA 6.61 0.32 NA 13.48 090 65880 A Incise inner eye adhesions 7.09 NA 6.85 0.35 NA 14.29 090 65900 A Remove eye lesion 10.93 NA 9.95 0.54 NA 21.42 090 65920 A Remove implant of eye 8.41 NA 7.96 0.41 NA 16.78 090 65930 A Remove blood clot from eye 7.44 NA 6.64 0.37 NA 14.45 090 66020 A Injection treatment of eye 1.59 2.99 1.41 0.08 4.66 3.08 010 66030 A Injection treatment of eye 1.25 2.84 1.26 0.06 4.15 2.57 010 66130 A Remove eye lesion 7.70 9.24 5.49 0.38 17.31 13.56 090 66150 A Glaucoma surgery 8.31 NA 9.16 0.46 NA 17.93 090 66155 A Glaucoma surgery 8.30 NA 9.11 0.41 NA 17.81 090 66160 A Glaucoma surgery 10.17 NA 9.93 0.50 NA 20.60 090 66165 A Glaucoma surgery 8.02 NA 9.01 0.40 NA 17.42 090 66170 A Glaucoma surgery 12.16 NA 11.92 0.60 NA 24.68 090 66172 A Incision of eye 15.05 NA 14.84 0.74 NA 30.63 090 66180 A Implant eye shunt 14.56 NA 10.51 0.71 NA 25.78 090 66185 A Revise eye shunt 8.15 NA 7.20 0.40 NA 15.75 090 66220 A Repair eye lesion 7.78 NA 6.93 0.40 NA 15.11 090 66225 A Repair/graft eye lesion 11.05 NA 8.54 0.55 NA 20.14 090 66250 A Follow-up surgery of eye 5.98 11.17 5.37 0.30 17.45 11.65 090 66500 A Incision of iris 3.71 NA 4.49 0.18 NA 8.38 090 66505 A Incision of iris 4.08 NA 4.84 0.20 NA 9.12 090 66600 A Remove iris and lesion 8.69 NA 8.01 0.43 NA 17.12 090
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 66605 A Removal of iris 12.80 NA 9.77 0.77 NA 23.34 090 66625 A Removal of iris 5.13 NA 4.63 0.26 NA 10.02 090 66630 A Removal of iris 6.16 NA 5.59 0.31 NA 12.06 090 66635 A Removal of iris 6.25 NA 5.62 0.31 NA 12.18 090 66680 A Repair iris & ciliary body 5.44 NA 5.15 0.27 NA 10.86 090 66682 A Repair iris & ciliary body 6.21 NA 6.42 0.31 NA 12.95 090 66700 A Destruction, ciliary body 4.78 5.20 3.87 0.24 10.21 8.88 090 66710 A Ciliary transsleral therapy 4.78 5.03 3.77 0.23 10.04 8.78 090 66711 A Ciliary endoscopic ablation 6.61 NA 6.35 0.30 NA 13.26 090 66720 A Destruction, ciliary body 4.78 5.65 4.63 0.26 10.69 9.67 090 66740 A Destruction, ciliary body 4.78 4.96 3.89 0.23 9.97 8.90 090 66761 A Revision of iris 4.07 5.44 4.23 0.20 9.70 8.49 090 66762 A Revision of iris 4.58 5.49 4.20 0.23 10.30 9.01 090 66770 A Removal of inner eye lesion 5.18 5.91 4.70 0.26 11.35 10.14 090 66820 A Incision, secondary cataract 3.89 NA 5.58 0.19 NA 9.66 090 66821 A After cataract laser surgery 2.35 3.97 3.52 0.11 6.44 5.98 090 66825 A Reposition intraocular lens 8.24 NA 8.76 0.40 NA 17.40 090 66830 A Removal of lens lesion 8.21 NA 6.80 0.36 NA 15.36 090 66840 A Removal of lens material 7.92 NA 6.71 0.39 NA 15.01 090 66850 A Removal of lens material 9.12 NA 7.47 0.45 NA 17.04 090 66852 A Removal of lens material 9.98 NA 7.92 0.49 NA 18.39 090 66920 A Extraction of lens 8.87 NA 7.13 0.44 NA 16.44 090 66930 A Extraction of lens 10.18 NA 7.96 0.49 NA 18.63 090 66940 A Extraction of lens 8.94 NA 7.43 0.43 NA 16.80 090 66982 A Cataract surgery, complex 13.51 NA 9.65 0.63 NA 23.79 090 66983 A Cataract surg w/iol, 1 stage 9.00 NA 6.09 0.14 NA 15.23 090 66984 A Cataract surg w/iol, 1 stage 10.23 NA 7.27 0.39 NA 17.89 090 66985 A Insert lens prosthesis 8.40 NA 7.30 0.36 NA 16.06 090 66986 A Exchange lens prosthesis 12.28 NA 8.98 0.60 NA 21.86 090 66990 A Ophthalmic endoscope add-on 1.51 NA 0.67 0.07 NA 2.26 ZZZ 66999 C Eye surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY
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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 511 and 512: 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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