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 67005 A Partial removal of eye fluid 5.70 NA 4.77 0.28 NA 10.75 090 67010 A Partial removal of eye fluid 6.87 NA 5.30 0.34 NA 12.52 090 67015 A Release of eye fluid 6.92 NA 6.29 0.34 NA 13.55 090 67025 A Replace eye fluid 6.84 8.89 6.09 0.34 16.08 13.27 090 67027 A Implant eye drug system 10.85 NA 7.82 0.54 NA 19.21 090 67028 A Injection eye drug 2.53 2.60 1.43 0.12 5.25 4.08 000 67030 A Incise inner eye strands 4.84 NA 5.70 0.24 NA 10.78 090 67031 A Laser surgery, eye strands 3.67 4.46 3.56 0.18 8.31 7.41 090 67036 A Removal of inner eye fluid 11.89 NA 8.91 0.58 NA 21.38 090 67038 A Strip retinal membrane 21.25 NA 15.11 1.04 NA 37.40 090 67039 A Laser treatment of retina 14.53 NA 11.87 0.71 NA 27.11 090 67040 A Laser treatment of retina 17.23 NA 13.34 0.85 NA 31.43 090 67101 A Repair detached retina 7.54 8.91 6.39 0.37 16.81 14.30 090 67105 A Repair detached retina 7.41 7.88 6.02 0.37 15.67 13.80 090 67107 A Repair detached retina 14.85 NA 11.06 0.73 NA 26.64 090 67108 A Repair detached retina 20.83 NA 14.10 1.02 NA 35.95 090 67110 A Repair detached retina 8.82 9.91 7.23 0.44 19.16 16.49 090 67112 A Rerepair detached retina 16.86 NA 11.54 0.83 NA 29.24 090 67115 A Release encircling material 4.99 NA 4.97 0.25 NA 10.21 090 67120 A Remove eye implant material 5.98 8.27 5.42 0.29 14.54 11.69 090 67121 A Remove eye implant material 10.67 NA 8.34 0.53 NA 19.54 090 67141 A Treatment of retina 5.20 5.70 4.76 0.26 11.16 10.22 090 67145 A Treatment of retina 5.37 5.58 4.83 0.27 11.22 10.47 090 67208 A Treatment of retinal lesion 6.70 5.98 5.40 0.33 13.01 12.43 090 67210 A Treatment of retinal lesion 8.83 6.41 5.75 0.44 15.68 15.02 090 67218 A Treatment of retinal lesion 18.54 NA 11.83 0.92 NA 31.29 090 67220 A Treatment of choroid lesion 13.14 10.16 8.81 0.65 23.94 22.60 090 67221 R Ocular photodynamic ther 4.01 4.15 1.79 0.20 8.35 6.00 000 67225 A Eye photodynamic ther add-on 0.47 0.25 0.21 0.02 0.74 0.70 ZZZ 67227 A Treatment of retinal lesion 6.58 6.42 5.40 0.33 13.33 12.32 090 67228 A Treatment of retinal lesion 12.75 11.17 8.35 0.63 24.54 21.73 090
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 67250 A Reinforce eye wall 8.67 NA 8.85 0.47 NA 17.98 090 67255 A Reinforce/graft eye wall 8.91 NA 9.54 0.44 NA 18.89 090 67299 C Eye surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 67311 A Revise eye muscle 6.65 NA 5.88 0.37 NA 12.91 090 67312 A Revise two eye muscles 8.55 NA 6.60 0.43 NA 15.58 090 67314 A Revise eye muscle 7.53 NA 6.41 0.39 NA 14.32 090 67316 A Revise two eye muscles 9.67 NA 7.33 0.49 NA 17.49 090 67318 A Revise eye muscle(s) 7.86 NA 6.78 0.41 NA 15.05 090 67320 A Revise eye muscle(s) add-on 4.33 NA 1.90 0.22 NA 6.45 ZZZ 67331 A Eye surgery follow-up add-on 4.06 NA 1.79 0.21 NA 6.05 ZZZ 67332 A Rerevise eye muscles add-on 4.49 NA 1.97 0.23 NA 6.69 ZZZ 67334 A Revise eye muscle w/suture 3.98 NA 1.75 0.20 NA 5.93 ZZZ 67335 A Eye suture during surgery 2.49 NA 1.09 0.13 NA 3.72 ZZZ 67340 A Revise eye muscle add-on 4.93 NA 2.15 0.25 NA 7.33 ZZZ 67343 A Release eye tissue 7.35 NA 6.37 0.37 NA 14.09 090 67345 A Destroy nerve of eye muscle 2.97 2.52 1.97 0.17 5.65 5.10 010 67350 A Biopsy eye muscle 2.88 NA 1.84 0.15 NA 4.86 000 67399 C Eye muscle surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 67400 A Explore/biopsy eye socket 9.77 NA 10.83 0.56 NA 21.16 090 67405 A Explore/drain eye socket 7.94 NA 9.42 0.44 NA 17.80 090 67412 A Explore/treat eye socket 9.51 NA 10.47 0.48 NA 20.46 090 67413 A Explore/treat eye socket 10.01 NA 10.36 0.50 NA 20.87 090 67414 A Explr/decompress eye socket 11.13 NA 11.56 0.65 NA 23.34 090 67415 A Aspiration, orbital contents 1.76 NA 0.74 0.09 NA 2.60 000 67420 A Explore/treat eye socket 20.07 NA 16.76 1.15 NA 37.98 090 67430 A Explore/treat eye socket 13.40 NA 14.29 0.86 NA 28.55 090 67440 A Explore/drain eye socket 13.10 NA 13.73 0.70 NA 27.52 090 67445 A Explr/decompress eye socket 14.43 NA 13.40 0.90 NA 28.73 090 67450 A Explore/biopsy eye socket 13.52 NA 14.17 0.68 NA 28.36 090 67500 A Inject/treat eye socket 0.79 0.65 0.28 0.05 1.49 1.12 000 67505 A Inject/treat eye socket 0.82 0.67 0.30 0.05 1.54 1.17 000
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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 513 and 514: 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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