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 67515 A Inject/treat eye socket 0.61 0.57 0.37 0.03 1.21 1.01 000 67550 A Insert eye socket implant 10.19 NA 10.89 0.72 NA 21.80 090 67560 A Revise eye socket implant 10.60 NA 10.97 0.60 NA 22.17 090 67570 A Decompress optic nerve 13.59 NA 13.08 0.68 NA 27.35 090 67599 C Orbit surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 67700 A Drainage of eyelid abscess 1.35 5.70 1.24 0.07 7.12 2.66 010 67710 A Incision of eyelid 1.02 5.07 1.18 0.05 6.14 2.25 010 67715 A Incision of eyelid fold 1.22 5.09 1.26 0.06 6.37 2.54 010 67800 A Remove eyelid lesion 1.38 1.58 1.02 0.07 3.03 2.47 010 67801 A Remove eyelid lesions 1.88 1.91 1.23 0.09 3.89 3.21 010 67805 A Remove eyelid lesions 2.22 2.46 1.61 0.11 4.79 3.95 010 67808 A Remove eyelid lesion(s) 3.80 NA 3.69 0.19 NA 7.68 090 67810 A Biopsy of eyelid 1.48 3.44 0.67 0.06 4.98 2.22 000 67820 A Revise eyelashes 0.89 0.59 0.56 0.04 1.52 1.49 000 67825 A Revise eyelashes 1.38 1.67 1.38 0.07 3.13 2.84 010 67830 A Revise eyelashes 1.70 5.26 1.47 0.08 7.04 3.25 010 67835 A Revise eyelashes 5.56 NA 4.52 0.28 NA 10.36 090 67840 A Remove eyelid lesion 2.04 5.22 1.62 0.10 7.37 3.76 010 67850 A Treat eyelid lesion 1.69 3.41 1.45 0.07 5.17 3.21 010 67875 A Closure of eyelid by suture 1.35 3.13 0.92 0.07 4.56 2.35 000 67880 A Revision of eyelid 3.80 6.35 3.71 0.19 10.34 7.70 090 67882 A Revision of eyelid 5.07 7.35 4.70 0.25 12.67 10.02 090 67900 A Repair brow defect 6.14 8.72 5.11 0.38 15.24 11.63 090 67901 A Repair eyelid defect 6.97 NA 5.26 0.51 NA 12.74 090 67902 A Repair eyelid defect 7.03 NA 5.32 0.45 NA 12.80 090 67903 A Repair eyelid defect 6.37 9.07 5.33 0.47 15.92 12.17 090 67904 A Repair eyelid defect 6.26 9.25 5.11 0.41 15.92 11.78 090 67906 A Repair eyelid defect 6.79 NA 4.92 0.46 NA 12.17 090 67908 A Repair eyelid defect 5.13 6.41 5.19 0.28 11.82 10.60 090 67909 A Revise eyelid defect 5.40 7.70 4.82 0.31 13.41 10.53 090 67911 A Revise eyelid defect 5.27 NA 4.66 0.31 NA 10.24 090
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 67912 A Correction eyelid w/implant 5.68 17.75 5.37 0.28 23.71 11.33 090 67914 A Repair eyelid defect 3.68 6.06 2.99 0.19 9.92 6.85 090 67915 A Repair eyelid defect 3.19 5.70 2.74 0.16 9.05 6.09 090 67916 A Repair eyelid defect 5.31 7.74 4.65 0.28 13.33 10.24 090 67917 A Repair eyelid defect 6.02 8.14 4.95 0.36 14.52 11.33 090 67921 A Repair eyelid defect 3.40 5.91 2.83 0.17 9.48 6.40 090 67922 A Repair eyelid defect 3.07 5.63 2.70 0.15 8.84 5.91 090 67923 A Repair eyelid defect 5.88 7.82 4.86 0.30 14.00 11.04 090 67924 A Repair eyelid defect 5.79 8.56 4.58 0.30 14.65 10.67 090 67930 A Repair eyelid wound 3.61 5.47 2.12 0.19 9.26 5.91 010 67935 A Repair eyelid wound 6.22 8.21 4.28 0.39 14.82 10.89 090 67938 A Remove eyelid foreign body 1.33 5.11 1.24 0.06 6.50 2.63 010 67950 A Revision of eyelid 5.82 8.28 5.07 0.36 14.46 11.25 090 67961 A Revision of eyelid 5.69 8.35 4.90 0.33 14.37 10.92 090 67966 A Revision of eyelid 6.57 8.78 5.41 0.37 15.72 12.35 090 67971 A Reconstruction of eyelid 9.80 NA 7.11 0.53 NA 17.44 090 67973 A Reconstruction of eyelid 12.88 NA 9.07 0.75 NA 22.69 090 67974 A Reconstruction of eyelid 12.85 NA 9.00 0.75 NA 22.59 090 67975 A Reconstruction of eyelid 9.14 NA 6.79 0.50 NA 16.43 090 67999 C Revision of eyelid 0.00 0.00 0.00 0.00 0.00 0.00 YYY 68020 A Incise/drain eyelid lining 1.37 1.38 1.18 0.06 2.81 2.62 010 68040 A Treatment of eyelid lesions 0.85 0.69 0.42 0.04 1.59 1.31 000 68100 A Biopsy of eyelid lining 1.35 3.09 0.93 0.07 4.51 2.36 000 68110 A Remove eyelid lining lesion 1.77 3.91 1.62 0.09 5.78 3.48 010 68115 A Remove eyelid lining lesion 2.36 5.67 1.87 0.12 8.15 4.36 010 68130 A Remove eyelid lining lesion 4.93 8.34 4.50 0.24 13.51 9.67 090 68135 A Remove eyelid lining lesion 1.84 1.77 1.62 0.09 3.70 3.55 010 68200 A Treat eyelid by injection 0.49 0.52 0.32 0.02 1.03 0.83 000 68320 A Revise/graft eyelid lining 5.37 10.81 5.41 0.27 16.45 11.05 090 68325 A Revise/graft eyelid lining 7.36 NA 6.39 0.44 NA 14.19 090 68326 A Revise/graft eyelid lining 7.15 NA 6.27 0.35 NA 13.77 090
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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 515 and 516: 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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