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 72158 26 A Mri lumbar spine w/o & w/dye 2.36 0.82 0.82 0.10 3.28 3.28 XXX 72158 TC A Mri lumbar spine w/o & w/dye 0.00 22.63 NA 1.31 23.94 NA XXX 72159 N Mr angio spine w/o&w/dye 1.80 13.69 NA 0.74 16.23 NA XXX 72159 26 N Mr angio spine w/o&w/dye 1.80 0.69 0.69 0.10 2.59 2.59 XXX 72159 TC N Mr angio spine w/o&w/dye 0.00 13.00 NA 0.64 13.64 NA XXX 72170 A X-ray exam of pelvis 0.17 0.57 NA 0.03 0.77 NA XXX 72170 26 A X-ray exam of pelvis 0.17 0.06 0.06 0.01 0.24 0.24 XXX 72170 TC A X-ray exam of pelvis 0.00 0.51 NA 0.02 0.53 NA XXX 72190 A X-ray exam of pelvis 0.21 0.78 NA 0.05 1.04 NA XXX 72190 26 A X-ray exam of pelvis 0.21 0.07 0.07 0.01 0.29 0.29 XXX 72190 TC A X-ray exam of pelvis 0.00 0.71 NA 0.04 0.75 NA XXX 72191 A Ct angiograph pelv w/o&w/dye 1.81 12.28 NA 0.47 14.56 NA XXX 72191 26 A Ct angiograph pelv w/o&w/dye 1.81 0.62 0.62 0.08 2.52 2.52 XXX 72191 TC A Ct angiograph pelv w/o&w/dye 0.00 11.66 NA 0.39 12.05 NA XXX 72192 A Ct pelvis w/o dye 1.09 6.18 NA 0.36 7.63 NA XXX 72192 26 A Ct pelvis w/o dye 1.09 0.38 0.38 0.05 1.52 1.52 XXX 72192 TC A Ct pelvis w/o dye 0.00 5.80 NA 0.31 6.11 NA XXX 72193 A Ct pelvis w/dye 1.16 7.32 NA 0.41 8.89 NA XXX 72193 26 A Ct pelvis w/dye 1.16 0.40 0.40 0.05 1.61 1.61 XXX 72193 TC A Ct pelvis w/dye 0.00 6.92 NA 0.36 7.28 NA XXX 72194 A Ct pelvis w/o & w/dye 1.22 9.11 NA 0.48 10.81 NA XXX 72194 26 A Ct pelvis w/o & w/dye 1.22 0.42 0.42 0.05 1.69 1.69 XXX 72194 TC A Ct pelvis w/o & w/dye 0.00 8.69 NA 0.43 9.12 NA XXX 72195 A Mri pelvis w/o dye 1.46 12.01 NA 0.51 13.98 NA XXX 72195 26 A Mri pelvis w/o dye 1.46 0.50 0.50 0.06 2.03 2.03 XXX 72195 TC A Mri pelvis w/o dye 0.00 11.50 NA 0.45 11.95 NA XXX 72196 A Mri pelvis w/dye 1.73 14.11 NA 0.60 16.44 NA XXX 72196 26 A Mri pelvis w/dye 1.73 0.60 0.60 0.08 2.41 2.41 XXX 72196 TC A Mri pelvis w/dye 0.00 13.51 NA 0.52 14.03 NA XXX 72197 A Mri pelvis w/o & w/dye 2.26 23.58 NA 1.02 26.87 NA XXX 72197 26 A Mri pelvis w/o & w/dye 2.26 0.78 0.78 0.10 3.14 3.14 XXX
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 72197 TC A Mri pelvis w/o & w/dye 0.00 22.81 NA 0.92 23.73 NA XXX 72198 A Mr angio pelvis w/o & w/dye 1.80 12.37 NA 0.67 14.85 NA XXX 72198 26 A Mr angio pelvis w/o & w/dye 1.80 0.62 0.62 0.08 2.50 2.50 XXX 72198 TC A Mr angio pelvis w/o & w/dye 0.00 11.75 NA 0.59 12.34 NA XXX 72200 A X-ray exam sacroiliac joints 0.17 0.61 NA 0.03 0.81 NA XXX 72200 26 A X-ray exam sacroiliac joints 0.17 0.06 0.06 0.01 0.24 0.24 XXX 72200 TC A X-ray exam sacroiliac joints 0.00 0.54 NA 0.02 0.56 NA XXX 72202 A X-ray exam sacroiliac joints 0.19 0.72 NA 0.05 0.96 NA XXX 72202 26 A X-ray exam sacroiliac joints 0.19 0.06 0.06 0.01 0.26 0.26 XXX 72202 TC A X-ray exam sacroiliac joints 0.00 0.66 NA 0.04 0.70 NA XXX 72220 A X-ray exam of tailbone 0.17 0.63 NA 0.05 0.85 NA XXX 72220 26 A X-ray exam of tailbone 0.17 0.06 0.06 0.01 0.24 0.24 XXX 72220 TC A X-ray exam of tailbone 0.00 0.57 NA 0.04 0.61 NA XXX 72240 A Contrast x-ray of neck spine 0.91 4.45 NA 0.29 5.66 NA XXX 72240 26 A Contrast x-ray of neck spine 0.91 0.30 0.30 0.04 1.25 1.25 XXX 72240 TC A Contrast x-ray of neck spine 0.00 4.15 NA 0.25 4.40 NA XXX 72255 A Contrast x-ray, thorax spine 0.91 4.03 NA 0.26 5.20 NA XXX 72255 26 A Contrast x-ray, thorax spine 0.91 0.28 0.28 0.04 1.23 1.23 XXX 72255 TC A Contrast x-ray, thorax spine 0.00 3.74 NA 0.22 3.96 NA XXX 72265 A Contrast x-ray, lower spine 0.83 3.91 NA 0.26 5.00 NA XXX 72265 26 A Contrast x-ray, lower spine 0.83 0.26 0.26 0.04 1.13 1.13 XXX 72265 TC A Contrast x-ray, lower spine 0.00 3.65 NA 0.22 3.87 NA XXX 72270 A Contrast x-ray, spine 1.33 5.96 NA 0.39 7.68 NA XXX 72270 26 A Contrast x-ray, spine 1.33 0.44 0.44 0.06 1.83 1.83 XXX 72270 TC A Contrast x-ray, spine 0.00 5.52 NA 0.33 5.85 NA XXX 72275 A Epidurography 0.76 2.22 NA 0.26 3.25 NA XXX 72275 26 A Epidurography 0.76 0.20 0.20 0.04 1.00 1.00 XXX 72275 TC A Epidurography 0.00 2.03 NA 0.22 2.25 NA XXX 72285 A X-ray c/t spine disk 1.16 7.10 NA 0.50 8.76 NA XXX 72285 26 A X-ray c/t spine disk 1.16 0.37 0.37 0.07 1.60 1.60 XXX 72285 TC A X-ray c/t spine disk 0.00 6.73 NA 0.43 7.16 NA XXX
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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 533 and 534: 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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