2006 proposed fee schedule - American Society of Clinical Oncology

More documents

Recommendations

Info

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 90999 C Dialysis procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX 91000 A Esophageal intubation 0.73 0.84 NA 0.04 1.62 NA 000 91000 26 A Esophageal intubation 0.73 0.25 0.25 0.03 1.01 1.01 000 91000 TC A Esophageal intubation 0.00 0.59 NA 0.01 0.60 NA 000 91010 A Esophagus motility study 1.25 4.76 NA 0.12 6.14 NA 000 91010 26 A Esophagus motility study 1.25 0.47 0.47 0.06 1.78 1.78 000 91010 TC A Esophagus motility study 0.00 4.30 NA 0.06 4.36 NA 000 91011 A Esophagus motility study 1.50 5.79 NA 0.13 7.42 NA 000 91011 26 A Esophagus motility study 1.50 0.57 0.57 0.07 2.15 2.15 000 91011 TC A Esophagus motility study 0.00 5.22 NA 0.06 5.28 NA 000 91012 A Esophagus motility study 1.46 5.76 NA 0.13 7.35 NA 000 91012 26 A Esophagus motility study 1.46 0.55 0.55 0.06 2.07 2.07 000 91012 TC A Esophagus motility study 0.00 5.21 NA 0.07 5.28 NA 000 91020 A Gastric motility 1.44 4.49 NA 0.13 6.07 NA 000 91020 26 A Gastric motility 1.44 0.51 0.51 0.07 2.02 2.02 000 91020 TC A Gastric motility 0.00 3.99 NA 0.06 4.05 NA 000 91030 A Acid perfusion of esophagus 0.91 2.67 NA 0.06 3.64 NA 000 91030 26 A Acid perfusion of esophagus 0.91 0.35 0.35 0.04 1.30 1.30 000 91030 TC A Acid perfusion of esophagus 0.00 2.32 NA 0.02 2.34 NA 000 91034 A Gastroesophageal reflux test 0.97 5.70 NA 0.12 6.79 NA XXX 91034 26 A Gastroesophageal reflux test 0.97 0.36 0.36 0.06 1.40 1.40 XXX 91034 TC A Gastroesophageal reflux test 0.00 5.33 NA 0.06 5.39 NA XXX 91035 A G-esoph reflx tst w/electrod 1.59 11.65 NA 0.12 13.36 NA XXX 91035 26 A G-esoph reflx tst w/electrod 1.59 0.60 0.60 0.06 2.25 2.25 XXX 91035 TC A G-esoph reflx tst w/electrod 0.00 11.05 NA 0.06 11.11 NA XXX 91037 A Esoph imped function test 0.97 3.22 NA 0.12 4.32 NA XXX 91037 26 A Esoph imped function test 0.97 0.36 0.36 0.06 1.40 1.40 XXX 91037 TC A Esoph imped function test 0.00 2.86 NA 0.06 2.92 NA XXX 91038 A Esoph imped funct test > 1h 1.10 2.47 NA 0.12 3.69 NA XXX 91038 26 A Esoph imped funct test > 1h 1.10 0.42 0.42 0.06 1.58 1.58 XXX 91038 TC A Esoph imped funct test > 1h 0.00 2.05 NA 0.06 2.11 NA 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 91040 A Esoph balloon distension tst 0.97 11.26 NA 0.12 12.35 NA XXX 91040 26 A Esoph balloon distension tst 0.97 0.36 0.36 0.06 1.40 1.40 XXX 91040 TC A Esoph balloon distension tst 0.00 10.89 NA 0.06 10.95 NA XXX 91052 A Gastric analysis test 0.79 2.64 NA 0.05 3.48 NA 000 91052 26 A Gastric analysis test 0.79 0.30 0.30 0.03 1.12 1.12 000 91052 TC A Gastric analysis test 0.00 2.34 NA 0.02 2.36 NA 000 91055 A Gastric intubation for smear 0.94 2.91 NA 0.07 3.92 NA 000 91055 26 A Gastric intubation for smear 0.94 0.27 0.27 0.05 1.26 1.26 000 91055 TC A Gastric intubation for smear 0.00 2.64 NA 0.02 2.66 NA 000 91060 A Gastric saline load test 0.45 1.89 NA 0.05 2.39 NA 000 91060 26 A Gastric saline load test 0.45 0.14 0.14 0.03 0.62 0.62 000 91060 TC A Gastric saline load test 0.00 1.75 NA 0.02 1.77 NA 000 91065 A Breath hydrogen test 0.20 1.62 NA 0.03 1.85 NA 000 91065 26 A Breath hydrogen test 0.20 0.07 0.07 0.01 0.28 0.28 000 91065 TC A Breath hydrogen test 0.00 1.55 NA 0.02 1.57 NA 000 91100 A Pass intestine bleeding tube 1.08 2.70 0.28 0.07 3.85 1.43 000 91105 A Gastric intubation treatment 0.37 1.99 0.09 0.03 2.39 0.49 000 91110 A Gi tract capsule endoscopy 3.65 24.17 NA 0.16 27.98 NA XXX 91110 26 A Gi tract capsule endoscopy 3.65 1.38 1.38 0.09 5.12 5.12 XXX 91110 TC A Gi tract capsule endoscopy 0.00 22.79 NA 0.07 22.86 NA XXX 91120 A Rectal sensation test 0.97 11.11 NA 0.11 12.19 NA XXX 91120 26 A Rectal sensation test 0.97 0.36 0.36 0.07 1.41 1.41 XXX 91120 TC A Rectal sensation test 0.00 10.74 NA 0.04 10.78 NA XXX 91122 A Anal pressure record 1.77 5.15 NA 0.21 7.13 NA 000 91122 26 A Anal pressure record 1.77 0.62 0.62 0.13 2.52 2.52 000 91122 TC A Anal pressure record 0.00 4.53 NA 0.08 4.61 NA 000 91123 B Irrigate fecal impaction 0.00 0.00 0.00 0.00 0.00 0.00 XXX 91132 C Electrogastrography 0.00 0.00 0.00 0.00 0.00 0.00 XXX 91132 26 A Electrogastrography 0.52 0.20 0.20 0.02 0.74 0.74 XXX 91132 TC C Electrogastrography 0.00 0.00 0.00 0.00 0.00 0.00 XXX 91133 C Electrogastrography w/test 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Page 1 and 2:
DEPARTMENT OF HEALTH AND HUMAN SERV
Page 3 and 4:
2. By mail. You may mail written co
Page 5 and 6:
Rick Ensor (410) 786-5617 (for issu
Page 7 and 8:
service of the U.S. Government Prin
Page 9 and 10:
4. Proposed Revisions to §413.170
Page 11 and 12:
AGA American Gastroenterological As
Page 13 and 14:
GAO General Accounting Office GPCI
Page 15 and 16:
PLI Professional liability insuranc
Page 17 and 18:
Initially, only the physician work
Page 19 and 20:
This resource-based system was base
Page 21 and 22:
effect in 1997, published on Novemb
Page 23 and 24:
● Revised requirements for superv
Page 25 and 26:
efinement of work RVUs; and solicit
Page 27 and 28:
historical allowed charges. This le
Page 29 and 30:
November 1, 2001 (66 FR 55246).) Th
Page 31 and 32:
The CPEPs identified specific input
Page 33 and 34:
codes that the RUC has not yet revi
Page 35 and 36:
procedure: $27,305,408. In this exa
Page 37 and 38:
as a whole. Indirect costs include
Page 39 and 40:
● The unscaled indirect expense a
Page 41 and 42:
BNF is applied to (multiplied by) t
Page 43 and 44:
NPWP Step 2--Calculation of Charge-
Page 45 and 46:
In Table 11, the scaled total direc
Page 47 and 48:
TABLE 13--Budget Neutrality and Fin
Page 49 and 50:
The following discussion outlines t
Page 51 and 52:
exist, and suggests that the need f
Page 53 and 54:
TABLE 14--Practice Expense Per Hour
Page 55 and 56:
We believe that we have consistentl
Page 57 and 58:
Due to the ongoing refinement by th
Page 59 and 60:
indirect PE methodology is inaccura
Page 61 and 62:
multi-specialty PEAC that were base
Page 63 and 64:
the needed survey or other data or
Page 65 and 66:
PERC/RUC recommendations for these
Page 67 and 68:
eflect the typical number of cast c
Page 69 and 70:
on comments received and additional
Page 71 and 72:
We have reviewed the PE database an
Page 73 and 74:
the ACR. We have accepted the follo
Page 75 and 76:
● Clinical Labor for G-codes Rela
Page 77 and 78:
proposed associated prices that we
Page 79 and 80:
Supply Code Supply Description Unit
Page 81 and 82:
● Supply and Equipment Items Need
Page 83 and 84:
Code 2005 Description Unit Unit Pri
Page 85 and 86:
Code 2005 Description Price EQ212 p
Page 87 and 88:
Effective January 1, 2006, this pro
Page 89 and 90:
challenge the validity of a new loc
Page 91 and 92:
ones reconfigured). Yet we also rec
Page 93 and 94:
The issue of payment locality desig
Page 95 and 96:
specialties listed infrequently as
Page 97 and 98:
for premium rating purposes. ISO co
Page 99 and 100:
psychology to the nonsurgical risk
Page 101 and 102:
to anesthesiology which is 2.84 rat
Page 103 and 104:
103 However, as noted previously in
Page 105 and 106:
● Category #1: Services that are
Page 107 and 108:
G0270, G0271 and 97802 through 9780
Page 109 and 110:
Group Medical Nutritional Therapy (
Page 111 and 112:
111 furnished in the group setting
Page 113 and 114:
CMS Review 113 As noted previously,
Page 115 and 116:
system that permits the physician a
Page 117 and 118:
117 associated with the provided se
Page 119 and 120:
119 overlapping surgeries, the teac
Page 121 and 122:
anesthesia programs that have arran
Page 123 and 124:
123 Section 623 of the MMA also req
Page 125 and 126:
125 hospital-based facilities; whil
Page 127 and 128:
127 The next step would be to devel
Page 129 and 130:
Drugs Second Quarter ASP +6 Percent
Page 131 and 132:
131 independent facilities, to acco
Page 133 and 134:
133
Page 135 and 136:
distributed this over a total proje
Page 137 and 138:
137 additional 0.7 percent addition
Page 139 and 140:
139 billed drugs regardless of sett
Page 141 and 142:
141 than 0.9000 are paid more than
Page 143 and 144:
adoption of the new hospital wage i
Page 145 and 146:
of geographic designations for purp
Page 147 and 148:
and they may or may not be suitable
Page 149 and 150:
the Medicare Geographic Classificat
Page 151 and 152:
(2) Metropolitan Divisions Under OM
Page 153 and 154:
153 applying revised composite paym
Page 155 and 156:
ased on the labor components establ
Page 157 and 158:
157 actual cost structure faced by
Page 159 and 160:
159 ESRD facilities is 53.711, as s
Page 161 and 162:
from the cost reports. To avoid dou
Page 163 and 164:
from Worksheet A. The resulting mar
Page 165 and 166:
(1) Hospital Data Used In this prop
Page 167 and 168:
wage data ended. However, since the
Page 169 and 170:
approach to phasing-in the proposed
Page 171 and 172:
facilities that would receive lower
Page 173 and 174:
173 wage index values and then simu
Page 175 and 176:
175 Because Neighborhood Dialysis C
Page 177 and 178:
177 detected through our receipt of
Page 179 and 180:
179 CBSA Code Urban Area Wage (Cons
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
TABLE 28--Proposed ESRD Wage Index
Page 219 and 220:
● Extraordinary circumstances (§
Page 221 and 222:
effect as long as the rate exceeds
Page 223 and 224:
● Adding a definition of a “ped
Page 225 and 226:
exception rate. The facility would
Page 227 and 228:
their intermediaries. Current parag
Page 229 and 230:
229 costs are reasonable and allowa
Page 231 and 232:
231 revised paragraph, a facility w
Page 233 and 234:
H. Payment for Covered Outpatient D
Page 235 and 236:
calculation. We also discuss the su
Page 237 and 238:
customers (for example, physicians)
Page 239 and 240:
239 We believe the weighted average
Page 241 and 242:
number of 11-digit NDCs sold for ea
Page 243 and 244:
243 included in the template, it is
Page 245 and 246:
current reporting format is an appr
Page 247 and 248:
247 section 1847A of the Act for th
Page 249 and 250:
each quarter at the following web s
Page 251 and 252:
251 We also note MedPAC’s recomme
Page 253 and 254:
costs and units. We seek comments a
Page 255 and 256:
255 pays for DME and associated sup
Page 257 and 258:
pharmacy activities required to get
Page 259 and 260:
259 representing 42 percent of the
Page 261 and 262:
261 basic pharmacy services such as
Page 263 and 264:
seek comment on the potential impac
Page 265 and 266:
265 overpaying for the costs associ
Page 267 and 268:
267 and information about how pharm
Page 269 and 270:
269 takes good faith efforts to res
Page 271 and 272:
271 Specifically, we consider that
Page 273 and 274:
supplies. Using billing data, we id
Page 275 and 276:
70481 CT orbit/ear/fossa w/ dye 704
Page 277 and 278:
K. Therapy Cap 73223 MRI joint uppe
Page 279 and 280:
provided for an active subluxation
Page 281 and 282:
is less than 2 percent of spending
Page 283 and 284:
(2) entities determined by the Secr
Page 285 and 286:
285 We are proposing a supplemental
Page 287 and 288:
FQHC claim form to effectuate the b
Page 289 and 290:
289 can issue a final determination
Page 291 and 292:
291 conclude that Hispanic persons
Page 293 and 294:
293 nuclear medicine services in ei
Page 295 and 296:
adiopharmaceuticals. In the final r
Page 297 and 298:
297 (including Nuclear Medicine and
Page 299 and 300:
we would resolve any doubt on the m
Page 301 and 302:
facility payment rather than a TC c
Page 303 and 304:
ventures and leases, pose a risk of
Page 305 and 306:
305 Underlying the projected rate r
Page 307 and 308:
decisions are central to the health
Page 309 and 310:
however. We are particularly intere
Page 311 and 312:
The collection requirement in this
Page 313 and 314:
eporting requirements are discussed
Page 315 and 316:
IV. Response to Comments Because of
Page 317 and 318:
achieve the objectives with less si
Page 319 and 320:
319 The analysis and discussion pro
Page 321 and 322:
321 for a new code may change becau
Page 323 and 324:
323 TABLE 30--Impact of Practice Ex
Page 325 and 326:
hour for these specialties. As note
Page 327 and 328:
Both physical/occupational therapy
Page 329 and 330:
329 proposing to add cardiology cat
Page 331 and 332:
Speciality Impact of Removing Aberr
Page 333 and 334:
Family TABLE 32--Impact of Multiple
Page 335 and 336:
335 column includes the current est
Page 337 and 338:
Specialty Medicare Allowed Charges
Page 339 and 340:
339 Non-Facility Facility % % HCPCS
Page 341 and 342:
341 have undertaken a similar analy
Page 343 and 344:
of the updated GPCI data. For the R
Page 345 and 346:
C. Medicare Telehealth Services In
Page 347 and 348:
347 TABLE 37--Impact of Proposed Ch
Page 349 and 350:
349 of the increase to the drug add
Page 351 and 352:
plus current AAP priced drug paymen
Page 353 and 354:
353 the center up to what it would
Page 355 and 356:
satisfies the requirements of the i
Page 357 and 358:
357 certainty the extent of these s
Page 359 and 360:
delivery arrangements and would hel
Page 361 and 362:
List of Subjects 42 CFR Part 405 Ad
Page 363 and 364:
(including by refunding amounts in
Page 365 and 366:
(2) Any financial incentives provid
Page 367 and 368:
7. The authority citation for part
Page 369 and 370:
* * * * * PART 413--PRINCIPLES OF R
Page 371 and 372:
371 D. Redesignating paragraphs (l)
Page 373 and 374:
373 (3) The additional nursing hour
Page 375 and 376:
cost components relating to trainin
Page 377 and 378:
CAPD and CCPD) when the facility ac
Page 379 and 380:
Indirect Sales means from the manuf
Page 381 and 382:
amount for the quarter to the neare
Page 383 and 384:
383 25. The heading for Part 426 is
Page 385 and 386:
385 (Catalog of Federal Domestic As
Page 387 and 388:
1. CPT/HCPCS code. This is the CPT
Page 389 and 390:
grace period. This indicator is no
Page 391 and 392:
5. Physician work RVUs. These are t
Page 393 and 394:
ADDENDUM B: RELATIVE VALUE UNITS (R
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469 and 470:
Page 471 and 472:
Page 473 and 474:
Page 475 and 476:
Page 477 and 478:
Page 479 and 480:
Page 481 and 482:
Page 483 and 484:
Page 485 and 486:
Page 487 and 488:
Page 489 and 490:
Page 491 and 492:
Page 493 and 494:
Page 495 and 496:
Page 497 and 498:
Page 499 and 500:
Page 501 and 502:
Page 503 and 504:
Page 505 and 506:
Page 507 and 508:
Page 509 and 510:
Page 511 and 512:
Page 513 and 514:
Page 515 and 516:
Page 517 and 518:
Page 519 and 520:
Page 521 and 522:
Page 523 and 524:
Page 525 and 526:
Page 527 and 528:
Page 529 and 530:
Page 531 and 532:
Page 533 and 534:
Page 535 and 536:
Page 537 and 538:
Page 539 and 540:
Page 541 and 542:
Page 543 and 544:
Page 545 and 546:
Page 547 and 548:
Page 549 and 550:
Page 551 and 552:
Page 553 and 554:
Page 555 and 556:
Page 557 and 558:
Page 559 and 560:
Page 561 and 562:
Page 563 and 564:
Page 565 and 566:
Page 567 and 568:
Page 569 and 570:
Page 571 and 572:
Page 573 and 574:
Page 575 and 576:
Page 577 and 578:
Page 579 and 580:
Page 581 and 582:
Page 583 and 584:
Page 585 and 586:
Page 587 and 588:
Page 589 and 590:
Page 591 and 592:
Page 593 and 594:
Page 595 and 596:
Page 597 and 598: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 647: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 699 and 700:
Page 701 and 702:
Page 703 and 704:
CPT Code Short Descriptors 21480 Re
Page 705 and 706:
CPT Code Short Descriptors 92284 Da
Page 707 and 708:
Addendum D 2006 GEOGRAPHIC PRACTICE
Page 709 and 710:
Carrier Locality Locality name Work
Page 711 and 712:
Carrier Locality Locality Name 2006
Page 713 and 714:
Addendum F ESRD FACILITIES- METROPO
Page 715 and 716:
715 SSA State/County Code County an
Page 717 and 718:
Page 719 and 720:
Page 721 and 722:
Page 723 and 724:
Page 725 and 726:
Page 727 and 728:
Page 729 and 730:
Page 731 and 732:
Page 733 and 734:
Page 735 and 736:
Page 737 and 738:
Page 739 and 740:
Page 741 and 742:
Page 743 and 744:
Page 745 and 746:
Page 747 and 748:
Page 749 and 750:
Page 751 and 752:
Page 753 and 754:
Page 755 and 756:
Page 757 and 758:
Page 759 and 760:
Page 761 and 762:
Page 763 and 764:
Page 765 and 766:
Page 767 and 768:
Page 769 and 770:
Page 771 and 772:
Page 773 and 774:
Page 775 and 776:
Page 777 and 778:
CPT/HCPCS Codes MOD DESCRIPTION STA
Page 779 and 780:
Page 781 and 782:
Page 783 and 784:
Page 785 and 786:
Page 787:
show all

2006 proposed fee schedule - American Society of Clinical Oncology

Create successful ePaper yourself

Delete template?

Save as template?