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 92601 A Cochlear implt f/up exam < 7 0.00 3.54 NA 0.07 3.61 NA XXX 92602 A Reprogram cochlear implt < 7 0.00 2.41 NA 0.07 2.48 NA XXX 92603 A Cochlear implt f/up exam 7 > 0.00 2.19 NA 0.07 2.26 NA XXX 92604 A Reprogram cochlear implt 7 > 0.00 1.39 NA 0.07 1.46 NA XXX 92605 B Eval for nonspeech device rx 0.00 0.00 0.00 0.00 0.00 0.00 XXX 92606 B Non-speech device service 0.00 0.00 0.00 0.00 0.00 0.00 XXX 92607 A Ex for speech device rx, 1hr 0.00 3.11 NA 0.05 3.16 NA XXX 92608 A Ex for speech device rx addl 0.00 0.56 NA 0.05 0.61 NA XXX 92609 A Use of speech device service 0.00 1.61 NA 0.04 1.65 NA XXX 92610 A Evaluate swallowing function 0.00 2.97 NA 0.08 3.05 NA XXX 92611 A Motion fluoroscopy/swallow 0.00 3.09 NA 0.08 3.17 NA XXX 92612 A Endoscopy swallow tst (fees) 1.27 2.74 0.63 0.04 4.06 1.95 XXX 92613 A Endoscopy swallow tst (fees) 0.71 0.38 0.38 0.05 1.14 1.14 XXX 92614 A Laryngoscopic sensory test 1.27 2.47 0.63 0.04 3.78 1.95 XXX 92615 A Eval laryngoscopy sense tst 0.63 0.34 0.34 0.05 1.02 1.02 XXX 92616 A Fees w/laryngeal sense test 1.88 3.31 0.95 0.06 5.26 2.90 XXX 92617 A Interprt fees/laryngeal test 0.79 0.42 0.42 0.05 1.26 1.26 XXX 92620 A Auditory function, 60 min 0.00 1.18 NA 0.06 1.24 NA XXX 92621 A Auditory function, + 15 min 0.00 0.26 NA 0.06 0.32 NA ZZZ 92625 A Tinnitus assessment 0.00 1.16 NA 0.06 1.22 NA XXX 92700 C Ent procedure/service 0.00 0.00 0.00 0.00 0.00 0.00 XXX 92950 A Heart/lung resuscitation cpr 3.80 3.97 0.95 0.28 8.04 5.03 000 92953 A Temporary external pacing 0.23 NA 0.07 0.02 NA 0.32 000 92960 A Cardioversion electric, ext 2.25 6.22 1.26 0.07 8.55 3.58 000 92961 A Cardioversion, electric, int 4.60 NA 2.19 0.29 NA 7.08 000 92970 A Cardioassist, internal 3.52 NA 1.06 0.16 NA 4.74 000 92971 A Cardioassist, external 1.77 NA 0.91 0.06 NA 2.74 000 92973 A Percut coronary thrombectomy 3.29 NA 1.35 0.23 NA 4.86 ZZZ 92974 A Cath place, cardio brachytx 3.01 NA 1.24 0.21 NA 4.45 ZZZ 92975 A Dissolve clot, heart vessel 7.25 NA 2.94 0.50 NA 10.69 000 92977 A Dissolve clot, heart vessel 0.00 6.62 NA 0.46 7.08 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 92978 A Intravasc us, heart add-on 1.80 NA NA 0.30 NA NA ZZZ 92978 26 A Intravasc us, heart add-on 1.80 0.74 0.74 0.06 2.61 2.61 ZZZ 92978 TC A Intravasc us, heart add-on 0.00 NA NA 0.24 NA NA ZZZ 92979 A Intravasc us, heart add-on 1.44 NA NA 0.19 NA NA ZZZ 92979 26 A Intravasc us, heart add-on 1.44 0.59 0.59 0.06 2.09 2.09 ZZZ 92979 TC A Intravasc us, heart add-on 0.00 NA NA 0.13 NA NA ZZZ 92980 A Insert intracoronary stent 14.85 NA 6.36 1.03 NA 22.24 000 92981 A Insert intracoronary stent 4.17 NA 1.71 0.29 NA 6.17 ZZZ 92982 A Coronary artery dilation 10.98 NA 4.77 0.76 NA 16.52 000 92984 A Coronary artery dilation 2.98 NA 1.21 0.21 NA 4.40 ZZZ 92986 A Revision of aortic valve 21.81 NA 12.62 1.51 NA 35.94 090 92987 A Revision of mitral valve 22.72 NA 13.01 1.59 NA 37.32 090 92990 A Revision of pulmonary valve 17.34 NA 10.33 1.20 NA 28.87 090 92992 C Revision of heart chamber 0.00 0.00 0.00 0.00 0.00 0.00 090 92993 C Revision of heart chamber 0.00 0.00 0.00 0.00 0.00 0.00 090 92995 A Coronary atherectomy 12.09 NA 5.22 0.84 NA 18.16 000 92996 A Coronary atherectomy add-on 3.27 NA 1.33 0.10 NA 4.70 ZZZ 92997 A Pul art balloon repr, percut 12.00 NA 5.04 0.40 NA 17.44 000 92998 A Pul art balloon repr, percut 6.00 NA 2.24 0.28 NA 8.53 ZZZ 93000 A Electrocardiogram, complete 0.17 0.47 NA 0.03 0.67 NA XXX 93005 A Electrocardiogram, tracing 0.00 0.41 NA 0.02 0.43 NA XXX 93010 A Electrocardiogram report 0.17 0.06 0.06 0.01 0.24 0.24 XXX 93012 A Transmission of ecg 0.00 4.81 NA 0.18 4.99 NA XXX 93014 A Report on transmitted ecg 0.52 0.19 0.19 0.02 0.73 0.73 XXX 93015 A Cardiovascular stress test 0.75 2.11 NA 0.14 3.00 NA XXX 93016 A Cardiovascular stress test 0.45 0.18 0.18 0.02 0.65 0.65 XXX 93017 A Cardiovascular stress test 0.00 1.82 NA 0.11 1.93 NA XXX 93018 A Cardiovascular stress test 0.30 0.12 0.12 0.01 0.43 0.43 XXX 93024 A Cardiac drug stress test 1.17 1.93 NA 0.12 3.22 NA XXX 93024 26 A Cardiac drug stress test 1.17 0.47 0.47 0.04 1.68 1.68 XXX 93024 TC A Cardiac drug stress test 0.00 1.46 NA 0.08 1.54 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 605 and 606: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 655: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 703 and 704: CPT Code Short Descriptors 21480 Re
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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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CPT/HCPCS Codes MOD DESCRIPTION STA
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