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 99450 N Life/disability evaluation 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99455 R Disability examination 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99456 R Disability examination 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99499 C Unlisted e&m service 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99500 I Home visit, prenatal 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99501 I Home visit, postnatal 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99502 I Home visit, nb care 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99503 I Home visit, resp therapy 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99504 I Home visit mech ventilator 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99505 I Home visit, stoma care 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99506 I Home visit, im injection 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99507 I Home visit, cath maintain 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99509 I Home visit day life activity 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99510 I Home visit, sing/m/fam couns 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99511 I Home visit, fecal/enema mgmt 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99512 I Home visit for hemodialysis 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99600 I Home visit nos 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99601 I Home infusion/visit, 2 hrs 0.00 0.00 0.00 0.00 0.00 0.00 XXX 99602 I Home infusion, each addtl hr 0.00 0.00 0.00 0.00 0.00 0.00 XXX A4890 R Repair/maint cont hemo equip 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0150 R Comprehensve oral evaluation 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0240 R Intraoral occlusal film 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0250 R Extraoral first film 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0260 R Extraoral ea additional film 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0270 R Dental bitewing single film 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0272 R Dental bitewings two films 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0274 R Dental bitewings four films 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0277 R Vert bitewings-sev to eight 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0416 R Viral culture 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0421 R Gen tst suscept oral disease 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0431 R Diag tst detect mucos abnorm 0.00 0.00 0.00 0.00 0.00 0.00 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 D0460 R Pulp vitality test 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0472 R Gross exam, prep & report 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0473 R Micro exam, prep & report 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0474 R Micro w exam of surg margins 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0475 R Decalcification procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0476 R Spec stains for microorganis 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0477 R Spec stains not for microorg 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0478 R Immunohistochemical stains 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0479 R Tissue in-situ hybridization 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0480 R Cytopath smear prep & report 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0481 R Electron microscopy diagnost 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0482 R Direct immunofluorescence 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0483 R Indirect immunofluorescence 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0484 R Consult slides prep elsewher 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0485 R Consult inc prep of slides 0.00 0.00 0.00 0.00 0.00 0.00 XXX D0502 R Other oral pathology procedu 0.00 0.00 0.00 0.00 0.00 0.00 YYY D0999 R Unspecified diagnostic proce 0.00 0.00 0.00 0.00 0.00 0.00 YYY D1510 R Space maintainer fxd unilat 0.00 0.00 0.00 0.00 0.00 0.00 YYY D1515 R Fixed bilat space maintainer 0.00 0.00 0.00 0.00 0.00 0.00 YYY D1520 R Remove unilat space maintain 0.00 0.00 0.00 0.00 0.00 0.00 YYY D1525 R Remove bilat space maintain 0.00 0.00 0.00 0.00 0.00 0.00 YYY D1550 R Recement space maintainer 0.00 0.00 0.00 0.00 0.00 0.00 YYY D2999 R Dental unspec restorative pr 0.00 0.00 0.00 0.00 0.00 0.00 YYY D3460 R Endodontic endosseous implan 0.00 0.00 0.00 0.00 0.00 0.00 YYY D3999 R Endodontic procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY D4260 R Osseous surgery per quadrant 0.00 0.00 0.00 0.00 0.00 0.00 YYY D4263 R Bone replce graft first site 0.00 0.00 0.00 0.00 0.00 0.00 YYY D4264 R Bone replce graft each add 0.00 0.00 0.00 0.00 0.00 0.00 YYY D4268 R Surgical revision procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX D4270 R Pedicle soft tissue graft pr 0.00 0.00 0.00 0.00 0.00 0.00 YYY D4271 R Free soft tissue graft proc 0.00 0.00 0.00 0.00 0.00 0.00 YYY
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:
Page 599 and 600:
Page 601 and 602:
Page 603 and 604:
Page 605 and 606:
Page 607 and 608:
Page 609 and 610:
Page 611 and 612:
Page 613 and 614:
Page 615 and 616:
Page 617 and 618:
Page 619 and 620:
Page 621 and 622:
Page 623 and 624:
Page 625 and 626:
Page 627 and 628:
Page 629 and 630:
Page 631 and 632:
Page 633 and 634:
Page 635 and 636:
Page 637 and 638: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 687: ADDENDUM B: RELATIVE VALUE UNITS (R
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 739 and 740:
739 SSA State/County Code County an
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?