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 G0037 26 I PET follow cornry angio mult 1.87 0.74 0.74 0.06 2.67 2.67 XXX G0037 TC I PET follow cornry angio mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0038 I PET follow myocard perf sing 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0038 26 I PET follow myocard perf sing 1.50 0.51 0.51 0.07 2.09 2.09 XXX G0038 TC I PET follow myocard perf sing 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0039 I PET follow myocard perf mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0039 26 I PET follow myocard perf mult 1.87 0.74 0.74 0.07 2.69 2.69 XXX G0039 TC I PET follow myocard perf mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0040 I PET follow stress echo singl 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0040 26 I PET follow stress echo singl 1.50 0.61 0.61 0.06 2.18 2.18 XXX G0040 TC I PET follow stress echo singl 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0041 I PET follow stress echo mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0041 26 I PET follow stress echo mult 1.87 0.76 0.76 0.06 2.70 2.70 XXX G0041 TC I PET follow stress echo mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0042 I PET follow ventriculogm sing 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0042 26 I PET follow ventriculogm sing 1.50 0.63 0.63 0.05 2.18 2.18 XXX G0042 TC I PET follow ventriculogm sing 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0043 I PET follow ventriculogm mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0043 26 I PET follow ventriculogm mult 1.87 0.79 0.79 0.07 2.73 2.73 XXX G0043 TC I PET follow ventriculogm mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0044 I PET following rest ECG singl 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0044 26 I PET following rest ECG singl 1.50 0.62 0.62 0.05 2.17 2.17 XXX G0044 TC I PET following rest ECG singl 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0045 I PET following rest ECG mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0045 26 I PET following rest ECG mult 1.87 0.75 0.75 0.06 2.69 2.69 XXX G0045 TC I PET following rest ECG mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0046 I PET follow stress ECG singl 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0046 26 I PET follow stress ECG singl 1.50 0.62 0.62 0.05 2.17 2.17 XXX G0046 TC I PET follow stress ECG singl 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0047 I PET follow stress ECG mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0047 26 I PET follow stress ECG mult 1.87 0.76 0.76 0.06 2.70 2.70 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 G0047 TC I PET follow stress ECG mult 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0101 A CA screen;pelvic/breast exam 0.45 0.51 0.17 0.02 0.98 0.64 XXX G0102 A Prostate ca screening; dre 0.17 0.38 0.06 0.01 0.56 0.24 XXX G0104 A CA screen;flexi sigmoidscope 0.96 2.33 0.55 0.08 3.37 1.59 000 G0105 A Colorectal scrn; hi risk ind 3.70 6.60 1.58 0.30 10.59 5.57 000 G0105 53 A Colorectal scrn; hi risk ind 0.96 2.33 0.55 0.08 3.37 1.59 000 G0106 A Colon CA screen;barium enema 0.99 3.35 NA 0.17 4.51 NA XXX G0106 26 A Colon CA screen;barium enema 0.99 0.34 0.34 0.04 1.37 1.37 XXX G0106 TC A Colon CA screen;barium enema 0.00 3.02 NA 0.13 3.15 NA XXX G0108 A Diab manage trn per indiv 0.00 0.83 NA 0.01 0.84 NA XXX G0109 A Diab manage trn ind/group 0.00 0.48 NA 0.01 0.49 NA XXX G0110 R Nett pulm-rehab educ; ind 0.90 0.68 NA 0.04 1.62 NA XXX G0111 R Nett pulm-rehab educ; group 0.27 0.30 NA 0.01 0.58 NA XXX G0112 R Nett;nutrition guid, initial 1.72 1.26 0.65 0.04 3.02 2.41 XXX G0113 R Nett;nutrition guid,subseqnt 1.29 0.81 0.40 0.05 2.15 1.74 XXX G0114 R Nett; psychosocial consult 1.20 0.46 NA 0.05 1.71 NA XXX G0115 R Nett; psychological testing 1.20 0.78 NA 0.03 2.01 NA XXX G0116 R Nett; psychosocial counsel 1.11 0.94 0.32 0.05 2.10 1.49 XXX G0117 T Glaucoma scrn hgh risk direc 0.45 0.73 0.19 0.01 1.19 0.65 XXX G0118 T Glaucoma scrn hgh risk direc 0.17 0.55 0.06 0.01 0.73 0.24 XXX G0120 A Colon ca scrn; barium enema 0.99 3.35 NA 0.17 4.51 NA XXX G0120 26 A Colon ca scrn; barium enema 0.99 0.34 0.34 0.04 1.37 1.37 XXX G0120 TC A Colon ca scrn; barium enema 0.00 3.02 NA 0.13 3.15 NA XXX G0121 A Colon ca scrn not hi rsk ind 3.70 6.60 1.58 0.30 10.59 5.57 000 G0121 53 A Colon ca scrn not hi rsk ind 0.96 2.33 0.55 0.08 3.37 1.59 000 G0122 N Colon ca scrn; barium enema 0.99 3.51 NA 0.18 4.68 NA XXX G0122 26 N Colon ca scrn; barium enema 0.99 0.38 0.38 0.05 1.42 1.42 XXX G0122 TC N Colon ca scrn; barium enema 0.00 3.13 NA 0.13 3.26 NA XXX G0124 A Screen c/v thin layer by MD 0.42 0.23 0.15 0.02 0.67 0.59 XXX G0125 I PET image pulmonary nodule 0.00 0.00 0.00 0.00 0.00 0.00 XXX G0125 26 I PET image pulmonary nodule 1.50 0.54 0.54 0.06 2.11 2.11 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 641 and 642: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 691: 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
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CPT/HCPCS Codes MOD DESCRIPTION STA
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