2006 proposed fee schedule - American Society of Clinical Oncology

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CPT Code Short Descriptors 60001 Aspirate/inject thyriod cyst 61888 Revise/remove neuroreceiver 62194 Replace/irrigate catheter 67221 Ocular photodynamic ther 67225 Eye photodynamic ther add-on 68400 Incise/drain tear gland 68420 Incise/drain tear sac 68510 Biopsy of tear gland 68530 Clearance of tear duct 69100 Biopsy of external ear 69300 Revise external ear 76120 Cine/video x-rays 76940 Us guide, tissue ablation 76942 Echo guide for biopsy 76975 GI endoscopic ultrasound 78160 Plasma iron turnover 78162 Radioiron absorption exam 78170 Red cell iron utilization 78172 Total body iron estimation 78282 GI protein loss exam 78350 Bone mineral, single photon 78351 Bone mineral, dual photon 78455 Venous thrombosis study 79200 Nuclear rx, intracav admin 79300 Nuclr rx, interstit colloid 79440 Nuclear rx, intra-articular 86585 TB tine test 88355 Analysis, skeletal muscle 88356 Analysis, nerve 89100 Sample intestinal contents 89105 Sample intestinal contents 89130 Sample stomach contents 89132 Sample stomach contents 89135 Sample stomach contents 89136 Sample stomach contents 89140 Sample stomach contents 89141 Sample stomach contents 90465 Immune admin 1 inj, < 8 yrs 90466 Immune admin addl inj, < 8 y 90467 Immune admin o or n, < 8 yrs 90468 Immune admin o/n, addl < 8 y 90880 Hypnotherapy 90997 Hemoperfusion 92015 Refraction 92230 Eye exam with photos 92260 Ophthalmoscopy/dynamometry 92265 Eye muscle evaluation 704
CPT Code Short Descriptors 92284 Dark adaptation eye exam 92287 Internal eye photography 92310 Contact lens fitting 92311 Contact lens fitting 92312 Contact lens fitting 92313 Contact lens fitting 92314 Prescription of contact lens 92315 Prescription of contact lens 92316 Prescription of contact lens 92317 Prescription of contact lens 92340 Fitting of spectacles 92341 Fitting of spectacles 92342 Fitting of spectacles 92370 Repair & adjust spectacles 92510 Rehab for ear implant 92551 Pure tone hearing test, air 93012 Transmission of ecg 93271 Ecg/monitoring and analysis 93561 Cardiac output measurement 93562 Cardiac output measurement 94014 Patient recorded spirometry 94015 Patient recorded spirometry 94016 Review patient spirometry 94200 Lung function test (MBC/MVV) 94250 Expired gas collection 94350 Lung nitrogen washout curve 94370 Breath airway closing volume 94400 CO2 breathing response curve 94620 Pulmonary stress test/simple 94660 Pos airway pressure, CPAP 94667 Chest wall manipulation 94668 Chest wall manipulation 94680 Exhaled air analysis, o2 94681 Exhaled air analysis, o2/co2 94690 Exhaled air analysis 94725 Membrane diffusion capacity 94750 Pulmonary compliance study 95060 Eye allergy tests 95065 Nose allergy test 95071 Bronchial allergy tests 95075 Ingestion challenge test 95078 Provocative testing 95805 Multiple sleep latency test 95812 Eeg, 41-60 minutes 95813 Eeg, over 1 hour 95816 Eeg, awake and drowsy 95819 Eeg, awake and asleep 705
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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 653 and 654: ADDENDUM B: RELATIVE VALUE UNITS (R
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755 SSA State/County Code County an
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CPT/HCPCS Codes MOD DESCRIPTION STA
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