2006 proposed fee schedule - American Society of Clinical Oncology

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CPT Code Short Descriptors 95822 Eeg, coma or sleep only 95950 Ambulatory eeg monitoring 95954 EEG monitoring/giving drugs 95956 Eeg monitoring, cable/radio 96900 Ultraviolet light therapy 96105 Assessment of aphasia 99185 Regional hypothermia 99186 Total body hypothermia 706
Addendum D 2006 GEOGRAPHIC PRACTICE COST INDICIES (GPCI) BY MEDICARE CARRIER AND LOCALITY Carrier Locality Locality name Work GPCI PE GPCI MP GPCI 00510 00 Alabama 1.000 0.846 0.752 00831 01 Alaska 1.017 1.103 1.029 00832 00 Arizona 1.000 0.992 1.069 00520 13 Arkansas 1.000 0.831 0.438 31140 03 Marin/Napa/Solano, CA 1.035 1.340 0.651 31140 05 San Francisco, CA 1.060 1.543 0.651 31140 06 San Mateo, CA 1.073 1.536 0.639 31140 07 Oakland/Berkley, CA 1.054 1.371 0.651 31140 09 Santa Clara, CA 1.083 1.540 0.604 31140 TBD** Santa Cruz, CA 1.014 1.218 0.717 31140 99 Rest of California* 1.010 1.042 0.717 31146 17 Ventura, CA 1.028 1.179 0.744 31146 18 Los Angeles, CA 1.041 1.156 0.954 31146 26 Anaheim/Santa Ana, CA 1.034 1.236 0.954 31140 TBD** Sonoma, CA 1.017 1.230 0.717 31146 99 Rest of California* 1.010 1.042 0.717 00824 01 Colorado 1.000 1.014 0.803 00591 00 Connecticut 1.038 1.170 0.900 00903 01 DC + MD/VA Suburbs 1.048 1.250 0.926 00902 01 Delaware 1.012 1.018 0.892 00590 03 Fort Lauderdale, FL 1.000 0.988 1.703 00590 04 Miami, FL 1.000 1.046 2.269 00590 99 Rest of Florida 1.000 0.934 1.272 00511 01 Atlanta, GA 1.010 1.089 0.966 00511 99 Rest of Georgia 1.000 0.872 0.966 00833 01 Hawaii/Guam 1.005 1.111 0.800 05130 00 Idaho 1.000 0.868 0.459 00952 12 East St. Louis, IL 1.000 0.939 1.750 00952 15 Suburban Chicago, IL 1.018 1.115 1.652 00952 16 Chicago, IL 1.025 1.126 1.867 00952 99 Rest of Illinois 1.000 0.872 1.193 00630 00 Indiana 1.000 0.906 0.436 00826 00 Iowa 1.000 0.868 0.589 00650 00 Kansas* 1.000 0.878 0.721 00740 04 Kansas* 1.000 0.878 0.721 00660 00 Kentucky 1.000 0.854 0.873 00528 01 New Orleans, LA 1.000 0.946 1.197 00528 99 Rest of Louisiana 1.000 0.847 1.058 31142 03 Southern Maine 1.000 1.013 0.637 31142 99 Rest of Maine 1.000 0.886 0.637 00901 01 Baltimore/Surr. Cntys, MD 1.012 1.078 0.947 707
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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 655 and 656: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 703 and 704: CPT Code Short Descriptors 21480 Re
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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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757 SSA State/County Code County an
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CPT/HCPCS Codes MOD DESCRIPTION STA
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2006 proposed fee schedule - American Society of Clinical Oncology

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