2006 proposed fee schedule - American Society of Clinical Oncology

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Carrier Locality Locality name Work GPCI PE GPCI MP GPCI 00901 99 Rest of Maryland 1.000 0.980 0.760 31143 01 Metropolitan Boston 1.030 1.329 0.823 31143 99 Rest of Massachusetts 1.007 1.103 0.823 00953 01 Detroit, MI 1.037 1.054 2.744 00953 99 Rest of Michigan 1.000 0.921 1.518 00954 00 Minnesota 1.000 1.005 0.410 00512 00 Mississippi 1.000 0.839 0.722 00740 02 Metropolitan Kansas City, MO 1.000 0.975 0.946 00523 01 Metropolitan St. Louis, MO 1.000 0.955 0.941 00523 99 Rest of Missouri* 1.000 0.802 0.892 00740 99 Rest of Missouri* 1.000 0.802 0.892 00751 01 Montana 1.000 0.844 0.904 00655 00 Nebraska 1.000 0.875 0.454 00834 00 Nevada 1.003 1.043 1.068 31144 40 New Hampshire 1.000 1.027 0.942 00805 01 Northern NJ 1.058 1.220 0.973 00805 99 Rest of New Jersey 1.043 1.119 0.973 00521 05 New Mexico 1.000 0.887 0.895 00801 99 Rest of New York 1.000 0.917 0.677 00803 01 Manhattan, NY 1.065 1.298 1.504 00803 02 NYC Suburbs/Long I., NY 1.052 1.280 1.785 00803 03 Poughkpsie/N NYC Suburbs, NY 1.014 1.074 1.167 14330 04 Queens, NY 1.032 1.228 1.710 05535 00 North Carolina 1.000 0.920 0.640 00820 01 North Dakota 1.000 0.860 0.602 00883 00 Ohio 1.000 0.933 0.976 00522 00 Oklahoma 1.000 0.854 0.382 00835 01 Portland, OR 1.002 1.057 0.441 00835 99 Rest of Oregon 1.000 0.925 0.441 00865 01 Metropolitan Philadelphia, PA 1.016 1.104 1.386 00865 99 Rest of Pennsylvania 1.000 0.902 0.806 00973 20 Puerto Rico 1.000 0.698 0.261 00870 01 Rhode Island 1.045 0.989 0.909 00880 01 South Carolina 1.000 0.893 0.394 00820 02 South Dakota 1.000 0.876 0.365 05440 35 Tennessee 1.000 0.879 0.631 00900 09 Brazoria, TX 1.020 0.961 1.298 00900 11 Dallas, TX 1.009 1.062 1.061 00900 15 Galveston, TX 1.000 0.952 1.298 00900 18 Houston, TX 1.016 1.014 1.297 00900 20 Beaumont, TX 1.000 0.860 1.298 00900 28 Fort Worth, TX 1.000 0.989 1.061 00900 31 Austin, TX 1.000 1.046 0.986 00900 99 Rest of Texas 1.000 0.865 1.138 00910 09 Utah 1.000 0.937 0.662 31145 50 Vermont 1.000 0.968 0.514 00973 50 Virgin Islands 1.000 1.014 1.003 708
Carrier Locality Locality name Work GPCI PE GPCI MP GPCI 00904 00 Virginia 1.000 0.940 0.579 00836 02 Seattle (King Cnty), WA 1.014 1.131 0.819 00836 99 Rest of Washington 1.000 0.978 0.819 00884 16 West Virginia 1.000 0.819 1.547 00951 00 Wisconsin 1.000 0.918 0.790 00825 21 Wyoming 1.000 0.853 0.935 709 For 2005 and 2006, if the work GPCI falls below a 1.0 work index, then the work GPCI equals 1.0. For 2005, if the Work, PE and MP GPCI for Alaska falls below 1.67, then the Work, PE and MP GPCIs equal 1.67. * states are served by more than one carrier ** locality numbers not assigned to proposed localities
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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 657 and 658: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 703 and 704: CPT Code Short Descriptors 21480 Re
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Page 707: Addendum D 2006 GEOGRAPHIC PRACTICE
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Page 713 and 714: Addendum F ESRD FACILITIES- METROPO
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2006 proposed fee schedule - American Society of Clinical Oncology

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