2006 proposed fee schedule - American Society of Clinical Oncology

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Addendum E PROPOSED 2006 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs) Carrier Locality Locality Name 2006 GAF 31140 06 San Mateo, CA 1.259 31140 05 San Francisco, CA 1.256 31140 09 Santa Clara, CA 1.256 00803 01 Manhattan, NY 1.184 00803 02 NYC Suburbs/Long I., NY 1.180 31140 07 Oakland/Berkley, CA 1.177 31140 03 Marin/Napa/Solano, CA 1.154 31143 01 Metropolitan Boston 1.153 14330 04 Queens, NY 1.144 00903 01 DC + MD/VA Suburbs 1.132 00805 01 Northern NJ 1.126 31146 26 Anaheim/Santa Ana, CA 1.119 31140 TBD** Santa Cruz, CA 1.119 00953 01 Detroit, MI 1.111 00952 16 Chicago, IL 1.102 31140 TBD** Sonoma, CA 1.098 00591 00 Connecticut 1.091 31146 18 Los Angeles, CA 1.088 00952 15 Suburban Chicago, IL 1.085 31146 17 Ventura, CA 1.083 00805 99 Rest of New Jersey 1.074 00865 01 Metropolitan Philadelphia, PA 1.069 00590 04 Miami, FL 1.069 00836 02 Seattle (King Cnty), WA 1.058 00831 01 Alaska 1.055 00803 03 Poughkpsie/N NYC Suburbs, NY 1.046 00833 01 Hawaii/Guam 1.044 00511 01 Atlanta, GA 1.043 31143 99 Rest of Massachusetts 1.042 00901 01 Baltimore/Surr. Cntys, MD 1.039 00900 11 Dallas, TX 1.034 00900 18 Houston, TX 1.026 00834 00 Nevada 1.023 00590 03 Fort Lauderdale, FL 1.022 00900 31 Austin, TX 1.020 31146 99 Rest of California* 1.014 31140 99 Rest of California* 1.014 31144 40 New Hampshire 1.010 00902 01 Delaware 1.010 00973 50 Virgin Islands 1.007 00900 09 Brazoria, TX 1.005 00835 01 Portland, OR 1.005 00952 12 East St. Louis, IL 1.003 710
Carrier Locality Locality Name 2006 GAF 00832 00 Arizona 0.999 00824 01 Colorado 0.999 00900 28 Fort Worth, TX 0.998 31142 03 Southern Maine 0.992 00900 15 Galveston, TX 0.991 00740 02 Metropolitan Kansas City, MO 0.987 00953 99 Rest of Michigan 0.986 00836 99 Rest of Washington 0.984 00528 01 New Orleans, LA 0.984 00901 99 Rest of Maryland 0.982 00590 99 Rest of Florida 0.982 00954 00 Minnesota 0.980 00523 01 Metropolitan St. Louis, MO 0.978 00883 00 Ohio 0.970 31145 50 Vermont 0.968 00910 09 Utah 0.960 00904 00 Virginia 0.958 00951 00 Wisconsin 0.956 00952 99 Rest of Illinois 0.952 00801 99 Rest of New York 0.952 05535 00 North Carolina 0.951 00900 20 Beaumont, TX 0.951 00865 99 Rest of Pennsylvania 0.950 00900 99 Rest of Texas 0.947 00521 05 New Mexico 0.947 00835 99 Rest of Oregon 0.946 00511 99 Rest of Georgia 0.943 00884 16 West Virginia 0.942 00630 00 Indiana 0.937 31142 99 Rest of Maine 0.936 00740 04 Kansas* 0.936 00650 00 Kansas* 0.936 00528 99 Rest of Louisiana 0.936 00825 21 Wyoming 0.934 05440 35 Tennessee 0.933 00660 00 Kentucky 0.932 00880 01 South Carolina 0.930 00870 01 Rhode Island 0.930 00751 01 Montana 0.928 00826 00 Iowa 0.927 00655 00 Nebraska 0.925 00820 01 North Dakota 0.924 00510 00 Alabama 0.923 05130 00 Idaho 0.922 00820 02 South Dakota 0.922 00512 00 Mississippi 0.919 00522 00 Oklahoma 0.913 711
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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 659 and 660: 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: Carrier Locality Locality name Work
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761 SSA State/County Code County an
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CPT/HCPCS Codes MOD DESCRIPTION STA
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