2006 proposed fee schedule - American Society of Clinical Oncology

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714 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 01450 Marengo County, Alabama 01 01 01460 Marion County, Alabama 01 01 01470 Marshall County, Alabama 01 01 01480 Mobile County, Alabama 5160 33660 01490 Monroe County, Alabama 01 01 01500 Montgomery County, Alabama 5240 33860 01510 Morgan County, Alabama 01 19460 01520 Perry County, Alabama 01 01 01530 Pickens County, Alabama 01 01 01540 Pike County, Alabama 01 01 01550 Randolph County, Alabama 01 01 01560 Russell County, Alabama 1800 17980 01570 St Clair County, Alabama 1000 13820 01580 Shelby County, Alabama 1000 13820 01590 Sumter County, Alabama 01 01 01600 Talladega County, Alabama 01 01 01610 Tallapoosa County, Alabama 01 01 01620 Tuscaloosa County, Alabama 8600 46220 01630 Walker County, Alabama 1000 13820 01640 Washington County, Alabama 01 01 01650 Wilcox County, Alabama 01 01 01660 Winston County, Alabama 01 01 02013 Aleutians County East, Alaska 02 02 02016 Aleutians County West, Alaska 02 02 02020 Anchorage County, Alaska 0380 11260 02030 Angoon County, Alaska 02 02 02040 Barrow-North Slope County, Alaska 02 02 02050 Bethel County, Alaska 02 02 02060 Bristol Bay Borough County, Alaska 02 02 02068 Denali County, Alaska 02 02 02070 Bristol Bay County, Alaska 02 02 02080 Cordova-Mc Carthy County, Alaska 02 02 02090 Fairbanks County, Alaska 02 21820 02100 Haines County, Alaska 02 02 02110 Juneau County, Alaska 02 02 02120 Kenai-Cook Inlet County, Alaska 02 02 02122 Kenai Peninsula Borough, Alaska 02 02 02130 Ketchikan County, Alaska 02 02 02140 Kobuk County, Alaska 02 02 02150 Kodiak County, Alaska 02 02 02160 Kuskokwin County, Alaska 02 02 02164 Lake and Peninsula Borough, Alaska 02 02 02170 Matanuska County, Alaska 02 11260 02180 Nome County, Alaska 02 02 02185 North Slope Borough, Alaska 02 02 02188 Northwest Arctic Borough, Alaska 02 02 02190 Outer Ketchikan County, Alaska 02 02 02200 Prince Of Wales County, Alaska Prince <strong>of</strong> Wales-Outer Ketchikan Census Area, 02 02 02201 Alaska 02 02 02210 Seward County, Alaska 02 02 02220 Sitka County, Alaska 02 02
715 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 02230 Skagway-Yakutat County, Alaska 02 02 02231 Skagway-Yakutat-Angoon Census Area, Alaska 02 02 02232 Skagway-Hoonah-Angoon Census Area, Alaska 02 02 02240 Southeast Fairbanks County, Alaska 02 02 02250 Upper Yukon County, Alaska 02 02 02260 Valdz-Chitna-Whitier County, Alaska 02 02 02261 Valdex-Cordove Census Area, Alaska 02 02 02270 Wade Hampton County, Alaska 02 02 02280 Wrangell-Petersburg County, Alaska 02 02 02282 Yakutat Borough, Alaska 02 02 02290 Yukon-Koyukuk County, Alaska 02 02 03000 Apache County, Arizona 03 03 03010 Cochise County, Arizona 03 03 03020 Coconino County, Arizona 03 22380 03030 Gila County, Arizona 03 03 03040 Graham County, Arizona 03 03 03050 Greenlee County, Arizona 03 03 03055 La Paz County, Arizona 03 03 03060 Maricopa County, Arizona 6200 38060 03070 Mohave County, Arizona 03 03 03080 Navajo County, Arizona 03 03 03090 Pima County, Arizona 8520 46060 03100 Pinal County, Arizona 03 38060 03110 Santa Cruz County, Arizona 03 03 03120 Yavapai County, Arizona 03 39140 03130 Yuma County, Arizona 03 49740 04000 Arkansas County, Arkansas 04 04 04010 Ashley County, Arkansas 04 04 04020 Baxter County, Arkansas 04 04 04030 Benton County, Arkansas 04 22220 04040 Boone County, Arkansas 04 04 04050 Bradley County, Arkansas 04 04 04060 Calhoun County, Arkansas 04 04 04070 Carroll County, Arkansas 04 04 04080 Chicot County, Arkansas 04 04 04090 Clark County, Arkansas 04 04 04100 Clay County, Arkansas 04 04 04110 Cleburne County, Arkansas 04 04 04120 Cleveland County, Arkansas 04 38220 04130 Columbia County, Arkansas 04 04 04140 Conway County, Arkansas 04 04 04150 Craighead County, Arkansas 04 27860 04160 Crawford County, Arkansas 2720 22900 04170 Crittenden County, Arkansas 4920 32820 04180 Cross County, Arkansas 04 04 04190 Dallas County, Arkansas 04 04 04200 Desha County, Arkansas 04 04 04210 Drew County, Arkansas 04 04 04220 Faulkner County, Arkansas 4400 30780 04230 Franklin County, Arkansas 04 22900 04240 Fulton County, Arkansas 04 04 04250 Garland County, Arkansas 04 26300
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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 663 and 664: ADDENDUM B: RELATIVE VALUE UNITS (R
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Page 707 and 708: Addendum D 2006 GEOGRAPHIC PRACTICE
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Page 711 and 712: Carrier Locality Locality Name 2006
Page 713: Addendum F ESRD FACILITIES- METROPO
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765 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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