2006 proposed fee schedule - American Society of Clinical Oncology

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716 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 04260 Grant County, Arkansas 04 30780 04270 Greene County, Arkansas 04 04 04280 Hempstead County, Arkansas 04 04 04290 Hot Spring County, Arkansas 04 04 04300 Howard County, Arkansas 04 04 04310 Independence County, Arkansas 04 04 04320 Izard County, Arkansas 04 04 04330 Jackson County, Arkansas 04 04 04340 Jefferson County, Arkansas 6240 38220 04350 Johnson County, Arkansas 04 04 04360 Lafayette County, Arkansas 04 04 04370 Lawrence County, Arkansas 04 04 04380 Lee County, Arkansas 04 04 04390 Lincoln County, Arkansas 04 38220 04400 Little River County, Arkansas 04 04 04410 Logan County, Arkansas 04 04 04420 Lonoke County, Arkansas 4400 30780 04430 Madison County, Arkansas 04 22220 04440 Marion County, Arkansas 04 04 04450 Miller County, Arkansas 8360 45500 04460 Mississippi County, Arkansas 04 04 04470 Monroe County, Arkansas 04 04 04480 Montgomery County, Arkansas 04 04 04490 Nevada County, Arkansas 04 04 04500 Newton County, Arkansas 04 04 04510 Ouachita County, Arkansas 04 04 04520 Perry County, Arkansas 04 30780 04530 Phillips County, Arkansas 04 04 04540 Pike County, Arkansas 04 04 04550 Poinsett County, Arkansas 04 27860 04560 Polk County, Arkansas 04 04 04570 Pope County, Arkansas 04 04 04580 Prairie County, Arkansas 04 04 04590 Pulaski County, Arkansas 4400 30780 04600 Randolph County, Arkansas 04 04 04610 St Francis County, Arkansas 04 04 04620 Saline County, Arkansas 4400 30780 04630 Scott County, Arkansas 04 04 04640 Searcy County, Arkansas 04 04 04650 Sebastian County, Arkansas 2720 22900 04660 Sevier County, Arkansas 04 04 04670 Sharp County, Arkansas 04 04 04680 Stone County, Arkansas 04 04 04690 Union County, Arkansas 04 04 04700 Van Buren County, Arkansas 04 04 04710 Washington County, Arkansas 2580 22220 04720 White County, Arkansas 04 04 04730 Woodruff County, Arkansas 04 04 04740 Yell County, Arkansas 04 04 05000 Alameda County, California 5775 36084 05010 Alpine County, California 05 05 05020 Amador County, California 05 05
717 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 05030 Butte County, California 1620 17020 05040 Calaveras County, California 05 05 05050 Colusa County, California 05 05 05060 Contra Costa County, California 5775 36084 05070 Del Norte County, California 05 05 05080 Eldorado County, California 6920 40900 05090 Fresno County, California 2840 23420 05100 Glenn County, California 05 05 05110 Humboldt County, California 05 05 05120 Imperial County, California 05 20940 05130 Inyo County, California 05 05 05140 Kern County, California 0680 12540 05150 Kings County, California 05 25260 05160 Lake County, California 05 05 05170 Lassen County, California 05 05 05200 Los Angeles County, California 4480 31084 05210 Los Angeles County, California 4480 31084 05300 Madera County, California 05 31460 05310 Marin County, California 7360 41884 05320 Mariposa County, California 05 05 05330 Mendocino County, California 05 05 05340 Merced County, California 4940 32900 05350 Modoc County, California 05 05 05360 Mono County, California 05 05 05370 Monterey County, California 7120 41500 05380 Napa County, California 8720 34900 05390 Nevada County, California 05 05 05400 Orange County, California 0360 42044 05410 Placer County, California 6920 40900 05420 Plumas County, California 05 05 05430 Riverside County, California 6780 40140 05440 Sacramento County, California 6920 40900 05450 San Benito County, California 05 41940 05460 San Bernardino County, California 6780 40140 05470 San Diego County, California 7320 41740 05480 San Francisco County, California 7360 41884 05490 San Joaquin County, California 8120 44700 05500 San Luis Obispo County, California 05 42020 05510 San Mateo County, California 7360 41884 05520 Santa Barbara County, California 7480 42060 05530 Santa Clara County, California 7400 41940 05540 Santa Cruz County, California 7485 42100 05550 Shasta County, California 6690 39820 05560 Sierra County, California 05 05 05570 Siskiyou County, California 05 05 05580 Solano County, California 8720 46700 05590 Sonoma County, California 7500 42220 05600 Stanislaus County, California 5170 33700 05610 Sutter County, California 9340 49700 05620 Tehama County, California 05 05 05630 Trinity County, California 05 05 05640 Tulare County, California 8780 47300
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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 665 and 666: 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 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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CPT/HCPCS Codes MOD DESCRIPTION STA
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2006 proposed fee schedule - American Society of Clinical Oncology

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