2006 proposed fee schedule - American Society of Clinical Oncology

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722 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 11480 Glascock County, Georgia 11 11 11490 Glynn County, Georgia 11 15260 11500 Gordon County, Georgia 11 11 11510 Grady County, Georgia 11 11 11520 Greene County, Georgia 11 11 11530 Gwinnett County, Georgia 0520 12060 11540 Habersham County, Georgia 11 11 11550 Hall County, Georgia 11 23580 11560 Hancock County, Georgia 11 11 11570 Haralson County, Georgia 11 12060 11580 Harris County, Georgia 11 17980 11581 Hart County, Georgia 11 11 11590 Heard County, Georgia 11 12060 11591 Henry County, Georgia 0520 12060 11600 Houston County, Georgia 4680 47580 11601 Irwin County, Georgia 11 11 11610 Jackson County, Georgia 0500 11 11611 Jasper County, Georgia 11 12060 11612 Jeff Davis County, Georgia 11 11 11620 Jefferson County, Georgia 11 11 11630 Jenkins County, Georgia 11 11 11640 Johnson County, Georgia 11 11 11650 Jones County, Georgia 4680 31420 11651 Lamar County, Georgia 11 12060 11652 Lanier County, Georgia 11 46660 11660 Laurens County, Georgia 11 11 11670 Lee County, Georgia 0120 10500 11680 Liberty County, Georgia 11 25980 11690 Lincoln County, Georgia 11 11 11691 Long County, Georgia 11 25980 11700 Lowndes County, Georgia 11 46660 11701 Lumpkin County, Georgia 11 11 11702 Mc Duffie County, Georgia 0600 12260 11703 Mc Intosh County, Georgia 11 15260 11710 Macon County, Georgia 11 11 11720 Madison County, Georgia 0500 12020 11730 Marion County, Georgia 11 17980 11740 Meriwether County, Georgia 11 12060 11741 Miller County, Georgia 11 11 11750 Mitchell County, Georgia 11 11 11760 Monroe County, Georgia 11 31420 11770 Montgomery County, Georgia 11 11 11771 Morgan County, Georgia 11 11 11772 Murray County, Georgia 11 19140 11780 Muscogee County, Georgia 1800 17980 11790 Newton County, Georgia 0520 12060 11800 Oconee County, Georgia 0500 12020 11801 Oglethorpe County, Georgia 11 12020 11810 Paulding County, Georgia 0520 12060 11811 Peach County, Georgia 4680 11 11812 Pickens County, Georgia 11 12060 11820 Pierce County, Georgia 11 11
723 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 11821 Pike County, Georgia 11 12060 11830 Polk County, Georgia 11 11 11831 Pulaski County, Georgia 11 11 11832 Putnam County, Georgia 11 11 11833 Quitman County, Georgia 11 11 11834 Rabun County, Georgia 11 11 11835 Randolph County, Georgia 11 11 11840 Richmond County, Georgia 0600 12260 11841 Rockdale County, Georgia 0520 12060 11842 Schley County, Georgia 11 11 11850 Screven County, Georgia 11 11 11851 Seminole County, Georgia 11 11 11860 Spalding County, Georgia 0520 12060 11861 Stephens County, Georgia 11 11 11862 Stewart County, Georgia 11 11 11870 Sumter County, Georgia 11 11 11880 Talbot County, Georgia 11 11 11881 Taliaferro County, Georgia 11 11 11882 Tattnall County, Georgia 11 11 11883 Taylor County, Georgia 11 11 11884 Telfair County, Georgia 11 11 11885 Terrell County, Georgia 11 10500 11890 Thomas County, Georgia 11 11 11900 Tift County, Georgia 11 11 11901 Toombs County, Georgia 11 11 11902 Towns County, Georgia 11 11 11903 Treutlen County, Georgia 11 11 11910 Troup County, Georgia 11 11 11911 Turner County, Georgia 11 11 11912 Twiggs County, Georgia 11 31420 11913 Union County, Georgia 11 11 11920 Upson County, Georgia 11 11 11921 Walker County, Georgia 1560 16860 11930 Walton County, Georgia 0520 12060 11940 Ware County, Georgia 11 11 11941 Warren County, Georgia 11 11 11950 Washington County, Georgia 11 11 11960 Wayne County, Georgia 11 11 11961 Webster County, Georgia 11 11 11962 Wheeler County, Georgia 11 11 11963 White County, Georgia 11 11 11970 Whitfield County, Georgia 11 19140 11971 Wilcox County, Georgia 11 11 11972 Wilkes County, Georgia 11 11 11973 Wilkinson County, Georgia 11 11 11980 Worth County, Georgia 11 10500 12005 Kalawao County, Hawaii 12 12 12010 Hawaii County, Hawaii 12 12 12020 Honolulu County, Hawaii 3320 26180 12040 Kauai County, Hawaii 12 12 12050 Maui County, Hawaii 12 12 13000 Ada County, Idaho 1080 14260
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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 671 and 672: ADDENDUM B: RELATIVE VALUE UNITS (R
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Page 713 and 714: Addendum F ESRD FACILITIES- METROPO
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773 SSA State/County Code County an
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775 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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