2006 proposed fee schedule - American Society of Clinical Oncology

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724 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 13010 Adams County, Idaho 13 13 13020 Bannock County, Idaho 13 38540 13030 Bear Lake County, Idaho 13 13 13040 Benewah County, Idaho 13 13 13050 Bingham County, Idaho 13 13 13060 Blaine County, Idaho 13 13 13070 Boise County, Idaho 13 14260 13080 Bonner County, Idaho 13 13 13090 Bonneville County, Idaho 13 26820 13100 Boundary County, Idaho 13 13 13110 Butte County, Idaho 13 13 13120 Camas County, Idaho 13 13 13130 Canyon County, Idaho 13 14260 13140 Caribou County, Idaho 13 13 13150 Cassia County, Idaho 13 13 13160 Clark County, Idaho 13 13 13170 Clearwater County, Idaho 13 13 13180 Custer County, Idaho 13 13 13190 Elmore County, Idaho 13 13 13200 Franklin County, Idaho 13 30860 13210 Fremont County, Idaho 13 13 13220 Gem County, Idaho 13 14260 13230 Gooding County, Idaho 13 13 13240 Idaho County, Idaho 13 13 13250 Jefferson County, Idaho 13 26820 13260 Jerome County, Idaho 13 13 13270 Kootenai County, Idaho 13 17660 13280 Latah County, Idaho 13 13 13290 Lemhi County, Idaho 13 13 13300 Lewis County, Idaho 13 13 13310 Lincoln County, Idaho 13 13 13320 Madison County, Idaho 13 13 13330 Minidoka County, Idaho 13 13 13340 Nez Perce County, Idaho 13 30300 13350 Oneida County, Idaho 13 13 13360 Owyhee County, Idaho 13 14260 13370 Payette County, Idaho 13 13 13380 Power County, Idaho 13 38540 13390 Shoshone County, Idaho 13 13 13400 Teton County, Idaho 13 13 13410 Twin Falls County, Idaho 13 13 13420 Valley County, Idaho 13 13 13430 Washington County, Idaho 13 13 14000 Adams County, Illinois 14 14 14010 Alexander County, Illinois 14 14 14020 Bond County, Illinois 14 41180 14030 Boone County, Illinois 6880 40420 14040 Brown County, Illinois 14 14 14050 Bureau County, Illinois 14 14 14060 Calhoun County, Illinois 14 41180 14070 Carroll County, Illinois 14 14 14080 Cass County, Illinois 14 14
725 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 14090 Champaign County, Illinois 1400 16580 14100 Christian County, Illinois 14 14 14110 Clark County, Illinois 14 14 14120 Clay County, Illinois 14 14 14130 Clinton County, Illinois 7040 41180 14140 Coles County, Illinois 14 14 14141 Cook County, Illinois 1600 16974 14150 Crawford County, Illinois 14 14 14160 Cumberland County, Illinois 14 14 14170 De Kalb County, Illinois 14 16974 14180 De Witt County, Illinois 14 14 14190 Douglas County, Illinois 14 14 14250 Du Page County, Illinois 1600 16974 14310 Edgar County, Illinois 14 14 14320 Edwards County, Illinois 14 14 14330 Effingham County, Illinois 14 14 14340 Fayette County, Illinois 14 14 14350 Ford County, Illinois 14 16580 14360 Franklin County, Illinois 14 14 14370 Fulton County, Illinois 14 14 14380 Gallatin County, Illinois 14 14 14390 Greene County, Illinois 14 14 14400 Grundy County, Illinois 3690 16974 14410 Hamilton County, Illinois 14 14 14420 Hancock County, Illinois 14 14 14421 Hardin County, Illinois 14 14 14440 Henderson County, Illinois 14 14 14450 Henry County, Illinois 1960 19340 14460 Iroquois County, Illinois 14 14 14470 Jackson County, Illinois 14 14 14480 Jasper County, Illinois 14 14 14490 Jefferson County, Illinois 14 14 14500 Jersey County, Illinois 7040 41180 14510 Jo Daviess County, Illinois 14 14 14520 Johnson County, Illinois 14 14 14530 Kane County, Illinois 0620 16974 14540 Kankakee County, Illinois 3740 28100 14550 Kendall County, Illinois 0620 16974 14560 Knox County, Illinois 14 14 14570 Lake County, Illinois 3965 29404 14580 La Salle County, Illinois 14 14 14590 Lawrence County, Illinois 14 14 14600 Lee County, Illinois 14 14 14610 Livingston County, Illinois 14 14 14620 Logan County, Illinois 14 14 14630 Mc Donough County, Illinois 14 14 14640 Mc Henry County, Illinois 1600 16974 14650 Mclean County, Illinois 1040 14060 14660 Macon County, Illinois 2040 19500 14670 Macoupin County, Illinois 14 41180 14680 Madison County, Illinois 7040 41180 14690 Marion County, Illinois 14 14
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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 673 and 674: ADDENDUM B: RELATIVE VALUE UNITS (R
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Page 713 and 714: Addendum F ESRD FACILITIES- METROPO
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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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