2006 proposed fee schedule - American Society of Clinical Oncology

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726 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 14700 Marshall County, Illinois 14 37900 14710 Mason County, Illinois 14 14 14720 Massac County, Illinois 14 14 14730 Menard County, Illinois 7880 44100 14740 Mercer County, Illinois 14 19340 14750 Monroe County, Illinois 7040 41180 14760 Montgomery County, Illinois 14 14 14770 Morgan County, Illinois 14 14 14780 Moultrie County, Illinois 14 14 14790 Ogle County, Illinois 14 14 14800 Peoria County, Illinois 6120 37900 14810 Perry County, Illinois 14 14 14820 Piatt County, Illinois 14 16580 14830 Pike County, Illinois 14 14 14831 Pope County, Illinois 14 14 14850 Pulaski County, Illinois 14 14 14860 Putnam County, Illinois 14 14 14870 Randolph County, Illinois 14 14 14880 Richland County, Illinois 14 14 14890 Rock Island County, Illinois 1960 19340 14900 St Clair County, Illinois 7040 41180 14910 Saline County, Illinois 14 14 14920 Sangamon County, Illinois 7880 44100 14921 Schuyler County, Illinois 14 14 14940 Scott County, Illinois 14 14 14950 Shelby County, Illinois 14 14 14960 Stark County, Illinois 14 37900 14970 Stephenson County, Illinois 14 14 14980 Tazewell County, Illinois 6120 37900 14981 Union County, Illinois 14 14 14982 Vermilion County, Illinois 14 19180 14983 Wabash County, Illinois 14 14 14984 Warren County, Illinois 14 14 14985 Washington County, Illinois 14 14 14986 Wayne County, Illinois 14 14 14987 White County, Illinois 14 14 14988 Whiteside County, Illinois 14 14 14989 Will County, Illinois 3690 16974 14990 Williamson County, Illinois 14 14 14991 Winnebago County, Illinois 6880 40420 14992 Woodford County, Illinois 6120 37900 15000 Adams County, Indiana 15 15 15010 Allen County, Indiana 2760 23060 15020 Bartholomew County, Indiana 15 18020 15030 Benton County, Indiana 15 29140 15040 Blackford County, Indiana 15 15 15050 Boone County, Indiana 3480 26900 15060 Brown County, Indiana 15 26900 15070 Carroll County, Indiana 15 29140 15080 Cass County, Indiana 15 15 15090 Clark County, Indiana 4520 31140 15100 Clay County, Indiana 8320 45460
727 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 15110 Clinton County, Indiana 15 15 15120 Crawford County, Indiana 15 15 15130 Daviess County, Indiana 15 15 15140 Dearborn County, Indiana 1640 17140 15150 Decatur County, Indiana 15 15 15160 De Kalb County, Indiana 2760 15 15170 Delaware County, Indiana 5280 34620 15180 Dubois County, Indiana 15 15 15190 Elkhart County, Indiana 2330 21140 15200 Fayette County, Indiana 15 15 15210 Floyd County, Indiana 4520 31140 15220 Fountain County, Indiana 15 15 15230 Franklin County, Indiana 15 17140 15240 Fulton County, Indiana 15 15 15250 Gibson County, Indiana 15 21780 15260 Grant County, Indiana 15 15 15270 Greene County, Indiana 15 14020 15280 Hamilton County, Indiana 3480 26900 15290 Hancock County, Indiana 3480 26900 15300 Harrison County, Indiana 4520 31140 15310 Hendricks County, Indiana 3480 26900 15320 Henry County, Indiana 15 15 15330 Howard County, Indiana 3850 29020 15340 Huntington County, Indiana 15 15 15350 Jackson County, Indiana 15 15 15360 Jasper County, Indiana 15 23844 15370 Jay County, Indiana 15 15 15380 Jefferson County, Indiana 15 15 15390 Jennings County, Indiana 15 15 15400 Johnson County, Indiana 3480 26900 15410 Knox County, Indiana 15 15 15420 Kosciusko County, Indiana 15 15 15430 Lagrange County, Indiana 15 15 15440 Lake County, Indiana 2960 23844 15450 La Porte County, Indiana 15 33140 15460 Lawrence County, Indiana 15 15 15470 Madison County, Indiana 0400 11300 15480 Marion County, Indiana 3480 26900 15490 Marshall County, Indiana 15 15 15500 Martin County, Indiana 15 15 15510 Miami County, Indiana 15 15 15520 Monroe County, Indiana 1020 14020 15530 Montgomery County, Indiana 15 15 15540 Morgan County, Indiana 3480 26900 15550 Newton County, Indiana 15 23844 15560 Noble County, Indiana 15 15 15570 Ohio County, Indiana 15 17140 15580 Orange County, Indiana 15 15 15590 Owen County, Indiana 15 14020 15600 Parke County, Indiana 15 15 15610 Perry County, Indiana 15 15 15620 Pike County, Indiana 15 15
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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 675 and 676: ADDENDUM B: RELATIVE VALUE UNITS (R
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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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