2006 proposed fee schedule - American Society of Clinical Oncology

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728 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 15630 Porter County, Indiana 2960 23844 15640 Posey County, Indiana 2440 21780 15650 Pulaski County, Indiana 15 15 15660 Putnam County, Indiana 15 26900 15670 Randolph County, Indiana 15 15 15680 Ripley County, Indiana 15 15 15690 Rush County, Indiana 15 15 15700 St Joseph County, Indiana 7800 43780 15710 Scott County, Indiana 15 15 15720 Shelby County, Indiana 3480 26900 15730 Spencer County, Indiana 15 15 15740 Starke County, Indiana 15 15 15750 Steuben County, Indiana 15 15 15760 Sullivan County, Indiana 15 45460 15770 Switzerland County, Indiana 15 15 15780 Tippecanoe County, Indiana 3920 29140 15790 Tipton County, Indiana 3850 29020 15800 Union County, Indiana 15 15 15810 Vanderburgh County, Indiana 2440 21780 15820 Vermillion County, Indiana 15 45460 15830 Vigo County, Indiana 8320 45460 15840 Wabash County, Indiana 15 15 15850 Warren County, Indiana 15 15 15860 Warrick County, Indiana 2440 21780 15870 Washington County, Indiana 15 31140 15880 Wayne County, Indiana 15 15 15890 Wells County, Indiana 15 23060 15900 White County, Indiana 15 15 15910 Whitley County, Indiana 2760 23060 16000 Adair County, Iowa 16 16 16010 Adams County, Iowa 16 16 16020 Allamakee County, Iowa 16 16 16030 Appanoose County, Iowa 16 16 16040 Audubon County, Iowa 16 16 16050 Benton County, Iowa 16 16300 16060 Black Hawk County, Iowa 8920 47940 16070 Boone County, Iowa 16 16 16080 Bremer County, Iowa 8920 47940 16090 Buchanan County, Iowa 16 16 16100 Buena Vista County, Iowa 16 16 16110 Butler County, Iowa 16 16 16120 Calhoun County, Iowa 16 16 16130 Carroll County, Iowa 16 16 16140 Cass County, Iowa 16 16 16150 Cedar County, Iowa 16 16 16160 Cerro Gordo County, Iowa 16 16 16170 Cherokee County, Iowa 16 16 16180 Chickasaw County, Iowa 16 16 16190 Clarke County, Iowa 16 16 16200 Clay County, Iowa 16 16 16210 Clayton County, Iowa 16 16 16220 Clinton County, Iowa 16 16
729 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 16230 Crawford County, Iowa 16 16 16240 Dallas County, Iowa 2120 19780 16250 Davis County, Iowa 16 16 16260 Decatur County, Iowa 16 16 16270 Delaware County, Iowa 16 16 16280 Des Moines County, Iowa 16 16 16290 Dickinson County, Iowa 16 16 16300 Dubuque County, Iowa 2200 20220 16310 Emmet County, Iowa 16 16 16320 Fayette County, Iowa 16 16 16330 Floyd County, Iowa 16 16 16340 Franklin County, Iowa 16 16 16350 Fremont County, Iowa 16 16 16360 Greene County, Iowa 16 16 16370 Grundy County, Iowa 16 47940 16380 Guthrie County, Iowa 16 19780 16390 Hamilton County, Iowa 16 16 16400 Hancock County, Iowa 16 16 16410 Hardin County, Iowa 16 16 16420 Harrison County, Iowa 16 36540 16430 Henry County, Iowa 16 16 16440 Howard County, Iowa 16 16 16450 Humboldt County, Iowa 16 16 16460 Ida County, Iowa 16 16 16470 Iowa County, Iowa 16 16 16480 Jackson County, Iowa 16 16 16490 Jasper County, Iowa 16 16 16500 Jefferson County, Iowa 16 16 16510 Johnson County, Iowa 3500 26980 16520 Jones County, Iowa 16 16300 16530 Keokuk County, Iowa 16 16 16540 Kossuth County, Iowa 16 16 16550 Lee County, Iowa 16 16 16560 Linn County, Iowa 1360 16300 16570 Louisa County, Iowa 16 16 16580 Lucas County, Iowa 16 16 16590 Lyon County, Iowa 16 16 16600 Madison County, Iowa 16 19780 16610 Mahaska County, Iowa 16 16 16620 Marion County, Iowa 16 16 16630 Marshall County, Iowa 16 16 16640 Mills County, Iowa 16 36540 16650 Mitchell County, Iowa 16 16 16660 Monona County, Iowa 16 16 16670 Monroe County, Iowa 16 16 16680 Montgomery County, Iowa 16 16 16690 Muscatine County, Iowa 16 16 16700 O Brien County, Iowa 16 16 16710 Osceola County, Iowa 16 16 16720 Page County, Iowa 16 16 16730 Palo Alto County, Iowa 16 16 16740 Plymouth County, Iowa 16 16
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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 677 and 678: 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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