2006 proposed fee schedule - American Society of Clinical Oncology

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730 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 16750 Pocahontas County, Iowa 16 16 16760 Polk County, Iowa 2120 19780 16770 Pottawattamie County, Iowa 5920 36540 16780 Poweshiek County, Iowa 16 16 16790 Ringgold County, Iowa 16 16 16800 Sac County, Iowa 16 16 16810 Scott County, Iowa 1960 19340 16820 Shelby County, Iowa 16 16 16830 Sioux County, Iowa 16 16 16840 Story County, Iowa 16 11180 16850 Tama County, Iowa 16 16 16860 Taylor County, Iowa 16 16 16870 Union County, Iowa 16 16 16880 Van Buren County, Iowa 16 16 16890 Wapello County, Iowa 16 16 16900 Warren County, Iowa 2120 19780 16910 Washington County, Iowa 16 26980 16920 Wayne County, Iowa 16 16 16930 Webster County, Iowa 16 16 16940 Winnebago County, Iowa 16 16 16950 Winneshiek County, Iowa 16 16 16960 Woodbury County, Iowa 7720 43580 16970 Worth County, Iowa 16 16 16980 Wright County, Iowa 16 16 17000 Allen County, Kansas 17 17 17010 Anderson County, Kansas 17 17 17020 Atchison County, Kansas 17 17 17030 Barber County, Kansas 17 17 17040 Barton County, Kansas 17 17 17050 Bourbon County, Kansas 17 17 17060 Brown County, Kansas 17 17 17070 Butler County, Kansas 9040 48620 17080 Chase County, Kansas 17 17 17090 Chautauqua County, Kansas 17 17 17100 Cherokee County, Kansas 17 17 17110 Cheyenne County, Kansas 17 17 17120 Clark County, Kansas 17 17 17130 Clay County, Kansas 17 17 17140 Cloud County, Kansas 17 17 17150 C<strong>of</strong>fey County, Kansas 17 17 17160 Comanche County, Kansas 17 17 17170 Cowley County, Kansas 17 17 17180 Crawford County, Kansas 17 17 17190 Decatur County, Kansas 17 17 17200 Dickinson County, Kansas 17 17 17210 Doniphan County, Kansas 17 41140 17220 Douglas County, Kansas 4150 29940 17230 Edwards County, Kansas 17 17 17240 Elk County, Kansas 17 17 17250 Ellis County, Kansas 17 17 17260 Ellsworth County, Kansas 17 17 17270 Finney County, Kansas 17 17
731 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 17280 Ford County, Kansas 17 17 17290 Franklin County, Kansas 17 28140 17300 Geary County, Kansas 17 17 17310 Gove County, Kansas 17 17 17320 Graham County, Kansas 17 17 17330 Grant County, Kansas 17 17 17340 Gray County, Kansas 17 17 17350 Greeley County, Kansas 17 17 17360 Greenwood County, Kansas 17 17 17370 Hamilton County, Kansas 17 17 17380 Harper County, Kansas 17 17 17390 Harvey County, Kansas 17 48620 17391 Haskell County, Kansas 17 17 17410 Hodgeman County, Kansas 17 17 17420 Jackson County, Kansas 17 45820 17430 Jefferson County, Kansas 17 45820 17440 Jewell County, Kansas 17 17 17450 Johnson County, Kansas 3760 28140 17451 Kearny County, Kansas 17 17 17470 Kingman County, Kansas 17 17 17480 Kiowa County, Kansas 17 17 17490 Labette County, Kansas 17 17 17500 Lane County, Kansas 17 17 17510 Leavenworth County, Kansas 3760 28140 17520 Lincoln County, Kansas 17 17 17530 Linn County, Kansas 17 28140 17540 Logan County, Kansas 17 17 17550 Lyon County, Kansas 17 17 17560 Mc Pherson County, Kansas 17 17 17570 Marion County, Kansas 17 17 17580 Marshall County, Kansas 17 17 17590 Meade County, Kansas 17 17 17600 Miami County, Kansas 3760 28140 17610 Mitchell County, Kansas 17 17 17620 Montgomery County, Kansas 17 17 17630 Morris County, Kansas 17 17 17640 Morton County, Kansas 17 17 17650 Nemaha County, Kansas 17 17 17660 Neosho County, Kansas 17 17 17670 Ness County, Kansas 17 17 17680 Norton County, Kansas 17 17 17690 Osage County, Kansas 17 45820 17700 Osborne County, Kansas 17 17 17710 Ottawa County, Kansas 17 17 17720 Pawnee County, Kansas 17 17 17730 Phillips County, Kansas 17 17 17740 Pottawatomie County, Kansas 17 17 17750 Pratt County, Kansas 17 17 17760 Rawlins County, Kansas 17 17 17770 Reno County, Kansas 17 17 17780 Republic County, Kansas 17 17 17790 Rice County, Kansas 17 17
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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 679 and 680: 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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