2006 proposed fee schedule - American Society of Clinical Oncology

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732 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 17800 Riley County, Kansas 17 17 17810 Rooks County, Kansas 17 17 17820 Rush County, Kansas 17 17 17830 Russell County, Kansas 17 17 17840 Saline County, Kansas 17 17 17841 Scott County, Kansas 17 17 17860 Sedgwick County, Kansas 9040 48620 17870 Seward County, Kansas 17 17 17880 Shawnee County, Kansas 8440 45820 17890 Sheridan County, Kansas 17 17 17900 Sherman County, Kansas 17 17 17910 Smith County, Kansas 17 17 17920 Stafford County, Kansas 17 17 17921 Stanton County, Kansas 17 17 17940 Stevens County, Kansas 17 17 17950 Sumner County, Kansas 17 48620 17960 Thomas County, Kansas 17 17 17970 Trego County, Kansas 17 17 17980 Wabaunsee County, Kansas 17 17 17981 Wallace County, Kansas 17 17 17982 Washington County, Kansas 17 17 17983 Wichita County, Kansas 17 17 17984 Wilson County, Kansas 17 17 17985 Woodson County, Kansas 17 17 17986 Wyandotte County, Kansas 3760 28140 18000 Adair County, Kentucky 18 18 18010 Allen County, Kentucky 18 18 18020 Anderson County, Kentucky 18 18 18030 Ballard County, Kentucky 18 18 18040 Barren County, Kentucky 18 18 18050 Bath County, Kentucky 18 18 18060 Bell County, Kentucky 18 18 18070 Boone County, Kentucky 1640 17140 18080 Bourbon County, Kentucky 4280 30460 18090 Boyd County, Kentucky 3400 26580 18100 Boyle County, Kentucky 18 18 18110 Bracken County, Kentucky 18 17140 18120 Breathitt County, Kentucky 18 18 18130 Breckinridge County, Kentucky 18 18 18140 Bullitt County, Kentucky 4520 31140 18150 Butler County, Kentucky 18 18 18160 Caldwell County, Kentucky 18 18 18170 Calloway County, Kentucky 18 18 18180 Campbell County, Kentucky 1640 17140 18190 Carlisle County, Kentucky 18 18 18191 Carroll County, Kentucky 18 18 18210 Carter County, Kentucky 3400 18 18220 Casey County, Kentucky 18 18 18230 Christian County, Kentucky 1660 17300 18240 Clark County, Kentucky 4280 30460 18250 Clay County, Kentucky 18 18 18260 Clinton County, Kentucky 18 18
733 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 18270 Crittenden County, Kentucky 18 18 18271 Cumberland County, Kentucky 18 18 18290 Daviess County, Kentucky 5990 36980 18291 Edmonson County, Kentucky 18 14540 18310 Elliott County, Kentucky 18 18 18320 Estill County, Kentucky 18 18 18330 Fayette County, Kentucky 4280 30460 18340 Fleming County, Kentucky 18 18 18350 Floyd County, Kentucky 18 18 18360 Franklin County, Kentucky 18 18 18361 Fulton County, Kentucky 18 18 18362 Gallatin County, Kentucky 18 17140 18390 Garrard County, Kentucky 18 18 18400 Grant County, Kentucky 18 17140 18410 Graves County, Kentucky 18 18 18420 Grayson County, Kentucky 18 18 18421 Green County, Kentucky 18 18 18440 Greenup County, Kentucky 3400 26580 18450 Hancock County, Kentucky 18 36980 18460 Hardin County, Kentucky 18 21060 18470 Harlan County, Kentucky 18 18 18480 Harrison County, Kentucky 18 18 18490 Hart County, Kentucky 18 18 18500 Henderson County, Kentucky 2440 21780 18510 Henry County, Kentucky 18 31140 18511 Hickman County, Kentucky 18 18 18530 Hopkins County, Kentucky 18 18 18540 Jackson County, Kentucky 18 18 18550 Jefferson County, Kentucky 4520 31140 18560 Jessamine County, Kentucky 4280 30460 18570 Johnson County, Kentucky 18 18 18580 Kenton County, Kentucky 1640 17140 18590 Knott County, Kentucky 18 18 18600 Knox County, Kentucky 18 18 18610 Larue County, Kentucky 18 21060 18620 Laurel County, Kentucky 18 18 18630 Lawrence County, Kentucky 18 18 18640 Lee County, Kentucky 18 18 18650 Leslie County, Kentucky 18 18 18660 Letcher County, Kentucky 18 18 18670 Lewis County, Kentucky 18 18 18680 Lincoln County, Kentucky 18 18 18690 Livingston County, Kentucky 18 18 18700 Logan County, Kentucky 18 18 18710 Lyon County, Kentucky 18 18 18720 Mc Cracken County, Kentucky 18 18 18730 Mc Creary County, Kentucky 18 18 18740 Mc Lean County, Kentucky 18 18 18750 Madison County, Kentucky 18 18 18760 Mag<strong>of</strong>fin County, Kentucky 18 18 18770 Marion County, Kentucky 18 18 18780 Marshall County, Kentucky 18 18
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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 681 and 682: ADDENDUM B: RELATIVE VALUE UNITS (R
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Page 705 and 706: CPT Code Short Descriptors 92284 Da
Page 707 and 708: Addendum D 2006 GEOGRAPHIC PRACTICE
Page 709 and 710: Carrier Locality Locality name Work
Page 711 and 712: Carrier Locality Locality Name 2006
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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