2006 proposed fee schedule - American Society of Clinical Oncology

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736 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 19630 Winn County, Louisiana 19 19 20000 Androscoggin County, Maine 4243 30340 20010 Aroostook County, Maine 20 20 20020 Cumberland County, Maine 6403 38860 20030 Franklin County, Maine 20 20 20040 Hancock County, Maine 20 20 20050 Kennebec County, Maine 20 20 <strong>2006</strong>0 Knox County, Maine 20 20 20070 Lincoln County, Maine 20 20 20080 Oxford County, Maine 20 20 20090 Penobscot County, Maine 0733 12620 20100 Piscataquis County, Maine 20 20 20110 Sagadahoc County, Maine 6403 38860 20120 Somerset County, Maine 20 20 20130 Waldo County, Maine 20 20 20140 Washington County, Maine 20 20 20150 York County, Maine 6403 38860 21000 Allegany County, Maryland 1900 19060 21010 Anne Arundel County, Maryland 0720 12580 21020 Baltimore County, Maryland 0720 12580 21030 Baltimore City County, Maryland 0720 12580 21040 Calvert County, Maryland 8840 47894 21050 Caroline County, Maryland 21 21 21060 Carroll County, Maryland 0720 12580 21070 Cecil County, Maryland 9160 48864 21080 Charles County, Maryland 8840 47894 21090 Dorchester County, Maryland 21 21 21100 Frederick County, Maryland 8840 13644 21110 Garrett County, Maryland 21 21 21120 Harford County, Maryland 0720 12580 21130 Howard County, Maryland 0720 12580 21140 Kent County, Maryland 21 21 21150 Montgomery County, Maryland 8840 13644 21160 Prince Georges County, Maryland 8840 47894 21170 Queen Annes County, Maryland 0720 12580 21180 St Marys County, Maryland 21 21 21190 Somerset County, Maryland 21 41540 21200 Talbot County, Maryland 21 21 21210 Washington County, Maryland 3180 25180 21220 Wicomico County, Maryland 21 41540 21230 Worcester County, Maryland 21 21 22000 Barnstable County, Massachusetts 0743 12700 22010 Berkshire County, Massachusetts 6323 38340 22020 Bristol County, Massachusetts 5403 39300 22030 Dukes County, Massachusetts 22 22 22040 Essex County, Massachusetts 1123 21604 22060 Franklin County, Massachusetts 22 44140 22070 Hampden County, Massachusetts 8003 44140 22080 Hampshire County, Massachusetts 8003 44140 22090 Middlesex County, Massachusetts 1123 15764 22120 Nantucket County, Massachusetts 22 22 22130 Norfolk County, Massachusetts 1123 14484
737 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 22150 Plymouth County, Massachusetts 1123 14484 22160 Suffolk County, Massachusetts 1123 14484 22170 Worcester County, Massachusetts 9243 49340 23000 Alcona County, Michigan 23 23 23010 Alger County, Michigan 23 23 23020 Allegan County, Michigan 23 23 23030 Alpena County, Michigan 23 23 23040 Antrim County, Michigan 23 23 23050 Arenac County, Michigan 23 23 23060 Baraga County, Michigan 23 23 23070 Barry County, Michigan 23 24340 23080 Bay County, Michigan 6960 13020 23090 Benzie County, Michigan 23 23 23100 Berrien County, Michigan 0870 35660 23110 Branch County, Michigan 23 23 23120 Calhoun County, Michigan 0780 12980 23130 Cass County, Michigan 23 43780 23140 Charlevoix County, Michigan 23 23 23150 Cheboygan County, Michigan 23 23 23160 Chippewa County, Michigan 23 23 23170 Clare County, Michigan 23 23 23180 Clinton County, Michigan 4040 29620 23190 Crawford County, Michigan 23 23 23200 Delta County, Michigan 23 23 23210 Dickinson County, Michigan 23 23 23220 Eaton County, Michigan 4040 29620 23230 Emmet County, Michigan 23 23 23240 Genesee County, Michigan 2640 22420 23250 Gladwin County, Michigan 23 23 23260 Gogebic County, Michigan 23 23 23270 Grand Traverse County, Michigan 23 23 23280 Gratiot County, Michigan 23 23 23290 Hillsdale County, Michigan 23 23 23300 Houghton County, Michigan 23 23 23310 Huron County, Michigan 23 23 23320 Ingham County, Michigan 4040 29620 23330 Ionia County, Michigan 23 24340 23340 Iosco County, Michigan 23 23 23350 Iron County, Michigan 23 23 23360 Isabella County, Michigan 23 23 23370 Jackson County, Michigan 3520 27100 23380 Kalamazoo County, Michigan 3720 28020 23390 Kalkaska County, Michigan 23 23 23400 Kent County, Michigan 3000 24340 23410 Keweenaw County, Michigan 23 23 23420 Lake County, Michigan 23 23 23430 Lapeer County, Michigan 2160 47644 23440 Leelanau County, Michigan 23 23 23450 Lenawee County, Michigan 23 23 23460 Livingston County, Michigan 2160 47644 23470 Luce County, Michigan 23 23 23480 Mackinac County, Michigan 23 23
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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 685 and 686: ADDENDUM B: RELATIVE VALUE UNITS (R
Page 703 and 704: CPT Code Short Descriptors 21480 Re
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
Page 715 and 716: 715 SSA State/County Code County an
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Page 777 and 778: CPT/HCPCS Codes MOD DESCRIPTION STA
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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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