2006 proposed fee schedule - American Society of Clinical Oncology

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738 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 23490 Macomb County, Michigan 2160 47644 23500 Manistee County, Michigan 23 23 23510 Marquette County, Michigan 23 23 23520 Mason County, Michigan 23 23 23530 Mecosta County, Michigan 23 23 23540 Menominee County, Michigan 23 23 23550 Midland County, Michigan 6960 23 23560 Missaukee County, Michigan 23 23 23570 Monroe County, Michigan 2160 33780 23580 Montcalm County, Michigan 23 23 23590 Montmorency County, Michigan 23 23 23600 Muskegon County, Michigan 5320 34740 23610 Newaygo County, Michigan 23 24340 23620 Oakland County, Michigan 2160 47644 23630 Oceana County, Michigan 23 23 23640 Ogemaw County, Michigan 23 23 23650 Ontonagon County, Michigan 23 23 23660 Osceola County, Michigan 23 23 23670 Oscoda County, Michigan 23 23 23680 Otsego County, Michigan 23 23 23690 Ottawa County, Michigan 3000 26100 23700 Presque Isle County, Michigan 23 23 23710 Roscommon County, Michigan 23 23 23720 Saginaw County, Michigan 6960 40980 23730 St Clair County, Michigan 2160 47644 23740 St Joseph County, Michigan 23 23 23750 Sanilac County, Michigan 23 23 23760 Schoolcraft County, Michigan 23 23 23770 Shiawassee County, Michigan 23 23 23780 Tuscola County, Michigan 23 23 23790 Van Buren County, Michigan 23 28020 23800 Washtenaw County, Michigan 0440 11460 23810 Wayne County, Michigan 2160 19804 23830 Wexford County, Michigan 23 23 24000 Aitkin County, Minnesota 24 24 24010 Anoka County, Minnesota 5120 33460 24020 Becker County, Minnesota 24 24 24030 Beltrami County, Minnesota 24 24 24040 Benton County, Minnesota 6980 41060 24050 Big Stone County, Minnesota 24 24 24060 Blue Earth County, Minnesota 24 24 24070 Brown County, Minnesota 24 24 24080 Carlton County, Minnesota 24 20260 24090 Carver County, Minnesota 5120 33460 24100 Cass County, Minnesota 24 24 24110 Chippewa County, Minnesota 24 24 24120 Chisago County, Minnesota 5120 33460 24130 Clay County, Minnesota 2520 22020 24140 Clearwater County, Minnesota 24 24 24150 Cook County, Minnesota 24 24 24160 Cottonwood County, Minnesota 24 24 24170 Crow Wing County, Minnesota 24 24
739 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 24180 Dakota County, Minnesota 5120 33460 24190 Dodge County, Minnesota 24 40340 24200 Douglas County, Minnesota 24 24 24210 Faribault County, Minnesota 24 24 24220 Fillmore County, Minnesota 24 24 24230 Freeborn County, Minnesota 24 24 24240 Goodhue County, Minnesota 24 24 24250 Grant County, Minnesota 24 24 24260 Hennepin County, Minnesota 5120 33460 24270 Houston County, Minnesota 24 29100 24280 Hubbard County, Minnesota 24 24 24290 Isanti County, Minnesota 5120 33460 24300 Itasca County, Minnesota 24 24 24310 Jackson County, Minnesota 24 24 24320 Kanabec County, Minnesota 24 24 24330 Kandiyohi County, Minnesota 24 24 24340 Kittson County, Minnesota 24 24 24350 Koochiching County, Minnesota 24 24 24360 Lac Qui Parle County, Minnesota 24 24 24370 Lake County, Minnesota 24 24 24380 Lake Of Woods County, Minnesota 24 24 24390 Le Sueur County, Minnesota 24 24 24400 Lincoln County, Minnesota 24 24 24410 Lyon County, Minnesota 24 24 24420 Mc Leod County, Minnesota 24 24 24430 Mahnomen County, Minnesota 24 24 24440 Marshall County, Minnesota 24 24 24450 Martin County, Minnesota 24 24 24460 Meeker County, Minnesota 24 24 24470 Mille Lacs County, Minnesota 24 24 24480 Morrison County, Minnesota 24 24 24490 Mower County, Minnesota 24 24 24500 Murray County, Minnesota 24 24 24510 Nicollet County, Minnesota 24 24 24520 Nobles County, Minnesota 24 24 24530 Norman County, Minnesota 24 24 24540 Olmsted County, Minnesota 6820 40340 24550 Otter Tail County, Minnesota 24 24 24560 Pennington County, Minnesota 24 24 24570 Pine County, Minnesota 24 24 24580 Pipestone County, Minnesota 24 24 24590 Polk County, Minnesota 24 24220 24600 Pope County, Minnesota 24 24 24610 Ramsey County, Minnesota 5120 33460 24620 Red Lake County, Minnesota 24 24 24630 Redwood County, Minnesota 24 24 24640 Renville County, Minnesota 24 24 24650 Rice County, Minnesota 24 24 24660 Rock County, Minnesota 24 24 24670 Roseau County, Minnesota 24 24 24680 St Louis County, Minnesota 2240 20260 24690 Scott County, Minnesota 5120 33460
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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 687 and 688: 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
Page 737: 737 SSA State/County Code County an
Page 777 and 778: CPT/HCPCS Codes MOD DESCRIPTION STA
Page 787: CPT/HCPCS Codes MOD DESCRIPTION STA
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2006 proposed fee schedule - American Society of Clinical Oncology

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