2006 proposed fee schedule - American Society of Clinical Oncology

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740 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 24700 Sherburne County, Minnesota 6980 33460 24710 Sibley County, Minnesota 24 24 24720 Stearns County, Minnesota 6980 41060 24730 Steele County, Minnesota 24 24 24740 Stevens County, Minnesota 24 24 24750 Swift County, Minnesota 24 24 24760 Todd County, Minnesota 24 24 24770 Traverse County, Minnesota 24 24 24780 Wabasha County, Minnesota 24 40340 24790 Wadena County, Minnesota 24 24 24800 Waseca County, Minnesota 24 24 24810 Washington County, Minnesota 5120 33460 24820 Watonwan County, Minnesota 24 24 24830 Wilkin County, Minnesota 24 24 24840 Winona County, Minnesota 24 24 24850 Wright County, Minnesota 5120 33460 24860 Yellow Medicine County, Minnesota 24 24 25000 Adams County, Mississippi 25 25 25010 Alcorn County, Mississippi 25 25 25020 Amite County, Mississippi 25 25 25030 Attala County, Mississippi 25 25 25040 Benton County, Mississippi 25 25 25050 Bolivar County, Mississippi 25 25 25060 Calhoun County, Mississippi 25 25 25070 Carroll County, Mississippi 25 25 25080 Chickasaw County, Mississippi 25 25 25090 Choctaw County, Mississippi 25 25 25100 Claiborne County, Mississippi 25 25 25110 Clarke County, Mississippi 25 25 25120 Clay County, Mississippi 25 25 25130 Coahoma County, Mississippi 25 25 25140 Copiah County, Mississippi 25 27140 25150 Covington County, Mississippi 25 25 25160 Desoto County, Mississippi 4920 32820 25170 Forrest County, Mississippi 25 25620 25180 Franklin County, Mississippi 25 25 25190 George County, Mississippi 25 37700 25200 Greene County, Mississippi 25 25 25210 Grenada County, Mississippi 25 25 25220 Hancock County, Mississippi 0920 25060 25230 Harrison County, Mississippi 0920 25060 25240 Hinds County, Mississippi 3560 27140 25250 Holmes County, Mississippi 25 25 25260 Humphreys County, Mississippi 25 25 25270 Issaquena County, Mississippi 25 25 25280 Itawamba County, Mississippi 25 25 25290 Jackson County, Mississippi 6025 37700 25300 Jasper County, Mississippi 25 25 25310 Jefferson County, Mississippi 25 25 25320 Jefferson Davis County, Mississippi 25 25 25330 Jones County, Mississippi 25 25 25340 Kemper County, Mississippi 25 25
741 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 25350 Lafayette County, Mississippi 25 25 25360 Lamar County, Mississippi 25 25620 25370 Lauderdale County, Mississippi 25 25 25380 Lawrence County, Mississippi 25 25 25390 Leake County, Mississippi 25 25 25400 Lee County, Mississippi 25 25 25410 Leflore County, Mississippi 25 25 25420 Lincoln County, Mississippi 25 25 25430 Lowndes County, Mississippi 25 25 25440 Madison County, Mississippi 3560 27140 25450 Marion County, Mississippi 25 25 25460 Marshall County, Mississippi 25 32820 25470 Monroe County, Mississippi 25 25 25480 Montgomery County, Mississippi 25 25 25490 Neshoba County, Mississippi 25 25 25500 Newton County, Mississippi 25 25 25510 Noxubee County, Mississippi 25 25 25520 Oktibbeha County, Mississippi 25 25 25530 Panola County, Mississippi 25 25 25540 Pearl River County, Mississippi 25 25 25550 Perry County, Mississippi 25 25620 25560 Pike County, Mississippi 25 25 25570 Pontotoc County, Mississippi 25 25 25580 Prentiss County, Mississippi 25 25 25590 Quitman County, Mississippi 25 25 25600 Rankin County, Mississippi 3560 27140 25610 Scott County, Mississippi 25 25 25620 Sharkey County, Mississippi 25 25 25630 Simpson County, Mississippi 25 27140 25640 Smith County, Mississippi 25 25 25650 Stone County, Mississippi 25 25060 25660 Sunflower County, Mississippi 25 25 25670 Tallahatchie County, Mississippi 25 25 25680 Tate County, Mississippi 25 32820 25690 Tippah County, Mississippi 25 25 25700 Tishomingo County, Mississippi 25 25 25710 Tunica County, Mississippi 25 32820 25720 Union County, Mississippi 25 25 25730 Walthall County, Mississippi 25 25 25740 Warren County, Mississippi 25 25 25750 Washington County, Mississippi 25 25 25760 Wayne County, Mississippi 25 25 25770 Webster County, Mississippi 25 25 25780 Wilkinson County, Mississippi 25 25 25790 Winston County, Mississippi 25 25 25800 Yalobusha County, Mississippi 25 25 25810 Yazoo County, Mississippi 25 25 26000 Adair County, Missouri 26 26 26010 Andrew County, Missouri 26 41140 26020 Atchison County, Missouri 26 26 26030 Audrain County, Missouri 26 26 26040 Barry County, Missouri 26 26
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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 689 and 690: ADDENDUM B: RELATIVE VALUE UNITS (R
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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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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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