2006 proposed fee schedule - American Society of Clinical Oncology

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742 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 26050 Barton County, Missouri 26 26 26060 Bates County, Missouri 26 28140 26070 Benton County, Missouri 26 26 26080 Bollinger County, Missouri 26 26 26090 Boone County, Missouri 1740 17860 26100 Buchanan County, Missouri 7000 41140 26110 Butler County, Missouri 26 26 26120 Caldwell County, Missouri 26 28140 26130 Callaway County, Missouri 26 27620 26140 Camden County, Missouri 26 26 26150 Cape Girardeau County, Missouri 26 26 26160 Carroll County, Missouri 26 26 26170 Carter County, Missouri 26 26 26180 Cass County, Missouri 3760 28140 26190 Cedar County, Missouri 26 26 26200 Chariton County, Missouri 26 26 26210 Christian County, Missouri 7920 44180 26220 Clark County, Missouri 26 26 26230 Clay County, Missouri 3760 28140 26240 Clinton County, Missouri 26 28140 26250 Cole County, Missouri 26 27620 26260 Cooper County, Missouri 26 26 26270 Crawford County, Missouri 26 41180 26280 Dade County, Missouri 26 26 26290 Dallas County, Missouri 26 44180 26300 Daviess County, Missouri 26 26 26310 De Kalb County, Missouri 26 41140 26320 Dent County, Missouri 26 26 26330 Douglas County, Missouri 26 26 26340 Dunklin County, Missouri 26 26 26350 Franklin County, Missouri 7040 41180 26360 Gasconade County, Missouri 26 26 26370 Gentry County, Missouri 26 26 26380 Greene County, Missouri 7920 44180 26390 Grundy County, Missouri 26 26 26400 Harrison County, Missouri 26 26 26410 Henry County, Missouri 26 26 26411 Hickory County, Missouri 26 26 26412 Holt County, Missouri 26 26 26440 Howard County, Missouri 26 17860 26450 Howell County, Missouri 26 26 26460 Iron County, Missouri 26 26 26470 Jackson County, Missouri 3760 28140 26480 Jasper County, Missouri 3710 27900 26490 Jefferson County, Missouri 7040 41180 26500 Johnson County, Missouri 26 26 26510 Knox County, Missouri 26 26 26520 Laclede County, Missouri 26 26 26530 Lafayette County, Missouri 3760 28140 26540 Lawrence County, Missouri 26 26 26541 Lewis County, Missouri 26 26 26560 Lincoln County, Missouri 26 41180
743 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 26570 Linn County, Missouri 26 26 26580 Livingston County, Missouri 26 26 26590 Mc Donald County, Missouri 26 22220 26600 Macon County, Missouri 26 26 26601 Madison County, Missouri 26 26 26620 Maries County, Missouri 26 26 26630 Marion County, Missouri 26 26 26631 Mercer County, Missouri 26 26 26650 Miller County, Missouri 26 26 26660 Mississippi County, Missouri 26 26 26670 Moniteau County, Missouri 26 27620 26680 Monroe County, Missouri 26 26 26690 Montgomery County, Missouri 26 26 26700 Morgan County, Missouri 26 26 26710 New Madrid County, Missouri 26 26 26720 Newton County, Missouri 3710 27900 26730 Nodaway County, Missouri 26 26 26740 Oregon County, Missouri 26 26 26750 Osage County, Missouri 26 27620 26751 Ozark County, Missouri 26 26 26770 Pemiscot County, Missouri 26 26 26780 Perry County, Missouri 26 26 26790 Pettis County, Missouri 26 26 26800 Phelps County, Missouri 26 26 26810 Pike County, Missouri 26 26 26820 Platte County, Missouri 3760 28140 26821 Polk County, Missouri 26 44180 26840 Pulaski County, Missouri 26 26 26850 Putnam County, Missouri 26 26 26860 Ralls County, Missouri 26 26 26870 Randolph County, Missouri 26 26 26880 Ray County, Missouri 3760 28140 26881 Reynolds County, Missouri 26 26 26900 Ripley County, Missouri 26 26 26910 St Charles County, Missouri 7040 41180 26911 St Clair County, Missouri 26 26 26930 St Francois County, Missouri 26 26 26940 St Louis County, Missouri 7040 41180 26950 St Louis City County, Missouri 7040 41180 26960 Ste Genevieve County, Missouri 26 26 26970 Saline County, Missouri 26 26 26980 Schuyler County, Missouri 26 26 26981 Scotland County, Missouri 26 26 26982 Scott County, Missouri 26 26 26983 Shannon County, Missouri 26 26 26984 Shelby County, Missouri 26 26 26985 Stoddard County, Missouri 26 26 26986 Stone County, Missouri 26 26 26987 Sullivan County, Missouri 26 26 26988 Taney County, Missouri 26 26 26989 Texas County, Missouri 26 26 26990 Vernon 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 691 and 692: 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
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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