2006 proposed fee schedule - American Society of Clinical Oncology

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744 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 26991 Warren County, Missouri 26 41180 26992 Washington County, Missouri 26 41180 26993 Wayne County, Missouri 26 26 26994 Webster County, Missouri 26 44180 26995 Worth County, Missouri 26 26 26996 Wright County, Missouri 26 26 27000 Beaverhead County, Montana 27 27 27010 Big Horn County, Montana 27 27 27020 Blaine County, Montana 27 27 27030 Broadwater County, Montana 27 27 27040 Carbon County, Montana 27 13740 27050 Carter County, Montana 27 27 27060 Cascade County, Montana 3040 24500 27070 Chouteau County, Montana 27 27 27080 Custer County, Montana 27 27 27090 Daniels County, Montana 27 27 27100 Dawson County, Montana 27 27 27110 Deer Lodge County, Montana 27 27 27113 Yellowstone National Park, Montana 0880 27 27120 Fallon County, Montana 27 27 27130 Fergus County, Montana 27 27 27140 Flathead County, Montana 27 27 27150 Gallatin County, Montana 27 27 27160 Garfield County, Montana 27 27 27170 Glacier County, Montana 27 27 27180 Golden Valley County, Montana 27 27 27190 Granite County, Montana 27 27 27200 Hill County, Montana 27 27 27210 Jefferson County, Montana 27 27 27220 Judith Basin County, Montana 27 27 27230 Lake County, Montana 27 27 27240 Lewis And Clark County, Montana 27 27 27250 Liberty County, Montana 27 27 27260 Lincoln County, Montana 27 27 27270 Mc Cone County, Montana 27 27 27280 Madison County, Montana 27 27 27290 Meagher County, Montana 27 27 27300 Mineral County, Montana 27 27 27310 Missoula County, Montana 27 33540 27320 Musselshell County, Montana 27 27 27330 Park County, Montana 27 27 27340 Petroleum County, Montana 27 27 27350 Phillips County, Montana 27 27 27360 Pondera County, Montana 27 27 27370 Powder River County, Montana 27 27 27380 Powell County, Montana 27 27 27390 Prairie County, Montana 27 27 27400 Ravalli County, Montana 27 27 27410 Richland County, Montana 27 27 27420 Roosevelt County, Montana 27 27 27430 Rosebud County, Montana 27 27 27440 Sanders County, Montana 27 27
745 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 27450 Sheridan County, Montana 27 27 27460 Silver Bow County, Montana 27 27 27470 Stillwater County, Montana 27 27 27480 Sweet Grass County, Montana 27 27 27490 Teton County, Montana 27 27 27500 Toole County, Montana 27 27 27510 Treasure County, Montana 27 27 27520 Valley County, Montana 27 27 27530 Wheatland County, Montana 27 27 27540 Wibaux County, Montana 27 27 27550 Yellowstone County, Montana 0880 13740 28000 Adams County, Nebraska 28 28 28010 Antelope County, Nebraska 28 28 28020 Arthur County, Nebraska 28 28 28030 Banner County, Nebraska 28 28 28040 Blaine County, Nebraska 28 28 28050 Boone County, Nebraska 28 28 28060 Box Butte County, Nebraska 28 28 28070 Boyd County, Nebraska 28 28 28080 Brown County, Nebraska 28 28 28090 Buffalo County, Nebraska 28 28 28100 Burt County, Nebraska 28 28 28110 Butler County, Nebraska 28 28 28120 Cass County, Nebraska 28 36540 28130 Cedar County, Nebraska 28 28 28140 Chase County, Nebraska 28 28 28150 Cherry County, Nebraska 28 28 28160 Cheyenne County, Nebraska 28 28 28170 Clay County, Nebraska 28 28 28180 Colfax County, Nebraska 28 28 28190 Cuming County, Nebraska 28 28 28200 Custer County, Nebraska 28 28 28210 Dakota County, Nebraska 7720 43580 28220 Dawes County, Nebraska 28 28 28230 Dawson County, Nebraska 28 28 28240 Deuel County, Nebraska 28 28 28250 Dixon County, Nebraska 28 43580 28260 Dodge County, Nebraska 28 28 28270 Douglas County, Nebraska 5920 36540 28280 Dundy County, Nebraska 28 28 28290 Fillmore County, Nebraska 28 28 28300 Franklin County, Nebraska 28 28 28310 Frontier County, Nebraska 28 28 28320 Furnas County, Nebraska 28 28 28330 Gage County, Nebraska 28 28 28340 Garden County, Nebraska 28 28 28350 Garfield County, Nebraska 28 28 28360 Gosper County, Nebraska 28 28 28370 Grant County, Nebraska 28 28 28380 Greeley County, Nebraska 28 28 28390 Hall County, Nebraska 28 28 28400 Hamilton County, Nebraska 28 28
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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 693 and 694: 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
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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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