2006 proposed fee schedule - American Society of Clinical Oncology

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746 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 28410 Harlan County, Nebraska 28 28 28420 Hayes County, Nebraska 28 28 28430 Hitchcock County, Nebraska 28 28 28440 Holt County, Nebraska 28 28 28450 Hooker County, Nebraska 28 28 28460 Howard County, Nebraska 28 28 28470 Jefferson County, Nebraska 28 28 28480 Johnson County, Nebraska 28 28 28490 Kearney County, Nebraska 28 28 28500 Keith County, Nebraska 28 28 28510 Keya Paha County, Nebraska 28 28 28520 Kimball County, Nebraska 28 28 28530 Knox County, Nebraska 28 28 28540 Lancaster County, Nebraska 4360 30700 28550 Lincoln County, Nebraska 28 28 28560 Logan County, Nebraska 28 28 28570 Loup County, Nebraska 28 28 28580 Mc Pherson County, Nebraska 28 28 28590 Madison County, Nebraska 28 28 28600 Merrick County, Nebraska 28 28 28610 Morrill County, Nebraska 28 28 28620 Nance County, Nebraska 28 28 28630 Nemaha County, Nebraska 28 28 28640 Nuckolls County, Nebraska 28 28 28650 Otoe County, Nebraska 28 28 28660 Pawnee County, Nebraska 28 28 28670 Perkins County, Nebraska 28 28 28680 Phelps County, Nebraska 28 28 28690 Pierce County, Nebraska 28 28 28700 Platte County, Nebraska 28 28 28710 Polk County, Nebraska 28 28 28720 Redwillow County, Nebraska 28 28 28730 Richardson County, Nebraska 28 28 28740 Rock County, Nebraska 28 28 28750 Saline County, Nebraska 28 28 28760 Sarpy County, Nebraska 5920 36540 28770 Saunders County, Nebraska 28 36540 28780 Scotts Bluff County, Nebraska 28 28 28790 Seward County, Nebraska 28 30700 28800 Sheridan County, Nebraska 28 28 28810 Sherman County, Nebraska 28 28 28820 Sioux County, Nebraska 28 28 28830 Stanton County, Nebraska 28 28 28840 Thayer County, Nebraska 28 28 28850 Thomas County, Nebraska 28 28 28860 Thurston County, Nebraska 28 28 28870 Valley County, Nebraska 28 28 28880 Washington County, Nebraska 5920 36540 28890 Wayne County, Nebraska 28 28 28900 Webster County, Nebraska 28 28 28910 Wheeler County, Nebraska 28 28 28920 York County, Nebraska 28 28
747 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 29000 Churchill County, Nevada 29 29 29010 Clark County, Nevada 4120 29820 29020 Douglas County, Nevada 29 29 29030 Elko County, Nevada 29 29 29040 Esmeralda County, Nevada 29 29 29050 Eureka County, Nevada 29 29 29060 Humboldt County, Nevada 29 29 29070 Lander County, Nevada 29 29 29080 Lincoln County, Nevada 29 29 29090 Lyon County, Nevada 29 29 29100 Mineral County, Nevada 29 29 29110 Nye County, Nevada 29 29 29120 Carson City County, Nevada 29 16180 29130 Pershing County, Nevada 29 29 29140 Storey County, Nevada 29 39900 29150 Washoe County, Nevada 6720 39900 29160 White Pine County, Nevada 29 29 30000 Belknap County, New Hampshire 30 30 30010 Carroll County, New Hampshire 30 30 30020 Cheshire County, New Hampshire 30 30 30030 Coos County, New Hampshire 30 30 30040 Grafton County, New Hampshire 30 30 30050 Hillsboro County, New Hampshire 4763 31700 30060 Merrimack County, New Hampshire 4763 31700 30070 Rockingham County, New Hampshire 6453 40484 30080 Strafford County, New Hampshire 6453 40484 30090 Sullivan County, New Hampshire 30 30 31000 Atlantic County, New Jersey 0560 12100 31100 Bergen County, New Jersey 0875 35644 31150 Burlington County, New Jersey 6160 15804 31160 Camden County, New Jersey 6160 15804 31180 Cape May County, New Jersey 0560 36140 31190 Cumberland County, New Jersey 8760 47220 31200 Essex County, New Jersey 5640 35084 31220 Gloucester County, New Jersey 6160 15804 31230 Hudson County, New Jersey 3640 35644 31250 Hunterdon County, New Jersey 5015 35084 31260 Mercer County, New Jersey 8480 45940 31270 Middlesex County, New Jersey 5015 20764 31290 Monmouth County, New Jersey 5190 20764 31300 Morris County, New Jersey 5640 35084 31310 Ocean County, New Jersey 5190 20764 31320 Passaic County, New Jersey 0875 35644 31340 Salem County, New Jersey 9160 48864 31350 Somerset County, New Jersey 5015 20764 31360 Sussex County, New Jersey 5640 35084 31370 Union County, New Jersey 5640 35084 31390 Warren County, New Jersey 0240 10900 32000 Bernalillo County, New Mexico 0200 10740 32010 Catron County, New Mexico 32 32 32020 Chaves County, New Mexico 32 32 32025 Cibola County, New Mexico 32 32
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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 695 and 696: 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 745: 745 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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