2006 proposed fee schedule - American Society of Clinical Oncology

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750 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 34130 Caldwell County, N Carolina 34 25860 34140 Camden County, N Carolina 34 34 34150 Carteret County, N Carolina 34 34 34160 Caswell County, N Carolina 34 34 34170 Catawba County, N Carolina 3290 25860 34180 Chatham County, N Carolina 34 20500 34190 Cherokee County, N Carolina 34 34 34200 Chowan County, N Carolina 34 34 34210 Clay County, N Carolina 34 34 34220 Cleveland County, N Carolina 34 34 34230 Columbus County, N Carolina 34 34 34240 Craven County, N Carolina 34 34 34250 Cumberland County, N Carolina 2560 22180 34251 Currituck County, N Carolina 34 47260 34270 Dare County, N Carolina 34 34 34280 Davidson County, N Carolina 3120 34 34290 Davie County, N Carolina 3120 49180 34300 Duplin County, N Carolina 34 34 34310 Durham County, N Carolina 6640 20500 34320 Edgecombe County, N Carolina 34 40580 34330 Forsyth County, N Carolina 3120 49180 34340 Franklin County, N Carolina 6640 39580 34350 Gaston County, N Carolina 1520 16740 34360 Gates County, N Carolina 34 34 34370 Graham County, N Carolina 34 34 34380 Granville County, N Carolina 34 34 34390 Greene County, N Carolina 34 24780 34400 Guilford County, N Carolina 3120 24660 34410 Halifax County, N Carolina 34 34 34420 Harnett County, N Carolina 34 34 34430 Haywood County, N Carolina 34 11700 34440 Henderson County, N Carolina 34 11700 34450 Hertford County, N Carolina 34 34 34460 Hoke County, N Carolina 34 22180 34470 Hyde County, N Carolina 34 34 34480 Iredell County, N Carolina 34 34 34490 Jackson County, N Carolina 34 34 34500 Johnston County, N Carolina 34 39580 34510 Jones County, N Carolina 34 34 34520 Lee County, N Carolina 34 34 34530 Lenoir County, N Carolina 34 34 34540 Lincoln County, N Carolina 1520 34 34550 Mc Dowell County, N Carolina 34 34 34560 Macon County, N Carolina 34 34 34570 Madison County, N Carolina 34 11700 34580 Martin County, N Carolina 34 34 34590 Mecklenburg County, N Carolina 1520 16740 34600 Mitchell County, N Carolina 34 34 34610 Montgomery County, N Carolina 34 34 34620 Moore County, N Carolina 34 34 34630 Nash County, N Carolina 34 40580 34640 New Hanover County, N Carolina 9200 48900
751 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 34650 Northampton County, N Carolina 34 34 34660 Onslow County, N Carolina 3605 27340 34670 Orange County, N Carolina 6640 20500 34680 Pamlico County, N Carolina 34 34 34690 Pasquotank County, N Carolina 34 34 34700 Pender County, N Carolina 34 48900 34710 Perquimans County, N Carolina 34 34 34720 Person County, N Carolina 34 20500 34730 Pitt County, N Carolina 34 24780 34740 Polk County, N Carolina 34 34 34750 Randolph County, N Carolina 3120 24660 34760 Richmond County, N Carolina 34 34 34770 Robeson County, N Carolina 34 34 34780 Rockingham County, N Carolina 34 24660 34790 Rowan County, N Carolina 1520 34 34800 Rutherford County, N Carolina 34 34 34810 Sampson County, N Carolina 34 34 34820 Scotland County, N Carolina 34 34 34830 Stanly County, N Carolina 34 16740 34840 Stokes County, N Carolina 3120 49180 34850 Surry County, N Carolina 34 34 34860 Swain County, N Carolina 34 34 34870 Transylvania County, N Carolina 34 34 34880 Tyrrell County, N Carolina 34 34 34890 Union County, N Carolina 1520 16740 34900 Vance County, N Carolina 34 34 34910 Wake County, N Carolina 6640 39580 34920 Warren County, N Carolina 34 34 34930 Washington County, N Carolina 34 34 34940 Watauga County, N Carolina 34 34 34950 Wayne County, N Carolina 34 24140 34960 Wilkes County, N Carolina 34 34 34970 Wilson County, N Carolina 34 34 34980 Yadkin County, N Carolina 3120 49180 34981 Yancey County, N Carolina 34 34 35000 Adams County, N Dakota 35 35 35010 Barnes County, N Dakota 35 35 35020 Benson County, N Dakota 35 35 35030 Billings County, N Dakota 35 35 35040 Bottineau County, N Dakota 35 35 35050 Bowman County, N Dakota 35 35 35060 Burke County, N Dakota 35 35 35070 Burleigh County, N Dakota 1010 13900 35080 Cass County, N Dakota 2520 22020 35090 Cavalier County, N Dakota 35 35 35100 Dickey County, N Dakota 35 35 35110 Divide County, N Dakota 35 35 35120 Dunn County, N Dakota 35 35 35130 Eddy County, N Dakota 35 35 35140 Emmons County, N Dakota 35 35 35150 Foster County, N Dakota 35 35 35160 Golden Valley County, N Dakota 35 35
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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 699 and 700: ADDENDUM B: RELATIVE VALUE UNITS (R
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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 749: 749 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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