2006 proposed fee schedule - American Society of Clinical Oncology

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754 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 36700 Putnam County, Ohio 36 36 36710 Richland County, Ohio 4800 31900 36720 Ross County, Ohio 36 36 36730 Sandusky County, Ohio 36 36 36740 Scioto County, Ohio 36 36 36750 Seneca County, Ohio 36 36 36760 Shelby County, Ohio 36 36 36770 Stark County, Ohio 1320 15940 36780 Summit County, Ohio 0080 10420 36790 Trumbull County, Ohio 9320 49660 36800 Tuscarawas County, Ohio 36 36 36810 Union County, Ohio 1840 18140 36820 Van Wert County, Ohio 36 36 36830 Vinton County, Ohio 36 36 36840 Warren County, Ohio 1640 17140 36850 Washington County, Ohio 6020 37620 36860 Wayne County, Ohio 36 36 36870 Williams County, Ohio 36 36 36880 Wood County, Ohio 8400 45780 36890 Wyandot County, Ohio 36 36 37000 Adair County, Oklahoma 37 37 37010 Alfalfa County, Oklahoma 37 37 37020 Atoka County, Oklahoma 37 37 37030 Beaver County, Oklahoma 37 37 37040 Beckham County, Oklahoma 37 37 37050 Blaine County, Oklahoma 37 37 37060 Bryan County, Oklahoma 37 37 37070 Caddo County, Oklahoma 37 37 37080 Canadian County, Oklahoma 5880 36420 37090 Carter County, Oklahoma 37 37 37100 Cherokee County, Oklahoma 37 37 37110 Choctaw County, Oklahoma 37 37 37120 Cimarron County, Oklahoma 37 37 37130 Cleveland County, Oklahoma 5880 36420 37140 Coal County, Oklahoma 37 37 37150 Comanche County, Oklahoma 4200 30020 37160 Cotton County, Oklahoma 37 37 37170 Craig County, Oklahoma 37 37 37180 Creek County, Oklahoma 8560 46140 37190 Custer County, Oklahoma 37 37 37200 Delaware County, Oklahoma 37 37 37210 Dewey County, Oklahoma 37 37 37220 Ellis County, Oklahoma 37 37 37230 Garfield County, Oklahoma 2340 37 37240 Garvin County, Oklahoma 37 37 37250 Grady County, Oklahoma 37 36420 37260 Grant County, Oklahoma 37 37 37270 Greer County, Oklahoma 37 37 37280 Harmon County, Oklahoma 37 37 37290 Harper County, Oklahoma 37 37 37300 Haskell County, Oklahoma 37 37 37310 Hughes County, Oklahoma 37 37
755 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 37320 Jackson County, Oklahoma 37 37 37330 Jefferson County, Oklahoma 37 37 37340 Johnston County, Oklahoma 37 37 37350 Kay County, Oklahoma 37 37 37360 Kingfisher County, Oklahoma 37 37 37370 Kiowa County, Oklahoma 37 37 37380 Latimer County, Oklahoma 37 37 37390 Le Flore County, Oklahoma 37 22900 37400 Lincoln County, Oklahoma 37 36420 37410 Logan County, Oklahoma 5880 36420 37420 Love County, Oklahoma 37 37 37430 Mc Clain County, Oklahoma 5880 36420 37440 Mc Curtain County, Oklahoma 37 37 37450 Mc Intosh County, Oklahoma 37 37 37460 Major County, Oklahoma 37 37 37470 Marshall County, Oklahoma 37 37 37480 Mayes County, Oklahoma 37 37 37490 Murray County, Oklahoma 37 37 37500 Muskogee County, Oklahoma 37 37 37510 Noble County, Oklahoma 37 37 37520 Nowata County, Oklahoma 37 37 37530 Okfuskee County, Oklahoma 37 37 37540 Oklahoma County, Oklahoma 5880 36420 37550 Okmulgee County, Oklahoma 37 46140 37560 Osage County, Oklahoma 8560 46140 37570 Ottawa County, Oklahoma 37 37 37580 Pawnee County, Oklahoma 37 46140 37590 Payne County, Oklahoma 37 37 37600 Pittsburg County, Oklahoma 37 37 37610 Pontotoc County, Oklahoma 37 37 37620 Pottawatomie County, Oklahoma 5880 37 37630 Pushmataha County, Oklahoma 37 37 37640 Roger Mills County, Oklahoma 37 37 37650 Rogers County, Oklahoma 8560 46140 37660 Seminole County, Oklahoma 37 37 37670 Sequoyah County, Oklahoma 2720 22900 37680 Stephens County, Oklahoma 37 37 37690 Texas County, Oklahoma 37 37 37700 Tillman County, Oklahoma 37 37 37710 Tulsa County, Oklahoma 8560 46140 37720 Wagoner County, Oklahoma 8560 46140 37730 Washington County, Oklahoma 37 37 37740 Washita County, Oklahoma 37 37 37750 Woods County, Oklahoma 37 37 37760 Woodward County, Oklahoma 37 37 38000 Baker County, Oregon 38 38 38010 Benton County, Oregon 38 18700 38020 Clackamas County, Oregon 6440 38900 38030 Clatsop County, Oregon 38 38 38040 Columbia County, Oregon 38 38900 38050 Coos County, Oregon 38 38 38060 Crook County, Oregon 38 38
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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 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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