2006 proposed fee schedule - American Society of Clinical Oncology

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756 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 38070 Curry County, Oregon 38 38 38080 Deschutes County, Oregon 38 13460 38090 Douglas County, Oregon 38 38 38100 Gilliam County, Oregon 38 38 38110 Grant County, Oregon 38 38 38120 Harney County, Oregon 38 38 38130 Hood River County, Oregon 38 38 38140 Jackson County, Oregon 4890 32780 38150 Jefferson County, Oregon 38 38 38160 Josephine County, Oregon 38 38 38170 Klamath County, Oregon 38 38 38180 Lake County, Oregon 38 38 38190 Lane County, Oregon 2400 21660 38200 Lincoln County, Oregon 38 38 38210 Linn County, Oregon 38 38 38220 Malheur County, Oregon 38 38 38230 Marion County, Oregon 7080 41420 38240 Morrow County, Oregon 38 38 38250 Multnomah County, Oregon 6440 38900 38260 Polk County, Oregon 7080 41420 38270 Sherman County, Oregon 38 38 38280 Tillamook County, Oregon 38 38 38290 Umatilla County, Oregon 38 38 38300 Union County, Oregon 38 38 38310 Wallowa County, Oregon 38 38 38320 Wasco County, Oregon 38 38 38330 Washington County, Oregon 6440 38900 38340 Wheeler County, Oregon 38 38 38350 Yamhill County, Oregon 6440 38900 39000 Adams County, Pennsylvania 9280 39 39010 Allegheny County, Pennsylvania 6280 38300 39070 Armstrong County, Pennsylvania 39 38300 39080 Beaver County, Pennsylvania 0845 38300 39100 Bedford County, Pennsylvania 39 39 39110 Berks County, Pennsylvania 6680 39740 39120 Blair County, Pennsylvania 0280 11020 39130 Bradford County, Pennsylvania 39 39 39140 Bucks County, Pennsylvania 6160 37964 39150 Butler County, Pennsylvania 39 38300 39160 Cambria County, Pennsylvania 3680 27780 39180 Cameron County, Pennsylvania 39 39 39190 Carbon County, Pennsylvania 0240 10900 39200 Centre County, Pennsylvania 8050 44300 39210 Chester County, Pennsylvania 6160 37964 39220 Clarion County, Pennsylvania 39 39 39230 Clearfield County, Pennsylvania 39 39 39240 Clinton County, Pennsylvania 39 39 39250 Columbia County, Pennsylvania 7560 39 39260 Crawford County, Pennsylvania 39 39 39270 Cumberland County, Pennsylvania 3240 25420 39280 Dauphin County, Pennsylvania 3240 25420 39290 Delaware County, Pennsylvania 6160 37964
757 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 39310 Elk County, Pennsylvania 39 39 39320 Erie County, Pennsylvania 2360 21500 39330 Fayette County, Pennsylvania 6280 38300 39340 Forest County, Pennsylvania 39 39 39350 Franklin County, Pennsylvania 39 39 39360 Fulton County, Pennsylvania 39 39 39370 Greene County, Pennsylvania 39 39 39380 Huntingdon County, Pennsylvania 39 39 39390 Indiana County, Pennsylvania 39 39 39400 Jefferson County, Pennsylvania 39 39 39410 Juniata County, Pennsylvania 39 39 39420 Lackawanna County, Pennsylvania 7560 42540 39440 Lancaster County, Pennsylvania 4000 29540 39450 Lawrence County, Pennsylvania 39 39 39460 Lebanon County, Pennsylvania 3240 30140 39470 Lehigh County, Pennsylvania 0240 10900 39480 Luzerne County, Pennsylvania 7560 42540 39510 Lycoming County, Pennsylvania 9140 48700 39520 Mc Kean County, Pennsylvania 39 39 39530 Mercer County, Pennsylvania 7610 49660 39540 Mifflin County, Pennsylvania 39 39 39550 Monroe County, Pennsylvania 7560 39 39560 Montgomery County, Pennsylvania 6160 37964 39580 Montour County, Pennsylvania 39 39 39590 Northampton County, Pennsylvania 0240 10900 39600 Northumberland County, Pennsylvania 39 39 39610 Perry County, Pennsylvania 3240 25420 39620 Philadelphia County, Pennsylvania 6160 37964 39630 Pike County, Pennsylvania 5660 35084 39640 Potter County, Pennsylvania 39 39 39650 Schuylkill County, Pennsylvania 39 39 39670 Snyder County, Pennsylvania 39 39 39680 Somerset County, Pennsylvania 3680 39 39690 Sullivan County, Pennsylvania 39 39 39700 Susquehanna County, Pennsylvania 39 39 39710 Tioga County, Pennsylvania 39 39 39720 Union County, Pennsylvania 39 39 39730 Venango County, Pennsylvania 39 39 39740 Warren County, Pennsylvania 39 39 39750 Washington County, Pennsylvania 6280 38300 39760 Wayne County, Pennsylvania 39 39 39770 Westmoreland County, Pennsylvania 6280 38300 39790 Wyoming County, Pennsylvania 7560 42540 39800 York County, Pennsylvania 9280 49620 40010 Adjuntas County, Puerto Rico 40 40 40020 Aguada County, Puerto Rico 0060 10380 40030 Aguadilla County, Puerto Rico 0060 10380 40040 Aguas Buenas County, Puerto Rico 7440 41980 40050 Aibonito County, Puerto Rico 40 41980 40060 Anasco County, Puerto Rico 4840 10380 40070 Arecibo County, Puerto Rico 0470 41980 40080 Arroyo County, Puerto Rico 40 25020
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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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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 755: 755 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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