2006 proposed fee schedule - American Society of Clinical Oncology

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758 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 40090 Barceloneta County, Puerto Rico 7440 41980 40100 Barranquitas County, Puerto Rico 40 41980 40110 Bayamon County, Puerto Rico 7440 41980 40120 Cabo Rojo County, Puerto Rico 4840 41900 40130 Caguas County, Puerto Rico 1310 41980 40140 Camuy County, Puerto Rico 0470 41980 40145 Canovanas County, Puerto Rico 7440 41980 40150 Carolina County, Puerto Rico 7440 41980 40160 Catano County, Puerto Rico 7440 41980 40170 Cayey County, Puerto Rico 1310 41980 40180 Ceiba County, Puerto Rico 40 21940 40190 Ciales County, Puerto Rico 40 41980 40200 Cidra County, Puerto Rico 1310 41980 40210 Coamo County, Puerto Rico 40 40 40220 Comerio County, Puerto Rico 40 41980 40230 Corozal County, Puerto Rico 40 41980 40240 Culebra County, Puerto Rico 40 40 40250 Dorado County, Puerto Rico 40 41980 40260 Fajardo County, Puerto Rico 40 21940 40265 Florida County, Puerto Rico 40 41980 40270 Guanica County, Puerto Rico 40 49500 40280 Guayama County, Puerto Rico 40 25020 40290 Guayanilla County, Puerto Rico 6360 49500 40300 Guaynabo County, Puerto Rico 40 41980 40310 Gurabo County, Puerto Rico 1310 41980 40320 Hatillo County, Puerto Rico 0470 41980 40330 Hormigueros County, Puerto Rico 4840 32420 40340 Humacao County, Puerto Rico 40 41980 40350 Isabela County, Puerto Rico 40 10380 40360 Jayuya County, Puerto Rico 40 40 40370 Juana Diaz County, Puerto Rico 6360 38660 40380 Juncos County, Puerto Rico 40 41980 40390 Lajas County, Puerto Rico 40 41900 40400 Lares County, Puerto Rico 40 10380 40410 Las Marias County, Puerto Rico 40 40 40420 Las Piedras County, Puerto Rico 40 41980 40430 Loiza County, Puerto Rico 7440 41980 40440 Luquillo County, Puerto Rico 40 21940 40450 Manati County, Puerto Rico 40 41980 40460 Maricao County, Puerto Rico 40 40 40470 Maunabo County, Puerto Rico 40 41980 40480 Mayaguez County, Puerto Rico 4840 32420 40490 Moca County, Puerto Rico 0060 10380 40500 Morovis County, Puerto Rico 40 41980 40510 Naguabo County, Puerto Rico 40 41980 40520 Naranjito County, Puerto Rico 40 41980 40530 Orocovis County, Puerto Rico 40 41980 40540 Patillas County, Puerto Rico 40 25020 40550 Penuelas County, Puerto Rico 6360 49500 40560 Ponce County, Puerto Rico 6360 38660 40570 Quebradillas County, Puerto Rico 40 41980 40580 Rincon County, Puerto Rico 40 10380
759 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 40590 Rio Grande County, Puerto Rico 40 41980 40610 Sabana Grande County, Puerto Rico 4840 41900 40620 Salinas County, Puerto Rico 40 40 40630 San German County, Puerto Rico 4840 41900 40640 San Juan County, Puerto Rico 40 41980 40650 San Lorenzo County, Puerto Rico 1310 41980 40660 San Sebastian County, Puerto Rico 40 10380 40670 Santa Isabel County, Puerto Rico 40 40 40680 Toa Alta County, Puerto Rico 40 41980 40690 Toa Baja County, Puerto Rico 40 41980 40700 Trujillo Alto County, Puerto Rico 40 41980 40710 Utuado County, Puerto Rico 40 40 40720 Vega Alta County, Puerto Rico 40 41980 40730 Vega Baja County, Puerto Rico 40 41980 40740 Vieques County, Puerto Rico 40 40 40750 Villalba County, Puerto Rico 6360 38660 40760 Yabucoa County, Puerto Rico 40 41980 40770 Yauco County, Puerto Rico 6360 49500 41000 Bristol County, Rhode Island 6483 39300 41010 Kent County, Rhode Island 6483 39300 41020 Newport County, Rhode Island 6483 39300 41030 Providence County, Rhode Island 6483 39300 41050 Washington County, Rhode Island 6483 39300 42000 Abbeville County, S Carolina 42 42 42010 Aiken County, S Carolina 0600 12260 42020 Allendale County, S Carolina 42 42 42030 Anderson County, S Carolina 3160 11340 42040 Bamberg County, S Carolina 42 42 42050 Barnwell County, S Carolina 42 42 42060 Beaufort County, S Carolina 42 42 42070 Berkeley County, S Carolina 1440 16700 42080 Calhoun County, S Carolina 42 17900 42090 Charleston County, S Carolina 1440 16700 42100 Cherokee County, S Carolina 42 42 42110 Chester County, S Carolina 42 42 42120 Chesterfield County, S Carolina 42 42 42130 Clarendon County, S Carolina 42 42 42140 Colleton County, S Carolina 42 42 42150 Darlington County, S Carolina 42 22500 42160 Dillon County, S Carolina 42 42 42170 Dorchester County, S Carolina 1440 16700 42180 Edgefield County, S Carolina 42 12260 42190 Fairfield County, S Carolina 42 17900 42200 Florence County, S Carolina 2655 22500 42210 Georgetown County, S Carolina 42 42 42220 Greenville County, S Carolina 3160 24860 42230 Greenwood County, S Carolina 42 42 42240 Hampton County, S Carolina 42 42 42250 Horry County, S Carolina 42 34820 42260 Jasper County, S Carolina 42 42 42270 Kershaw County, S Carolina 42 17900 42280 Lancaster County, S Carolina 42 42
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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
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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 757: 757 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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