2006 proposed fee schedule - American Society of Clinical Oncology

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762 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 44200 De Kalb County, Tennessee 44 44 44210 Dickson County, Tennessee 5360 34980 44220 Dyer County, Tennessee 44 44 44230 Fayette County, Tennessee 44 32820 44240 Fentress County, Tennessee 44 44 44250 Franklin County, Tennessee 44 44 44260 Gibson County, Tennessee 44 44 44270 Giles County, Tennessee 44 44 44280 Grainger County, Tennessee 3840 34100 44290 Greene County, Tennessee 44 44 44300 Grundy County, Tennessee 44 44 44310 Hamblen County, Tennessee 44 34100 44320 Hamilton County, Tennessee 1560 16860 44330 Hancock County, Tennessee 44 44 44340 Hardeman County, Tennessee 44 44 44350 Hardin County, Tennessee 44 44 44360 Hawkins County, Tennessee 3660 28700 44370 Haywood County, Tennessee 44 44 44380 Henderson County, Tennessee 44 44 44390 Henry County, Tennessee 44 44 44400 Hickman County, Tennessee 44 34980 44410 Houston County, Tennessee 44 44 44420 Humphreys County, Tennessee 44 44 44430 Jackson County, Tennessee 44 44 44440 Jefferson County, Tennessee 3840 34100 44450 Johnson County, Tennessee 44 44 44460 Knox County, Tennessee 3840 28940 44470 Lake County, Tennessee 44 44 44480 Lauderdale County, Tennessee 44 44 44490 Lawrence County, Tennessee 44 44 44500 Lewis County, Tennessee 44 44 44510 Lincoln County, Tennessee 44 44 44520 Loudon County, Tennessee 44 28940 44530 Mc Minn County, Tennessee 44 44 44540 Mc Nairy County, Tennessee 44 44 44550 Macon County, Tennessee 44 34980 44560 Madison County, Tennessee 3580 27180 44570 Marion County, Tennessee 1560 16860 44580 Marshall County, Tennessee 44 44 44590 Maury County, Tennessee 44 44 44600 Meigs County, Tennessee 44 44 44610 Monroe County, Tennessee 44 44 44620 Montgomery County, Tennessee 1660 17300 44630 Moore County, Tennessee 44 44 44640 Morgan County, Tennessee 44 44 44650 Obion County, Tennessee 44 44 44660 Overton County, Tennessee 44 44 44670 Perry County, Tennessee 44 44 44680 Pickett County, Tennessee 44 44 44690 Polk County, Tennessee 44 17420 44700 Putnam County, Tennessee 44 44 44710 Rhea County, Tennessee 44 44
763 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 44720 Roane County, Tennessee 44 44 44730 Robertson County, Tennessee 5360 34980 44740 Rutherford County, Tennessee 5360 34980 44750 Scott County, Tennessee 44 44 44760 Sequatchie County, Tennessee 1560 16860 44770 Sevier County, Tennessee 3840 44 44780 Shelby County, Tennessee 4920 32820 44790 Smith County, Tennessee 44 34980 44800 Stewart County, Tennessee 44 17300 44810 Sullivan County, Tennessee 3660 28700 44820 Sumner County, Tennessee 5360 34980 44830 Tipton County, Tennessee 4920 32820 44840 Trousdale County, Tennessee 44 34980 44850 Unicoi County, Tennessee 3660 27740 44860 Union County, Tennessee 3840 28940 44870 Van Buren County, Tennessee 44 44 44880 Warren County, Tennessee 44 44 44890 Washington County, Tennessee 3660 27740 44900 Wayne County, Tennessee 44 44 44910 Weakley County, Tennessee 44 44 44920 White County, Tennessee 44 44 44930 Williamson County, Tennessee 5360 34980 44940 Wilson County, Tennessee 5360 34980 45000 Anderson County, Texas 45 45 45010 Andrews County, Texas 45 45 45020 Angelina County, Texas 45 45 45030 Aransas County, Texas 45 18580 45040 Archer County, Texas 9080 48660 45050 Armstrong County, Texas 45 11100 45060 Atascosa County, Texas 45 41700 45070 Austin County, Texas 45 26420 45080 Bailey County, Texas 45 45 45090 Bandera County, Texas 45 41700 45100 Bastrop County, Texas 0640 12420 45110 Baylor County, Texas 45 45 45113 Bee County, Texas 45 45 45120 Bell County, Texas 3810 28660 45130 Bexar County, Texas 7240 41700 45140 Blanco County, Texas 45 45 45150 Borden County, Texas 45 45 45160 Bosque County, Texas 45 45 45170 Bowie County, Texas 8360 45500 45180 Brazoria County, Texas 1145 26420 45190 Brazos County, Texas 1260 17780 45200 Brewster County, Texas 45 45 45201 Briscoe County, Texas 45 45 45210 Brooks County, Texas 45 45 45220 Brown County, Texas 45 45 45221 Burleson County, Texas 45 17780 45222 Burnet County, Texas 45 45 45223 Caldwell County, Texas 45 12420 45224 Calhoun County, Texas 45 47020
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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
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Addendum D 2006 GEOGRAPHIC PRACTICE
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Carrier Locality Locality name Work
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Page 713 and 714: Addendum F ESRD FACILITIES- METROPO
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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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