2006 proposed fee schedule - American Society of Clinical Oncology

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764 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 45230 Callahan County, Texas 45 10180 45240 Cameron County, Texas 1240 15180 45250 Camp County, Texas 45 45 45251 Carson County, Texas 45 11100 45260 Cass County, Texas 45 45 45270 Castro County, Texas 45 45 45280 Chambers County, Texas 45 26420 45281 Cherokee County, Texas 45 45 45290 Childress County, Texas 45 45 45291 Clay County, Texas 45 48660 45292 Cochran County, Texas 45 45 45300 Coke County, Texas 45 45 45301 Coleman County, Texas 45 45 45310 Collin County, Texas 1920 19124 45311 Collingsworth County, Texas 45 45 45312 Colorado County, Texas 45 45 45320 Comal County, Texas 7240 41700 45321 Comanche County, Texas 45 45 45330 Concho County, Texas 45 45 45340 Cooke County, Texas 45 45 45341 Coryell County, Texas 3810 28660 45350 Cottle County, Texas 45 45 45360 Crane County, Texas 45 45 45361 Crockett County, Texas 45 45 45362 Crosby County, Texas 45 31180 45370 Culberson County, Texas 45 45 45380 Dallam County, Texas 45 45 45390 Dallas County, Texas 1920 19124 45391 Dawson County, Texas 45 45 45392 Deaf Smith County, Texas 45 45 45400 Delta County, Texas 45 19124 45410 Denton County, Texas 1920 19124 45420 De Witt County, Texas 45 45 45421 Dickens County, Texas 45 45 45430 Dimmit County, Texas 45 45 45431 Donley County, Texas 45 45 45440 Duval County, Texas 45 45 45450 Eastland County, Texas 45 45 45451 Ector County, Texas 5800 36220 45460 Edwards County, Texas 45 45 45470 Ellis County, Texas 1920 19124 45480 El Paso County, Texas 2320 21340 45490 Erath County, Texas 45 45 45500 Falls County, Texas 45 45 45510 Fannin County, Texas 45 45 45511 Fayette County, Texas 45 45 45520 Fisher County, Texas 45 45 45521 Floyd County, Texas 45 45 45522 Foard County, Texas 45 45 45530 Fort Bend County, Texas 3360 26420 45531 Franklin County, Texas 45 45 45540 Freestone County, Texas 45 45
765 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 45541 Frio County, Texas 45 45 45542 Gaines County, Texas 45 45 45550 Galveston County, Texas 2920 26420 45551 Garza County, Texas 45 45 45552 Gillespie County, Texas 45 45 45560 Glasscock County, Texas 45 45 45561 Goliad County, Texas 45 47020 45562 Gonzales County, Texas 45 45 45563 Gray County, Texas 45 45 45564 Grayson County, Texas 7640 43300 45570 Gregg County, Texas 4420 30980 45580 Grimes County, Texas 45 45 45581 Guadaloupe County, Texas 7240 41700 45582 Hale County, Texas 45 45 45583 Hall County, Texas 45 45 45590 Hamilton County, Texas 45 45 45591 Hansford County, Texas 45 45 45592 Hardeman County, Texas 45 45 45600 Hardin County, Texas 0840 13140 45610 Harris County, Texas 3360 26420 45620 Harrison County, Texas 4420 45 45621 Hartley County, Texas 45 45 45630 Haskell County, Texas 45 45 45631 Hays County, Texas 0640 12420 45632 Hemphill County, Texas 45 45 45640 Henderson County, Texas 45 45 45650 Hidalgo County, Texas 4880 32580 45651 Hill County, Texas 45 45 45652 Hockley County, Texas 45 45 45653 Hood County, Texas 45 45 45654 Hopkins County, Texas 45 45 45660 Houston County, Texas 45 45 45661 Howard County, Texas 45 45 45662 Hudspeth County, Texas 45 45 45670 Hunt County, Texas 45 19124 45671 Hutchinson County, Texas 45 45 45672 Irion County, Texas 45 41660 45680 Jack County, Texas 45 45 45681 Jackson County, Texas 45 45 45690 Jasper County, Texas 45 45 45691 Jeff Davis County, Texas 45 45 45700 Jefferson County, Texas 0840 13140 45710 Jim Hogg County, Texas 45 45 45711 Jim Wells County, Texas 45 45 45720 Johnson County, Texas 2800 23104 45721 Jones County, Texas 45 10180 45722 Karnes County, Texas 45 45 45730 Kaufman County, Texas 1920 19124 45731 Kendall County, Texas 45 41700 45732 Kenedy County, Texas 45 45 45733 Kent County, Texas 45 45 45734 Kerr County, Texas 45 45
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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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Carrier Locality Locality Name 2006
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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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