2006 proposed fee schedule - American Society of Clinical Oncology

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766 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 45740 Kimble County, Texas 45 45 45741 King County, Texas 45 45 45742 Kinney County, Texas 45 45 45743 Kleberg County, Texas 45 45 45744 Knox County, Texas 45 45 45750 Lamar County, Texas 45 45 45751 Lamb County, Texas 45 45 45752 Lampasas County, Texas 45 28660 45753 La Salle County, Texas 45 45 45754 Lavaca County, Texas 45 45 45755 Lee County, Texas 45 45 45756 Leon County, Texas 45 45 45757 Liberty County, Texas 3360 26420 45758 Limestone County, Texas 45 45 45759 Lipscomb County, Texas 45 45 45760 Live Oak County, Texas 45 45 45761 Llano County, Texas 45 45 45762 Loving County, Texas 45 45 45770 Lubbock County, Texas 4600 31180 45771 Lynn County, Texas 45 45 45772 Mc Culloch County, Texas 45 45 45780 Mc Lennan County, Texas 8800 47380 45781 Mc Mullen County, Texas 45 45 45782 Madison County, Texas 45 45 45783 Marion County, Texas 45 45 45784 Martin County, Texas 45 45 45785 Mason County, Texas 45 45 45790 Matagorda County, Texas 45 45 45791 Maverick County, Texas 45 45 45792 Medina County, Texas 45 41700 45793 Menard County, Texas 45 45 45794 Midland County, Texas 5040 33260 45795 Milam County, Texas 45 45 45796 Mills County, Texas 45 45 45797 Mitchell County, Texas 45 45 45800 Montague County, Texas 45 45 45801 Montgomery County, Texas 3360 26420 45802 Moore County, Texas 45 45 45803 Morris County, Texas 45 45 45804 Motley County, Texas 45 45 45810 Nacogdoches County, Texas 45 45 45820 Navarro County, Texas 45 45 45821 Newton County, Texas 45 45 45822 Nolan County, Texas 45 45 45830 Nueces County, Texas 1880 18580 45831 Ochiltree County, Texas 45 45 45832 Oldham County, Texas 45 45 45840 Orange County, Texas 0840 13140 45841 Palo Pinto County, Texas 45 45 45842 Panola County, Texas 45 45 45843 Parker County, Texas 2800 23104 45844 Parmer County, Texas 45 45
767 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 45845 Pecos County, Texas 45 45 45850 Polk County, Texas 45 45 45860 Potter County, Texas 0320 11100 45861 Presidio County, Texas 45 45 45870 Rains County, Texas 45 45 45871 Randall County, Texas 0320 11100 45872 Reagan County, Texas 45 45 45873 Real County, Texas 45 45 45874 Red River County, Texas 45 45 45875 Reeves County, Texas 45 45 45876 Refugio County, Texas 45 45 45877 Roberts County, Texas 45 45 45878 Robertson County, Texas 45 17780 45879 Rockwall County, Texas 1920 19124 45880 Runnels County, Texas 45 45 45881 Rusk County, Texas 45 30980 45882 Sabine County, Texas 45 45 45883 San Augustine County, Texas 45 45 45884 San Jacinto County, Texas 45 26420 45885 San Patricio County, Texas 1880 18580 45886 San Saba County, Texas 45 45 45887 Schleicher County, Texas 45 45 45888 Scurry County, Texas 45 45 45889 Shackelford County, Texas 45 45 45890 Shelby County, Texas 45 45 45891 Sherman County, Texas 45 45 45892 Smith County, Texas 8640 46340 45893 Somervell County, Texas 45 45 45900 Starr County, Texas 45 45 45901 Stephens County, Texas 45 45 45902 Sterling County, Texas 45 45 45903 Stonewall County, Texas 45 45 45904 Sutton County, Texas 45 45 45905 Swisher County, Texas 45 45 45910 Tarrant County, Texas 2800 23104 45911 Taylor County, Texas 0040 10180 45912 Terrell County, Texas 45 45 45913 Terry County, Texas 45 45 45920 Throckmorton County, Texas 45 45 45921 Titus County, Texas 45 45 45930 Tom Green County, Texas 7200 41660 45940 Travis County, Texas 0640 12420 45941 Trinity County, Texas 45 45 45942 Tyler County, Texas 45 45 45943 Upshur County, Texas 45 30980 45944 Upton County, Texas 45 45 45945 Uvalde County, Texas 45 45 45946 Val Verde County, Texas 45 45 45947 Van Zandt County, Texas 45 45 45948 Victoria County, Texas 8750 47020 45949 Walker County, Texas 45 45 45950 Waller County, Texas 3360 26420
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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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Addendum F ESRD FACILITIES- METROPO
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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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