2006 proposed fee schedule - American Society of Clinical Oncology

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770 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 49320 Fluvanna County, Virginia 1540 16820 49328 Franklin City County, Virginia 49 49 49330 Franklin County, Virginia 49 40220 49340 Frederick County, Virginia 49 49020 49342 Fredericksburg City County, Virginia 49 47894 49343 Galax City County, Virginia 49 49 49350 Giles County, Virginia 49 13980 49360 Gloucester County, Virginia 5720 47260 49370 Goochland County, Virginia 6760 40060 49380 Grayson County, Virginia 49 49 49390 Greene County, Virginia 1540 16820 49400 Greensville County, Virginia 49 49 49410 Halifax County, Virginia 49 49 49411 Hampton City County, Virginia 5720 47260 49420 Hanover County, Virginia 6760 40060 49421 Harrisonburg City County, Virginia 49 25500 49430 Henrico County, Virginia 6760 40060 49440 Henry County, Virginia 49 49 49450 Highland County, Virginia 49 49 49451 Hopewell City County, Virginia 6760 40060 49460 Isle Of Wight County, Virginia 49 47260 49470 James City Co County, Virginia 5720 47260 49480 King And Queen County, Virginia 49 40060 49490 King George County, Virginia 49 49 49500 King William County, Virginia 49 40060 49510 Lancaster County, Virginia 49 49 49520 Lee County, Virginia 49 49 49522 Lexington County, Virginia 49 49 49530 Loudoun County, Virginia 8840 47894 49540 Louisa County, Virginia 49 40060 49550 Lunenburg County, Virginia 49 49 49551 Lynchburg City County, Virginia 4640 31340 49560 Madison County, Virginia 49 49 49561 Martinsville City County, Virginia 49 49 49563 Manassas City County, Virginia 8840 47894 49565 Manassas Park City County, Virginia 8840 47894 49570 Mathews County, Virginia 49 47260 49580 Mecklenburg County, Virginia 49 49 49590 Middlesex County, Virginia 49 49 49600 Montgomery County, Virginia 49 13980 49610 Nansemond County, Virginia 49 49 49620 Nelson County, Virginia 49 16820 49621 New Kent County, Virginia 6760 40060 49622 Newport News City County, Virginia 5720 47260 49641 Norfolk City County, Virginia 5720 47260 49650 Northampton County, Virginia 49 49 49660 Northumberland County, Virginia 49 49 49661 Norton City County, Virginia 49 49 49670 Nottoway County, Virginia 49 49 49680 Orange County, Virginia 49 49 49690 Page County, Virginia 49 49 49700 Patrick County, Virginia 49 49
771 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 49701 Petersburg City County, Virginia 6760 40060 49710 Pittsylvania County, Virginia 1950 19260 49711 Portsmouth City County, Virginia 5720 47260 49712 Poquoson City County, Virginia 5720 47260 49720 Powhatan County, Virginia 6760 40060 49730 Prince Edward County, Virginia 49 49 49740 Prince George County, Virginia 6760 40060 49750 Prince William County, Virginia 8840 47894 49770 Pulaski County, Virginia 49 13980 49771 Radford City County, Virginia 49 13980 49780 Rappahannock County, Virginia 49 49 49790 Richmond County, Virginia 49 49 49791 Richmond City County, Virginia 6760 40060 49800 Roanoke County, Virginia 6800 40220 49801 Roanoke City County, Virginia 6800 40220 49810 Rockbridge County, Virginia 49 49 49820 Rockingham County, Virginia 49 25500 49830 Russell County, Virginia 49 49 49838 Salem County, Virginia 6800 40220 49840 Scott County, Virginia 3660 28700 49850 Shenandoah County, Virginia 49 49 49860 Smyth County, Virginia 49 49 49867 South Boston City County, Virginia 49 49 49870 Southampton County, Virginia 49 49 49880 Spotsylvania County, Virginia 49 47894 49890 Stafford County, Virginia 8840 47894 49891 Staunton City County, Virginia 49 49 49892 Suffolk City County, Virginia 5720 47260 49900 Surry County, Virginia 49 47260 49910 Sussex County, Virginia 49 40060 49920 Tazewell County, Virginia 49 49 49921 Virginia Beach City County, Virginia 5720 47260 49930 Warren County, Virginia 49 47894 49950 Washington County, Virginia 3660 28700 49951 Waynesboro City County, Virginia 49 49 49960 Westmoreland County, Virginia 49 49 49961 Williamsburg City County, Virginia 5720 47260 49962 Winchester City County, Virginia 49 49020 49970 Wise County, Virginia 49 49 49980 Wythe County, Virginia 49 49 49981 York County, Virginia 5720 47260 50000 Adams County, Washington 50 50 50010 Asotin County, Washington 50 30300 50020 Benton County, Washington 6740 28420 50030 Chelan County, Washington 50 48300 50040 Clallam County, Washington 50 50 50050 Clark County, Washington 8725 38900 50060 Columbia County, Washington 50 50 50070 Cowlitz County, Washington 50 31020 50080 Douglas County, Washington 50 48300 50090 Ferry County, Washington 50 50 50100 Franklin County, Washington 6740 28420
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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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715 SSA State/County Code County an
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717 SSA State/County Code County an
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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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