2006 proposed fee schedule - American Society of Clinical Oncology

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772 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 50110 Garfield County, Washington 50 50 50120 Grant County, Washington 50 50 50130 Grays Harbor County, Washington 50 50 50140 Island County, Washington 50 50 50150 Jefferson County, Washington 50 50 50160 King County, Washington 7600 42644 50170 Kitsap County, Washington 1150 14740 50180 Kittitas County, Washington 50 50 50190 Klickitat County, Washington 50 50 50200 Lewis County, Washington 50 50 50210 Lincoln County, Washington 50 50 50220 Mason County, Washington 50 50 50230 Okanogan County, Washington 50 50 50240 Pacific County, Washington 50 50 50250 Pend Oreille County, Washington 50 50 50260 Pierce County, Washington 8200 45104 50270 San Juan County, Washington 50 50 50280 Skagit County, Washington 50 34580 50290 Skamania County, Washington 50 38900 50300 Snohomish County, Washington 7600 42644 50310 Spokane County, Washington 7840 44060 50320 Stevens County, Washington 50 50 50330 Thurston County, Washington 5910 36500 50340 Wahkiakum County, Washington 50 50 50350 Walla Walla County, Washington 50 50 50360 Whatcom County, Washington 0860 13380 50370 Whitman County, Washington 50 50 50380 Yakima County, Washington 9260 49420 51000 Barbour County, W Virginia 51 51 51010 Berkeley County, W Virginia 51 25180 51020 Boone County, W Virginia 51 16620 51030 Braxton County, W Virginia 51 51 51040 Brooke County, W Virginia 8080 48260 51050 Cabell County, W Virginia 3400 26580 51060 Calhoun County, W Virginia 51 51 51070 Clay County, W Virginia 51 16620 51080 Doddridge County, W Virginia 51 51 51090 Fayette County, W Virginia 51 51 51100 Gilmer County, W Virginia 51 51 51110 Grant County, W Virginia 51 51 51120 Greenbrier County, W Virginia 51 51 51130 Hampshire County, W Virginia 51 49020 51140 Hancock County, W Virginia 8080 48260 51150 Hardy County, W Virginia 51 51 51160 Harrison County, W Virginia 51 51 51170 Jackson County, W Virginia 51 51 51180 Jefferson County, W Virginia 51 47894 51190 Kanawha County, W Virginia 1480 16620 51200 Lewis County, W Virginia 51 51 51210 Lincoln County, W Virginia 51 16620 51220 Logan County, W Virginia 51 51 51230 Mc Dowell County, W Virginia 51 51
773 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 51240 Marion County, W Virginia 51 51 51250 Marshall County, W Virginia 9000 48540 51260 Mason County, W Virginia 51 51 51270 Mercer County, W Virginia 51 51 51280 Mineral County, W Virginia 1900 19060 51290 Mingo County, W Virginia 51 51 51300 Monongalia County, W Virginia 51 34060 51310 Monroe County, W Virginia 51 51 51320 Morgan County, W Virginia 51 25180 51330 Nicholas County, W Virginia 51 51 51340 Ohio County, W Virginia 9000 48540 51350 Pendleton County, W Virginia 51 51 51360 Pleasants County, W Virginia 51 37620 51370 Pocahontas County, W Virginia 51 51 51380 Preston County, W Virginia 51 34060 51390 Putnam County, W Virginia 1480 16620 51400 Raleigh County, W Virginia 51 51 51410 Randolph County, W Virginia 51 51 51420 Ritchie County, W Virginia 51 51 51430 Roane County, W Virginia 51 51 51440 Summers County, W Virginia 51 51 51450 Taylor County, W Virginia 51 51 51460 Tucker County, W Virginia 51 51 51470 Tyler County, W Virginia 51 51 51480 Upshur County, W Virginia 51 51 51490 Wayne County, W Virginia 3400 26580 51500 Webster County, W Virginia 51 51 51510 Wetzel County, W Virginia 51 51 51520 Wirt County, W Virginia 51 37620 51530 Wood County, W Virginia 6020 37620 51540 Wyoming County, W Virginia 51 51 52000 Adams County, Wisconsin 52 52 52010 Ashland County, Wisconsin 52 52 52020 Barron County, Wisconsin 52 52 52030 Bayfield County, Wisconsin 52 52 52040 Brown County, Wisconsin 3080 24580 52050 Buffalo County, Wisconsin 52 52 52060 Burnett County, Wisconsin 52 52 52070 Calumet County, Wisconsin 0460 11540 52080 Chippewa County, Wisconsin 2290 20740 52090 Clark County, Wisconsin 52 52 52100 Columbia County, Wisconsin 52 31540 52110 Crawford County, Wisconsin 52 52 52120 Dane County, Wisconsin 4720 31540 52130 Dodge County, Wisconsin 52 52 52140 Door County, Wisconsin 52 52 52150 Douglas County, Wisconsin 2240 20260 52160 Dunn County, Wisconsin 52 52 52170 Eau Claire County, Wisconsin 2290 20740 52180 Florence County, Wisconsin 52 52 52190 Fond Du Lac County, Wisconsin 52 22540 52200 Forest County, Wisconsin 52 52
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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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2006 proposed fee schedule - American Society of Clinical Oncology

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