2006 proposed fee schedule - American Society of Clinical Oncology

19.02.2013 Views
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

Page 1 and 2: DEPARTMENT OF HEALTH AND HUMAN SERV

Page 3 and 4: 2. By mail. You may mail written co

Page 5 and 6: Rick Ensor (410) 786-5617 (for issu

Page 7 and 8: service of the U.S. Government Prin

Page 9 and 10: 4. Proposed Revisions to §413.170

Page 11 and 12: AGA American Gastroenterological As

Page 13 and 14: GAO General Accounting Office GPCI

Page 15 and 16: PLI Professional liability insuranc

Page 17 and 18: Initially, only the physician work

Page 19 and 20: This resource-based system was base

Page 21 and 22: effect in 1997, published on Novemb

Page 23 and 24: ● Revised requirements for superv

Page 25 and 26: efinement of work RVUs; and solicit

Page 27 and 28: historical allowed charges. This le

Page 29 and 30: November 1, 2001 (66 FR 55246).) Th

Page 31 and 32: The CPEPs identified specific input

Page 33 and 34: codes that the RUC has not yet revi

Page 35 and 36: procedure: $27,305,408. In this exa

Page 37 and 38: as a whole. Indirect costs include

Page 39 and 40: ● The unscaled indirect expense a

Page 41 and 42: BNF is applied to (multiplied by) t

Page 43 and 44: NPWP Step 2--Calculation of Charge-

Page 45 and 46: In Table 11, the scaled total direc

Page 47 and 48: TABLE 13--Budget Neutrality and Fin

Page 49 and 50: The following discussion outlines t

Page 51 and 52: exist, and suggests that the need f

Page 53 and 54: TABLE 14--Practice Expense Per Hour

Page 55 and 56: We believe that we have consistentl

Page 57 and 58: Due to the ongoing refinement by th

Page 59 and 60: indirect PE methodology is inaccura

Page 61 and 62: multi-specialty PEAC that were base

Page 63 and 64: the needed survey or other data or

Page 65 and 66: PERC/RUC recommendations for these

Page 67 and 68: eflect the typical number of cast c

Page 69 and 70: on comments received and additional

Page 71 and 72: We have reviewed the PE database an

Page 73 and 74: the ACR. We have accepted the follo

Page 75 and 76: ● Clinical Labor for G-codes Rela

Page 77 and 78: proposed associated prices that we

Page 79 and 80: Supply Code Supply Description Unit

Page 81 and 82: ● Supply and Equipment Items Need

Page 83 and 84: Code 2005 Description Unit Unit Pri

Page 85 and 86: Code 2005 Description Price EQ212 p

Page 87 and 88: Effective January 1, 2006, this pro

Page 89 and 90: challenge the validity of a new loc

Page 91 and 92: ones reconfigured). Yet we also rec

Page 93 and 94: The issue of payment locality desig

Page 95 and 96: specialties listed infrequently as

Page 97 and 98: for premium rating purposes. ISO co

Page 99 and 100: psychology to the nonsurgical risk

Page 101 and 102: to anesthesiology which is 2.84 rat

Page 103 and 104: 103 However, as noted previously in

Page 105 and 106: ● Category #1: Services that are

Page 107 and 108: G0270, G0271 and 97802 through 9780

Page 109 and 110: Group Medical Nutritional Therapy (

Page 111 and 112: 111 furnished in the group setting

Page 113 and 114: CMS Review 113 As noted previously,

Page 115 and 116: system that permits the physician a

Page 117 and 118: 117 associated with the provided se

Page 119 and 120: 119 overlapping surgeries, the teac

Page 121 and 122: anesthesia programs that have arran

Page 123 and 124: 123 Section 623 of the MMA also req

Page 125 and 126: 125 hospital-based facilities; whil

Page 127 and 128: 127 The next step would be to devel

Page 129 and 130: Drugs Second Quarter ASP +6 Percent

Page 131 and 132: 131 independent facilities, to acco

Page 133 and 134: 133

Page 135 and 136: distributed this over a total proje

Page 137 and 138: 137 additional 0.7 percent addition

Page 139 and 140: 139 billed drugs regardless of sett

Page 141 and 142: 141 than 0.9000 are paid more than

Page 143 and 144: adoption of the new hospital wage i

Page 145 and 146: of geographic designations for purp

Page 147 and 148: and they may or may not be suitable

Page 149 and 150: the Medicare Geographic Classificat

Page 151 and 152: (2) Metropolitan Divisions Under OM

Page 153 and 154: 153 applying revised composite paym

Page 155 and 156: ased on the labor components establ

Page 157 and 158: 157 actual cost structure faced by

Page 159 and 160: 159 ESRD facilities is 53.711, as s

Page 161 and 162: from the cost reports. To avoid dou

Page 163 and 164: from Worksheet A. The resulting mar

Page 165 and 166: (1) Hospital Data Used In this prop

Page 167 and 168: wage data ended. However, since the

Page 169 and 170: approach to phasing-in the proposed

Page 171 and 172: facilities that would receive lower

Page 173 and 174: 173 wage index values and then simu

Page 175 and 176: 175 Because Neighborhood Dialysis C

Page 177 and 178: 177 detected through our receipt of

Page 179 and 180: 179 CBSA Code Urban Area Wage (Cons



















Page 217 and 218: TABLE 28--Proposed ESRD Wage Index

Page 219 and 220: ● Extraordinary circumstances (§

Page 221 and 222: effect as long as the rate exceeds

Page 223 and 224: ● Adding a definition of a “ped

Page 225 and 226: exception rate. The facility would

Page 227 and 228: their intermediaries. Current parag

Page 229 and 230: 229 costs are reasonable and allowa

Page 231 and 232: 231 revised paragraph, a facility w

Page 233 and 234: H. Payment for Covered Outpatient D

Page 235 and 236: calculation. We also discuss the su

Page 237 and 238: customers (for example, physicians)

Page 239 and 240: 239 We believe the weighted average

Page 241 and 242: number of 11-digit NDCs sold for ea

Page 243 and 244: 243 included in the template, it is

Page 245 and 246: current reporting format is an appr

Page 247 and 248: 247 section 1847A of the Act for th

Page 249 and 250: each quarter at the following web s

Page 251 and 252: 251 We also note MedPAC’s recomme

Page 253 and 254: costs and units. We seek comments a

Page 255 and 256: 255 pays for DME and associated sup

Page 257 and 258: pharmacy activities required to get

Page 259 and 260: 259 representing 42 percent of the

Page 261 and 262: 261 basic pharmacy services such as

Page 263 and 264: seek comment on the potential impac

Page 265 and 266: 265 overpaying for the costs associ

Page 267 and 268: 267 and information about how pharm

Page 269 and 270: 269 takes good faith efforts to res

Page 271 and 272: 271 Specifically, we consider that

Page 273 and 274: supplies. Using billing data, we id

Page 275 and 276: 70481 CT orbit/ear/fossa w/ dye 704

Page 277 and 278: K. Therapy Cap 73223 MRI joint uppe

Page 279 and 280: provided for an active subluxation

Page 281 and 282: is less than 2 percent of spending

Page 283 and 284: (2) entities determined by the Secr

Page 285 and 286: 285 We are proposing a supplemental

Page 287 and 288: FQHC claim form to effectuate the b

Page 289 and 290: 289 can issue a final determination

Page 291 and 292: 291 conclude that Hispanic persons

Page 293 and 294: 293 nuclear medicine services in ei

Page 295 and 296: adiopharmaceuticals. In the final r

Page 297 and 298: 297 (including Nuclear Medicine and

Page 299 and 300: we would resolve any doubt on the m

Page 301 and 302: facility payment rather than a TC c

Page 303 and 304: ventures and leases, pose a risk of

Page 305 and 306: 305 Underlying the projected rate r

Page 307 and 308: decisions are central to the health

Page 309 and 310: however. We are particularly intere

Page 311 and 312: The collection requirement in this

Page 313 and 314: eporting requirements are discussed

Page 315 and 316: IV. Response to Comments Because of

Page 317 and 318: achieve the objectives with less si

Page 319 and 320: 319 The analysis and discussion pro

Page 321 and 322: 321 for a new code may change becau

Page 323 and 324: 323 TABLE 30--Impact of Practice Ex

Page 325 and 326: hour for these specialties. As note

Page 327 and 328: Both physical/occupational therapy

Page 329 and 330: 329 proposing to add cardiology cat

Page 331 and 332: Speciality Impact of Removing Aberr

Page 333 and 334: Family TABLE 32--Impact of Multiple

Page 335 and 336: 335 column includes the current est

Page 337 and 338: Specialty Medicare Allowed Charges

Page 339 and 340: 339 Non-Facility Facility % % HCPCS

Page 341 and 342: 341 have undertaken a similar analy

Page 343 and 344: of the updated GPCI data. For the R

Page 345 and 346: C. Medicare Telehealth Services In

Page 347 and 348: 347 TABLE 37--Impact of Proposed Ch

Page 349 and 350: 349 of the increase to the drug add

Page 351 and 352: plus current AAP priced drug paymen

Page 353 and 354: 353 the center up to what it would

Page 355 and 356: satisfies the requirements of the i

Page 357 and 358: 357 certainty the extent of these s

Page 359 and 360: delivery arrangements and would hel

Page 361 and 362: List of Subjects 42 CFR Part 405 Ad

Page 363 and 364: (including by refunding amounts in

Page 365 and 366: (2) Any financial incentives provid

Page 367 and 368: 7. The authority citation for part

Page 369 and 370: * * * * * PART 413--PRINCIPLES OF R

Page 371 and 372: 371 D. Redesignating paragraphs (l)

Page 373 and 374: 373 (3) The additional nursing hour

Page 375 and 376: cost components relating to trainin

Page 377 and 378: CAPD and CCPD) when the facility ac

Page 379 and 380: Indirect Sales means from the manuf

Page 381 and 382: amount for the quarter to the neare

Page 383 and 384: 383 25. The heading for Part 426 is

Page 385 and 386: 385 (Catalog of Federal Domestic As

Page 387 and 388: 1. CPT/HCPCS code. This is the CPT

Page 389 and 390: grace period. This indicator is no

Page 391 and 392: 5. Physician work RVUs. These are t

Page 393 and 394: ADDENDUM B: RELATIVE VALUE UNITS (R



























































































































































Page 703 and 704: CPT Code Short Descriptors 21480 Re

Page 705 and 706: CPT Code Short Descriptors 92284 Da

Page 707 and 708: Addendum D 2006 GEOGRAPHIC PRACTICE

Page 709 and 710: Carrier Locality Locality name Work

Page 711 and 712: Carrier Locality Locality Name 2006

Page 713 and 714: Addendum F ESRD FACILITIES- METROPO

Page 715 and 716: 715 SSA State/County Code County an




























Page 771: 771 SSA State/County Code County an


Page 777 and 778: CPT/HCPCS Codes MOD DESCRIPTION STA





Page 787: CPT/HCPCS Codes MOD DESCRIPTION STA

rvus

copyright

medicare

repair

removal

physician

codes

imaging

lesion

relative

clinical

oncology

www.asco.org

2006 proposed fee schedule - American Society of Clinical Oncology

2006 proposed fee schedule - American Society of Clinical Oncology ... View more 2006 proposed fee schedule - American Society of Clinical Oncology

Delete template?

Save as template ?

2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology