2006 proposed fee schedule - American Society of Clinical Oncology

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774 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 52210 Grant County, Wisconsin 52 52 52220 Green County, Wisconsin 52 52 52230 Green Lake County, Wisconsin 52 52 52240 Iowa County, Wisconsin 52 31540 52250 Iron County, Wisconsin 52 52 52260 Jackson County, Wisconsin 52 52 52270 Jefferson County, Wisconsin 52 52 52280 Juneau County, Wisconsin 52 52 52290 Kenosha County, Wisconsin 3800 29404 52300 Kewaunee County, Wisconsin 52 24580 52310 La Crosse County, Wisconsin 3870 29100 52320 Lafayette County, Wisconsin 3880 52 52330 Langlade County, Wisconsin 52 52 52340 Lincoln County, Wisconsin 52 52 52350 Manitowoc County, Wisconsin 52 52 52360 Marathon County, Wisconsin 8940 48140 52370 Marinette County, Wisconsin 52 52 52380 Marquette County, Wisconsin 52 52 52381 Menominee County, Wisconsin 52 52 52390 Milwaukee County, Wisconsin 5080 33340 52400 Monroe County, Wisconsin 52 52 52410 Oconto County, Wisconsin 52 24580 52420 Oneida County, Wisconsin 52 52 52430 Outagamie County, Wisconsin 0460 11540 52440 Ozaukee County, Wisconsin 5080 33340 52450 Pepin County, Wisconsin 52 52 52460 Pierce County, Wisconsin 52 33460 52470 Polk County, Wisconsin 52 52 52480 Portage County, Wisconsin 52 52 52490 Price County, Wisconsin 52 52 52500 Racine County, Wisconsin 6600 39540 52510 Richland County, Wisconsin 52 52 52520 Rock County, Wisconsin 3620 27500 52530 Rusk County, Wisconsin 52 52 52540 St Croix County, Wisconsin 5120 33460 52550 Sauk County, Wisconsin 52 52 52560 Sawyer County, Wisconsin 52 52 52570 Shawano County, Wisconsin 52 52 52580 Sheboygan County, Wisconsin 7620 43100 52590 Taylor County, Wisconsin 52 52 52600 Trempealeau County, Wisconsin 52 52 52610 Vernon County, Wisconsin 52 52 52620 Vilas County, Wisconsin 52 52 52630 Walworth County, Wisconsin 52 52 52640 Washburn County, Wisconsin 52 52 52650 Washington County, Wisconsin 5080 33340 52660 Waukesha County, Wisconsin 5080 33340 52670 Waupaca County, Wisconsin 52 52 52680 Waushara County, Wisconsin 52 52 52690 Winnebago County, Wisconsin 0460 36780 52700 Wood County, Wisconsin 52 52 53000 Albany County, Wyoming 53 53
775 SSA State/County Code County and State Name ESRD MSA No. CBSA No. 53010 Big Horn County, Wyoming 53 53 53020 Campbell County, Wyoming 53 53 53030 Carbon County, Wyoming 53 53 53040 Converse County, Wyoming 53 53 53050 Crook County, Wyoming 53 53 53060 Fremont County, Wyoming 53 53 53070 Goshen County, Wyoming 53 53 53080 Hot Springs County, Wyoming 53 53 53090 Johnson County, Wyoming 53 53 53100 Laramie County, Wyoming 1580 16940 53110 Lincoln County, Wyoming 53 53 53120 Natrona County, Wyoming 1350 16220 53130 Niobrara County, Wyoming 53 53 53140 Park County, Wyoming 53 53 53150 Platte County, Wyoming 53 53 53160 Sheridan County, Wyoming 53 53 53170 Sublette County, Wyoming 53 53 53180 Sweetwater County, Wyoming 53 53 53190 Teton County, Wyoming 53 53 53200 Uinta County, Wyoming 53 53 53210 Washakie County, Wyoming 53 53 53220 Weston County, Wyoming 53 53
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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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