2006 proposed fee schedule - American Society of Clinical Oncology

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TABLE 16--Proposed Practice Expense Supply Item Additions for 2006 Supply Code Supply Description Unit Unit Price *CPT code(s) associated with item Supply Category SJ071 ACD-A anticoagulant item 6.58 36514, 36515, 36516 Pharmacy, NonRx SL186 Antibody, flow cytometry (each test) item 8.5 88184, 88185 Lab SL187 Balance salt solution (BSS), sterile, 15cc ml 92265 Lab SG093 Bandage, Dome paste, 3in item 14.95 29580 Wound care, dressings SJ072 Brush, disposable applicator item 17360 Pharmacy, NonRx SG094 Cast, padding 3in x 4yd (Webril) item 1.22 18 codes Wound care, dressings SG095 Cast, sole item 14.74 29355, 29425, 29440 Wound care, dressings SG096 Casting tape, fiberglass 3in x 4 yds item 9.2 29065, 29075, 29105, 29365, 29405, 29425 Wound care, dressings SD216 Catheter, balloon, esophageal or rectal (graded distention test) item 217.00 91120, 91040 Accessory, Procedure SK102 Communication book/treatment notebook item 92510 Office supply, grocery SB049 Condom, Diapulse, Asepticap item 0.69 G0329 Gown, drape SK103 Cork sheet, 1cm x 1cm item 88355 Office supply, grocery SD217 Diaphragm fitting set item 57170 Accessory, Procedure SJ073 DMV remover item 92311, 92312, 92313, 92314, 92315, 92317, 92316, 92310 Pharmacy, NonRx SL188 EM fixative, karnovsky’s ml 0.086 88355, 88356 Lab SL189 Ethanol, 100% ml 0.003 88365, 88367, 88368 Lab SL190 Ethanol, 70% ml 0.003 88367, 88368, 88365 Lab SL191 Ethanol, 85% ml 0.003 88368, 88367, 88365 Lab SC088 Fistula set, dialysis, 17g item 36522 Hypodermic, IV SK104 Foil, aluminum, 10cm x 10cm item 88355 Office supply, grocery SL192 Formamide ml 0.22 88368, 88365, 88367 Lab 78
Supply Code Supply Description Unit Unit Price *CPT code(s) associated with item Supply Category SL193 Glycolic acid, 20-50% ml 17360 Lab SL194 Hemo-De ml 0.008 88368, 88367, 88365 Lab SA089 Kit, boston original system kit 4.5 92311, 92315, 92310, 92313, 92313, 92314, 92317, 92316 Kit, Pack, Tray SL195 Kit, FISH paraffin pretreatment kit 20.85 88367, 88368, 88365 Lab SL196 Kit, HER-2/neu DNA Probe kit 105.00 88367, 88368 Lab SA090 Kit, moulage (implantech) kit 75.00 19396 Kit, Pack, Tray SL197 Label for blood tube item 0.004 36516, 36515, 36514 Lab SL198 Label, vial item 0.003 88355 Lab SJ074 Lens cleaner ounce 92342, 92313, 92340, 92341 Pharmacy, NonRx SL199 Lithium carbonate, saturated ml 88355, 88356 Lab SH092 LMX 4% anesthetic cream gm 1.6 96567 Pharmacy, Rx SJ075 Methoxsalen, 10ml vial item 49.5 36522 Pharmacy, NonRx Cutters, SF044 Micro air burr item 28755, 28750, 28740, 28760 closures, cautery SC089 Needle, Vacutainer item 0.32 36514, 36515, 36516 Hypodermic, IV SJ076 Nose pads item 92370 Pharmacy, NonRx SG092 Packing, gauze, plain, 1 in (5 yd uou) item 57180 Wound care, dressings SJ077 Screws, spectacles item 0.14 92370 Pharmacy, NonRx SL200 Sodium bicarbonate spray, 8 oz item 17360 Lab Splint, fiberglass, 4in x 15in item 16.5 29125 Wound care, dressings SL201 Stain, eosin ml 0.044 88356, 88355 Lab SJ078 Temple tips pair 1.00 92370 Pharmacy, NonRx SL202 Tissue conditioner, coesoft item 42280 Lab SA091 Tray, scoop, fast track system item 750.00 31730 Kit, Pack, Tray SC090 Tube, gastrostomy item 43760 Hypodermic, IV SC091 Vacutainer item 5.9 36514, 36515, 36516 Hypodermic, IV SL203 Vial, 10 ml, plastic (-70 degree storage) item 1.016 88355 Lab SL204 Vial, kimble sample, non sterile glass, 20 ml item 0.708 88356, 88355 Lab *CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 79
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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
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: proposed associated prices that we
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
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Page 127 and 128: 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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