2006 proposed fee schedule - American Society of Clinical Oncology

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TABLE 17--Proposed Practice Expense Equipment Item Additions for 2006 Equip Equipment Description Life Unit *CPT code(s) Equipment Code Price associated with item Category EQ269 Blood pressure monitor, ambulatory 5 3000 93786, 93784, 93788 OTHER EQUIP EP044 Centrifuge, cytospin 7 7330 88184 LABORATORY EP045 Chamber, hybridization 7 7107 88368, 88365, 88367 LABORATORY EP046 Freezer, ultradeep (-70 degrees) 10 16552 88355 LABORATORY Light assembly, photophoresis 36522 OTHER EQUIP EP047 Loader, FACS 7 22500 88184 LABORATORY EP048 Microfuge, benchtop 7 2410 88368, 88367, 88365 LABORATORY EQ270 Plasma pheresis machine w/ UV light 6 65000 36522 OTHER EQUIP EP049 Oven, isotemp (lab) 10 2383 88368, 88367, 88365 LABORATORY EQ271 Radiuscope 7 92315, 92317, 92316, 92310, 92314, 92313, 92312, 92311 OTHER EQUIP EP050 Scanner, AutoVysion 5 135000 88367 LABORATORY EQ272 Sleep diagnostic system, attended 5 46799 95805 OTHER EQUIP EP051 Slide warmer 7 568 88368, 88365, 88367 LABORATORY EP052 Ultrasonic nebulizer 10 1000 89220 LABORATORY EP053 Wash assistant, FACS 7 38000 88184 LABORATORY EP054 Water bath, FISH procedures (lab) 7 2111 88367, 88365 LABORATORY *CPT codes and descriptions only are copyright 2004 American medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 80
● Supply and Equipment Items Needing Specialty Input We have identified certain supply and equipment items for which we were unable to verify the pricing information (see Table 18: Supply Items Needing Specialty Input for Pricing and Table 19: Equipment Items Needing Specialty Input for Pricing). During last year’s rulemaking, we listed both supply and equipment items for which pricing documentation was needed from the medical specialty societies and, for many of these items, we received sufficient documentation in the form of catalog listings, vendor websites, and invoices. We have accepted the documented prices for many of these items and have already incorporated them into the PE database. The items listed on Tables 18 and 19 represent the outstanding items from last year and new items added from the RUC recommendations. Therefore, we are requesting that commenters, particularly specialty organizations, provide pricing information on items in these tables along with documentation to support the recommended price. 81
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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
Page 29 and 30: November 1, 2001 (66 FR 55246).) Th
Page 31 and 32: The CPEPs identified specific input
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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: Supply Code Supply Description Unit
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
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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
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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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