2006 proposed fee schedule - American Society of Clinical Oncology

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TABLE 18--Supply Items Needing Specialty Input for Pricing Code 2005 Description Unit Unit Price SK105 SJ072 SK102 blood pressure recording form, average Brush, disposable applicator Communication book/treatment notebook Primary specialties associated with item Item 0.31 Cardiology *CPT code(s) associated with item 93784, 93786, 93788 82 Status of item See Note A Item Dermatology 17360 See Note A Item Audiology, ENT 92510 See Note A Cork sheet, 1 cm x 1 SK103 cm Item Pathology 88355 See Note A SJ073 DMV remover Item Optometry, Opthalmology 92310 – 92317 See Note A SD217 Diaphragm fitting set Item Ob-gyn 57170 95812-13, 95816, See Note A Electrode, EEG, tin cup SD053 (12 pack uou) Item Neurology 95819, 95822, 95950, 95954, 95956 See Note A Fistula set, dialysis, SC088 17g Item Dermatology 36522 See note A SK104 SL193 SA090 Foil, aluminum, 10 cm x 10 cm Glycolic acid, 20 – 50% Kit, moulage (implantech) SJ074 Lens cleaner oz SL199 Lithium carbonate, saturated SF044 Micro air burr Item Item Pathology 88355 See Note A ml Dermatology 17360 See Note A Item 75.00 Ob-Gyn 19396 See Note A Optometry, Opthalmology 92313, 92341, 92342 See Note A ml Pathology 88355, 88356 See Note A Podiatry, Orthopedics 28740, 28750, 28755, 28760 See Note A SJ076 Nose pads Item Optometry 92370 See Note A SG092 Packing, gauze, plain, 1 in (5yd uou) Item Ob-Gyn 57180 See Note A SH087 Pentagastrin ml Gastroenterology 91052 See Note A SD140 pressure bag item 8.925 Cardiology SL119 Sealant spray oz SL200 SL203 Sodium bicarbonate spray, 8 oz Tissue conditioner, coesoft Radiation Oncology 93501, 93508, 93510, 93526 See Note A 77333 See Note A Item Dermatology 17360 See Note A Item Maxillofacial Surgery ENT 42280 See Note A
Code 2005 Description Unit Unit Price Primary specialties associated with item *CPT code(s) associated with item 83 Status of item Tray, scoop, fast track SA091 tray 750.00 ENT 31730 See Note A system tubing, sterile, non- 93501, 93508, SD213 vented (fluid item 1.99 Cardiology See Note A 93510, 93526 administration) *CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. Note A: Additional information required. Need detailed description (including kit contents), source, and current pricing information (including pricing per specified unit of measure in database).
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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
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: ● Supply and Equipment Items Need
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
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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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