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CMS-1403-FC
range of samples for G0417, G0418, and G0419 to calculate
the average number of samples for each code. We assumed
15 percent of the samples taken require considerable
clinical expertise to differentiate and distinguish
carcinoma from hyperplasia. We assigned the work and PE
values of 88305 to the 15 percent of samples requiring this
level of expertise. The remaining 85 percent of samples
require confirmation of prostate tissue and interpretation
indicating the presence of cancer or not since the
diagnosis had been identified in the 15 percent of samples.
We assigned the work and PE of 88304 to this group of
samples. We assigned the full work and PE payment to the
15 percent sample component to reflect the skill, time, and
effort required to identify and diagnose carcinoma. We
applied the multiple surgical procedure discount (RVUs were
reduced by 50 percent in accordance with current CMS
policy) to the remaining 85 percent of samples reviewed for
identification and confirmation of prostate tissue. We
selected the 75 th percentile of samples from G0416 to
recognize the greater degree of skill, time, and effort
required to review, identify, and interpret the initial
biopsy specimens sampled. (See Addendum B for the values
assigned to these G codes.).
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