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CMS-1403-FC 1, 2008), we stated that we planned to issue clarifying guidance as to what constitutes the “office of the billing physician or other supplier” within the following 12 months (73 FR 405). We proposed the clarification and other revisions in the CY 2009 PFS proposed rule in order to introduce the possible changes under consideration. The revisions being finalized in this regulation stem from that proposal and we believe that sufficient time has been given for consideration of and response to the anti-markup revisions. Irrespective of whether “pod lab” arrangements otherwise would continue to exist or proliferate, we believe that the anti-markup provisions are needed in order to address potential program and patient abuse through the ordering of unnecessary diagnostic tests. Although several commenters made mention of MIPPA and the impact that it may have, we are not swayed by these arguments. MIPPA is a separate authority with a different focus than that of the anti-markup provisions. If, in the future, the anti-markup provisions are impacted through our implementation of MIPPA, we will address this in subsequent rulemaking. j. Miscellaneous Comment: One commenter, a professional association of pathologists, suggested an exception from the anti-markup 512
CMS-1403-FC provisions for single-specialty pathology physician groups and independent laboratories. The commenter suggested that such entities be defined as those in which all physicians within the group are pathologists and for which 75 percent of all CPT codes billed by the entity are pathology and laboratory CPT codes. According to the commenter, such an exception would “clarify” that dedicated pathology groups and independent laboratories are not subject to the anti- markup provisions for certain purchased diagnostic tests and interpretations or the ordering of special stains to perform better the tests ordered by outside, independent physicians. The commenter asserted that its proposed exception would be consistent with the physician self- referral’s exclusion from the definition of “referral” for services ordered by pathologists (and radiologists and radiation oncologists) pursuant to a consultation with another physician. According to the commenter, the exclusion from the definition of “referral” reflects the Congress’s recognition that services ordered by such physicians pursuant to a consultation with another physician do not pose the same risk of abuse that physician self-referral generally poses. The commenter also suggested an alternative to its proposed exception, for independent laboratories for which at least 75 percent of 513
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Notice: This CMS-approved document
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CMS-1403-FC 3 1. Electronically. Yo
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CMS-1403-FC 5 FOR FURTHER INFORMATI
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CMS-1403-FC 7 Trisha Brooks, (410)7
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CMS-1403-FC 9 ● The physician sel
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CMS-1403-FC 11 Schedule C. Malpract
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CMS-1403-FC 13 3. Beneficiary Signa
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CMS-1403-FC 15 A. Summary of Issues
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CMS-1403-FC 17 XIII. Waiver of Prop
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CMS-1403-FC 19 BBRA [Medicare, Medi
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CMS-1403-FC 21 E/M Evaluation and m
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CMS-1403-FC 23 MA-PD Medicare Advan
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CMS-1403-FC 25 OSCAR Online Survey
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CMS-1403-FC 27 WAMP Widely availabl
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CMS-1403-FC 29 2. Practice Expense
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CMS-1403-FC 31 extent practicable a
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CMS-1403-FC 33 AMA's Current Proced
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CMS-1403-FC 35 Payment = [(RVU work
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CMS-1403-FC 37 legislation, the PFS
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CMS-1403-FC that time, PE RVUs were
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CMS-1403-FC utilize a “bottom-up
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CMS-1403-FC ● All other expenses,
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CMS-1403-FC b. Allocation of PE to
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CMS-1403-FC combined survey data fr
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CMS-1403-FC for the global componen
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CMS-1403-FC equipment cost per minu
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CMS-1403-FC components), then the i
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CMS-1403-FC indirect PE for all PFS
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CMS-1403-FC • Physical therapy ut
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CMS-1403-FC TABLE 1: Calculation of
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CMS-1403-FC 2. PE Proposals for CY
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CMS-1403-FC The formula for estimat
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CMS-1403-FC arbitrary method for ch
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CMS-1403-FC We received no comments
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CMS-1403-FC (iv) Contractor Pricing
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CMS-1403-FC Response: We will ask t
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Code CMS-1403-FC 2008/9 Description
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CMS-1403-FC TABLE 4: Practice Expen
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CMS-1403-FC B. Geographic Practice
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CMS-1403-FC services, and are adjus
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CMS-1403-FC by at least 5 percent,
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CMS-1403-FC we decided not to proce
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CMS-1403-FC so as part of the CY 20
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CMS-1403-FC In the CY 2008 PFS fina
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CMS-1403-FC are available, we would
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CMS-1403-FC is no duplication of co
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CMS-1403-FC practitioner) at the di
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CMS-1403-FC PFS final rule with com
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CMS-1403-FC individual MNT (or any
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CMS-1403-FC Group DSMT (which compr
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CMS-1403-FC The acuity of a critica
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CMS-1403-FC needed regarding a crit
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CMS-1403-FC errors; enhanced patien
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CMS-1403-FC 99233). For CY 2006, we
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CMS-1403-FC follow-up inpatient con
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CMS-1403-FC As noted previously, CP
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CMS-1403-FC face-to-face encounter
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CMS-1403-FC visits requested by the
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CMS-1403-FC Follow-up inpatient tel
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CMS-1403-FC that were appropriate t
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CMS-1403-FC HCPCS codes 96150 throu
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CMS-1403-FC G0332). The Medicare pa
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CMS-1403-FC code G0332. For CY 2009
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CMS-1403-FC Response: The separate
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CMS-1403-FC preadministration-relat
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CMS-1403-FC pricing of IVIG and Med
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CMS-1403-FC CPT Code Short Descript
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CMS-1403-FC percent for the subsequ
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CMS-1403-FC in the same session, on
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CMS-1403-FC jeopardizes beneficiary
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CMS-1403-FC As discussed in the pro
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CMS-1403-FC Note: Under the PFS, CP
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CMS-1403-FC The methodology for dev
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CMS-1403-FC drugs furnished through
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CMS-1403-FC Response: We disagree w
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CMS-1403-FC available to support a
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CMS-1403-FC that there are complica
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CMS-1403-FC administered to a benef
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CMS-1403-FC as we assess potential
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CMS-1403-FC add a modifier to their
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CMS-1403-FC application of the AQ m
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CMS-1403-FC 0.7000. ● A reduction
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CMS-1403-FC so the CY 2009 base com
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CMS-1403-FC patient utilization gro
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CMS-1403-FC make those estimates. A
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CMS-1403-FC After removing the enro
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CMS-1403-FC For CY 2009, we propose
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CMS-1403-FC plain language over pol
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CMS-1403-FC four quarters of ASP pr
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CMS-1403-FC composite rates. The wa
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CMS-1403-FC from the figure in the
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CMS-1403-FC that our goal is the ev
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CMS-1403-FC the average wage index
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CMS-1403-FC Labor Statistics, to de
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CMS-1403-FC been previously deemed
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CMS-1403-FC CBSA where the campuses
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CMS-1403-FC composite rates during
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CMS-1403-FC target amount of compos
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CMS-1403-FC admission. That is, the
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CMS-1403-FC that CMS consider issue
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CMS-1403-FC hold the provider in wh
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CMS-1403-FC Comment: Commenters rai
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CMS-1403-FC who have enrolled in th
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CMS-1403-FC ● Posting IDTF standa
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CMS-1403-FC other diagnostic testin
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CMS-1403-FC entities furnishing mob
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CMS-1403-FC state Radioactive Mater
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CMS-1403-FC equipment and provide t
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CMS-1403-FC Response: We understand
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CMS-1403-FC believe that requiring
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CMS-1403-FC these claims will ensur
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CMS-1403-FC and NPP organizations,
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CMS-1403-FC prior to their enrollin
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CMS-1403-FC The date of approval is
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CMS-1403-FC organizations, and indi
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CMS-1403-FC To assist physician and
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CMS-1403-FC Comment: Several commen
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CMS-1403-FC date of filing and circ
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CMS-1403-FC services are complying
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CMS-1403-FC days when a Presidentia
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CMS-1403-FC effective date under ap
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CMS-1403-FC Comment: The suggestion
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CMS-1403-FC Response: We thank the
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CMS-1403-FC provider enrollment giv
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CMS-1403-FC instead, it will force
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CMS-1403-FC Response: As stated abo
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CMS-1403-FC Comment: One commenter
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CMS-1403-FC In an attempt to ensure
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CMS-1403-FC rule, rather than limit
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CMS-1403-FC changes have occurred,
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CMS-1403-FC Response: While we moni
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CMS-1403-FC records faster and more
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CMS-1403-FC In §424.521(a)(1), we
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CMS-1403-FC practitioners with the
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CMS-1403-FC In June 2002 and Novemb
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CMS-1403-FC full implementation sch
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CMS-1403-FC with billing agents, cl
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CMS-1403-FC 2. Medicare Billing Pri
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CMS-1403-FC The FPLP is a collectio
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CMS-1403-FC continued enrollment to
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CMS-1403-FC Federal Payment Levy Pr
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CMS-1403-FC Consistent with existin
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CMS-1403-FC facilitate the enrollme
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CMS-1403-FC determination. Specific
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CMS-1403-FC individual practitioner
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CMS-1403-FC determines in February
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CMS-1403-FC Management Manual (IOM
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CMS-1403-FC Response: Based on thes
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CMS-1403-FC or continues to meet th
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CMS-1403-FC to identify and discipl
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CMS-1403-FC save our severe penalti
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CMS-1403-FC affords the supplier ap
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CMS-1403-FC privileges and assess a
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CMS-1403-FC §424.535(a)(10) that w
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CMS-1403-FC documentation for 7 yea
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CMS-1403-FC pharmacies to follow re
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CMS-1403-FC practitioners, includin
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CMS-1403-FC that require a revoked
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CMS-1403-FC provider and supplier e
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CMS-1403-FC K. Amendment to the Exe
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CMS-1403-FC Prescription Fill Statu
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CMS-1403-FC dispensers to move towa
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CMS-1403-FC Following the publicati
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CMS-1403-FC does not respond to the
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CMS-1403-FC facsimiles in all insta
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CMS-1403-FC Similarly, other commen
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CMS-1403-FC proposed rule's publica
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CMS-1403-FC elimination of the comp
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CMS-1403-FC exemption originally cr
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CMS-1403-FC dispensers are not requ
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CMS-1403-FC products, or, where upg
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CMS-1403-FC take time to develop, a
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CMS-1403-FC integrated this technol
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CMS-1403-FC Version 10.2 or higher)
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CMS-1403-FC proposed January 2009 c
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CMS-1403-FC L. Comprehensive Outpat
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CMS-1403-FC examination. In order t
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CMS-1403-FC qualifications for HHAs
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CMS-1403-FC distinction in the lice
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CMS-1403-FC (2) Have successfully c
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CMS-1403-FC risk-taking behaviors,
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CMS-1403-FC Therefore, we proposed
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CMS-1403-FC commenter stated that o
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CMS-1403-FC psychological services
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CMS-1403-FC 3. CORF Conditions of P
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CMS-1403-FC The following is a summ
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CMS-1403-FC We are not making any c
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CMS-1403-FC N. Physician Self-Refer
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CMS-1403-FC arrangements, and the l
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CMS-1403-FC below are related to ea
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CMS-1403-FC clinical practice. With
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CMS-1403-FC In the CY 2009 PFS prop
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CMS-1403-FC would be outside the sc
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CMS-1403-FC reflect objective quali
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CMS-1403-FC quality resulting from
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CMS-1403-FC payments should be reas
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CMS-1403-FC changes in referral pat
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CMS-1403-FC the alternative, we pro
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CMS-1403-FC finalize this condition
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CMS-1403-FC and “quality maintena
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CMS-1403-FC date. We seek comments
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CMS-1403-FC existing exceptions to
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CMS-1403-FC our general rulemaking
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CMS-1403-FC these approaches. We pr
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CMS-1403-FC building in which the b
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CMS-1403-FC were concerned that thi
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CMS-1403-FC supplier will be subjec
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CMS-1403-FC numerical test for the
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CMS-1403-FC space in which the orde
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CMS-1403-FC disadvantage nonproblem
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CMS-1403-FC would be simpler to not
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CMS-1403-FC IDTF standards in §410
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CMS-1403-FC that rule, the Governme
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CMS-1403-FC with comment period, th
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CMS-1403-FC 1842(n)(1) of the Act,
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CMS-1403-FC anti-markup provisions
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CMS-1403-FC her group practice woul
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CMS-1403-FC A commenter representin
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CMS-1403-FC tenens arrangements cou
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CMS-1403-FC other supplier. We are
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CMS-1403-FC on pathology reports or
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CMS-1403-FC patients. According to
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CMS-1403-FC from sharing a practice
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CMS-1403-FC Group A orders the TC a
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CMS-1403-FC physicians the flexibil
Page 461 and 462: CMS-1403-FC Response: We recognize
Page 463 and 464: CMS-1403-FC Response: Because the d
Page 465 and 466: CMS-1403-FC limited by the proposed
Page 467 and 468: CMS-1403-FC Response: With respect
Page 469 and 470: CMS-1403-FC to focus on the medical
Page 471 and 472: CMS-1403-FC service” approach bec
Page 473 and 474: CMS-1403-FC have the right to recei
Page 475 and 476: CMS-1403-FC 2 approach finalized he
Page 477 and 478: CMS-1403-FC the ordering physician
Page 479 and 480: CMS-1403-FC ensure an adequate nexu
Page 481 and 482: CMS-1403-FC entity” should be def
Page 483 and 484: CMS-1403-FC between the performing
Page 485 and 486: CMS-1403-FC supplier” to encompas
Page 487 and 488: CMS-1403-FC to continue to provide
Page 489 and 490: CMS-1403-FC requirements of the Alt
Page 491 and 492: CMS-1403-FC supervised in the offic
Page 493 and 494: CMS-1403-FC reducing access to care
Page 495 and 496: CMS-1403-FC commenter supported ado
Page 497 and 498: CMS-1403-FC “outside supplier,”
Page 499 and 500: CMS-1403-FC group could recover onl
Page 501 and 502: CMS-1403-FC incurred, thereby compe
Page 503 and 504: CMS-1403-FC needed to provide the t
Page 505 and 506: CMS-1403-FC performing supplier for
Page 507 and 508: CMS-1403-FC providers, the services
Page 509 and 510: CMS-1403-FC commenter also expresse
Page 511: CMS-1403-FC overutilization of in-o
Page 515 and 516: CMS-1403-FC we did not propose such
Page 517 and 518: CMS-1403-FC and PCs supervised or p
Page 519 and 520: CMS-1403-FC provisions will not app
Page 521 and 522: CMS-1403-FC (Pub. L. 110-173) (MMSE
Page 523 and 524: CMS-1403-FC reporting data on quali
Page 525 and 526: CMS-1403-FC PQRI and a more detaile
Page 527 and 528: CMS-1403-FC and our responses to th
Page 529 and 530: CMS-1403-FC provisions of the Priva
Page 531 and 532: CMS-1403-FC reducing eligible profe
Page 533 and 534: CMS-1403-FC administrative or judic
Page 535 and 536: CMS-1403-FC professionals who did n
Page 537 and 538: CMS-1403-FC base the incentive paym
Page 539 and 540: CMS-1403-FC A few commenters noted
Page 541 and 542: CMS-1403-FC administrative burden t
Page 543 and 544: CMS-1403-FC requested that more det
Page 545 and 546: CMS-1403-FC incentive payments for
Page 547 and 548: CMS-1403-FC December 31, 2009 and J
Page 549 and 550: CMS-1403-FC the reporting period fo
Page 551 and 552: CMS-1403-FC proposed to carry forwa
Page 553 and 554: CMS-1403-FC measures group is appli
Page 555 and 556: CMS-1403-FC measures results and nu
Page 557 and 558: CMS-1403-FC (Delmarva Foundation fo
Page 559 and 560: CMS-1403-FC registries to report on
Page 561 and 562: CMS-1403-FC reporting options for r
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CMS-1403-FC incentive payment for P
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CMS-1403-FC to report 2009 PQRI qua
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CMS-1403-FC Comment: We received nu
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CMS-1403-FC Comment: One comment su
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CMS-1403-FC quality measures result
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CMS-1403-FC requirements listed on
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CMS-1403-FC a data submission vendo
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CMS-1403-FC As we stated in the CY
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CMS-1403-FC whether eligible profes
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CMS-1403-FC ● Agree that the regi
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CMS-1403-FC soon thereafter as is t
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CMS-1403-FC Comment: We received ma
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Page 589 and 590:
CMS-1403-FC additional 2.0 percent
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CMS-1403-FC EHRs in 2009. The measu
Page 593 and 594:
CMS-1403-FC i. Overview and Summary
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CMS-1403-FC voluntary consensus sta
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CMS-1403-FC the AMA-PCPI should be
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CMS-1403-FC are appropriate and do
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CMS-1403-FC to make any changes to
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CMS-1403-FC post the measures for p
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CMS-1403-FC beneficiaries. We now h
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CMS-1403-FC identified in Tables 15
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CMS-1403-FC important difference in
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CMS-1403-FC not use Measures #73 Ca
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CMS-1403-FC measures, but which are
Page 617 and 618:
CMS-1403-FC with comment period. Ho
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CMS-1403-FC ● Measure #41 Osteopo
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CMS-1403-FC professional to simply
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CMS-1403-FC measures. We consider t
Page 625 and 626:
CMS-1403-FC Measure Number and Titl
Page 627 and 628:
CMS-1403-FC Measure Number and Titl
Page 629 and 630:
CMS-1403-FC ● Measure #120 CKD: A
Page 631 and 632:
CMS-1403-FC For the 2009 PQRI quali
Page 633 and 634:
CMS-1403-FC rule indicated that the
Page 635 and 636:
CMS-1403-FC Response: As suggested
Page 637 and 638:
CMS-1403-FC required for the measur
Page 639 and 640:
CMS-1403-FC ● Achievement of NQF
Page 641 and 642:
CMS-1403-FC These additional measur
Page 643 and 644:
CMS-1403-FC We did not include this
Page 645 and 646:
CMS-1403-FC Comment: Many commenter
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CMS-1403-FC groups must have a part
Page 649 and 650:
CMS-1403-FC selected for inclusion
Page 651 and 652:
CMS-1403-FC Measure Title Measure S
Page 653 and 654:
CMS-1403-FC proposed HIV/AIDS measu
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CMS-1403-FC set of denominator spec
Page 657 and 658:
CMS-1403-FC results, for this purpo
Page 659 and 660:
CMS-1403-FC informed decision-makin
Page 661 and 662:
Page 663 and 664:
CMS-1403-FC prior commitments that
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CMS-1403-FC groups who successfully
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CMS-1403-FC ● Eligible profession
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CMS-1403-FC patients, families, and
Page 671 and 672:
CMS-1403-FC that have satisfactoril
Page 673 and 674:
CMS-1403-FC e-prescribing quality m
Page 675 and 676:
CMS-1403-FC Douglas S. and Friedman
Page 677 and 678:
CMS-1403-FC subsequent year, if the
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CMS-1403-FC eligible professional f
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CMS-1403-FC and is included in the
Page 683 and 684:
CMS-1403-FC The measure becomes app
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CMS-1403-FC is, Measure #125) appli
Page 687 and 688:
CMS-1403-FC outpatient setting. Whi
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CMS-1403-FC ability of an electroni
Page 691 and 692:
CMS-1403-FC October 2005 (hereinaft
Page 693 and 694:
CMS-1403-FC We are aware that there
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CMS-1403-FC provided during the enc
Page 697 and 698:
CMS-1403-FC denominator of a measur
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CMS-1403-FC cases. If the is determ
Page 701 and 702:
CMS-1403-FC during 2009; and (3) wh
Page 703 and 704:
CMS-1403-FC on this quality measure
Page 705 and 706:
CMS-1403-FC become effective until
Page 707 and 708:
CMS-1403-FC and CY 2007 PFS final r
Page 709 and 710:
CMS-1403-FC directly affected by th
Page 711 and 712:
CMS-1403-FC requires advanced pract
Page 713 and 714:
CMS-1403-FC applaud CMS for recogni
Page 715 and 716:
CMS-1403-FC standardization of DNP
Page 717 and 718:
CMS-1403-FC for the most part, been
Page 719 and 720:
CMS-1403-FC that the requirement fo
Page 721 and 722:
CMS-1403-FC degree in radiologic te
Page 723 and 724:
CMS-1403-FC the physicians that fur
Page 725 and 726:
CMS-1403-FC is associated with a te
Page 727 and 728:
CMS-1403-FC facility in which a tec
Page 729 and 730:
CMS-1403-FC by the Medicare program
Page 731 and 732:
CMS-1403-FC pressure (CPAP)” and
Page 733 and 734:
CMS-1403-FC for example chronic obs
Page 735 and 736:
CMS-1403-FC thus they believe leadi
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CMS-1403-FC Excepting attended faci
Page 739 and 740:
CMS-1403-FC supplier separately. Ho
Page 741 and 742:
CMS-1403-FC final rule’s provisio
Page 743 and 744:
CMS-1403-FC as a DME supplier and p
Page 745 and 746:
CMS-1403-FC Moreover, given our gen
Page 747 and 748:
CMS-1403-FC resources and infrastru
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Page 751 and 752:
CMS-1403-FC organization through a
Page 753 and 754:
CMS-1403-FC After reviewing the pub
Page 755 and 756:
CMS-1403-FC the nonparticipating ho
Page 757 and 758:
CMS-1403-FC be costly and burdensom
Page 759 and 760:
CMS-1403-FC adopting our proposal t
Page 761 and 762:
CMS-1403-FC We are not persuaded to
Page 763 and 764:
CMS-1403-FC §424.36(b)(6)(ii)(C)(2
Page 765 and 766:
CMS-1403-FC be made to obtain the s
Page 767 and 768:
CMS-1403-FC willing to sign at the
Page 769 and 770:
CMS-1403-FC and not suppliers, may
Page 771 and 772:
CMS-1403-FC crew member would have
Page 773 and 774:
CMS-1403-FC In order to determine f
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CMS-1403-FC retrieval of the variou
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CMS-1403-FC plan that demonstrates
Page 779 and 780:
CMS-1403-FC conviction, license sus
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CMS-1403-FC The following is a summ
Page 783 and 784:
CMS-1403-FC faith reduces the time
Page 785 and 786:
CMS-1403-FC suspension or revocatio
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CMS-1403-FC 9 percent per year. 2 I
Page 789 and 790:
CMS-1403-FC magnetic resonance imag
Page 791 and 792:
CMS-1403-FC Committee for Quality A
Page 793 and 794:
CMS-1403-FC measures in CMS’ VBP
Page 795 and 796:
CMS-1403-FC the Boston program site
Page 797 and 798:
CMS-1403-FC conditions that are hig
Page 799 and 800:
CMS-1403-FC reports? ● Do physici
Page 801 and 802:
CMS-1403-FC most Evaluation and Man
Page 803 and 804:
CMS-1403-FC III. Medicare Improveme
Page 805 and 806:
CMS-1403-FC Specifically, section 1
Page 807 and 808:
CMS-1403-FC period. The public will
Page 809 and 810:
CMS-1403-FC Section 101(b) of the M
Page 811 and 812:
CMS-1403-FC 1 year after the effect
Page 813 and 814:
CMS-1403-FC applies to both adult m
Page 815 and 816:
CMS-1403-FC period is limited to th
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CMS-1403-FC 2007 through 2010. In a
Page 819 and 820:
CMS-1403-FC Section 1848(m)(3)(D) o
Page 821 and 822:
CMS-1403-FC In addition to the prov
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CMS-1403-FC during the 2009 and 201
Page 825 and 826:
CMS-1403-FC prescribers for 2009 ar
Page 827 and 828:
CMS-1403-FC requirement by making a
Page 829 and 830:
CMS-1403-FC continue to bill the Me
Page 831 and 832:
CMS-1403-FC therapy and speech-lang
Page 833 and 834:
CMS-1403-FC ● Section 1835(a) of
Page 835 and 836:
CMS-1403-FC The amendments made by
Page 837 and 838:
CMS-1403-FC national associations a
Page 839 and 840:
CMS-1403-FC On November 9, 2006, we
Page 841 and 842:
CMS-1403-FC our regulations states
Page 843 and 844:
CMS-1403-FC rental period. The supp
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CMS-1403-FC reasonable useful lifet
Page 847 and 848:
CMS-1403-FC to use the equipment be
Page 849 and 850:
CMS-1403-FC oxygen contents after t
Page 851 and 852:
CMS-1403-FC the oxygen contents and
Page 853 and 854:
CMS-1403-FC Section 414.210(e)(2) a
Page 855 and 856:
CMS-1403-FC reported to us that, ba
Page 857 and 858:
CMS-1403-FC non-routine maintenance
Page 859 and 860:
CMS-1403-FC As a result, we will ma
Page 861 and 862:
CMS-1403-FC 31, 2009 amounts for gr
Page 863 and 864:
CMS-1403-FC under section 332(a)(1)
Page 865 and 866:
CMS-1403-FC furnishing services via
Page 867 and 868:
CMS-1403-FC required to furnish dir
Page 869 and 870:
CMS-1403-FC mental health services
Page 871 and 872:
CMS-1403-FC Skilled Nursing Facilit
Page 873 and 874:
CMS-1403-FC where the SNF resident
Page 875 and 876:
CMS-1403-FC describes the methodolo
Page 877 and 878:
CMS-1403-FC The RUC has created the
Page 879 and 880:
CMS-1403-FC Response: Although we r
Page 881 and 882:
CMS-1403-FC occurring code pairs. T
Page 883 and 884:
CMS-1403-FC a standing panel of exp
Page 885 and 886:
CMS-1403-FC extraction of the assoc
Page 887 and 888:
CMS-1403-FC TABLE 26: AMA RUC Recom
Page 889 and 890:
CMS-1403-FC AMA RUC Rec Site of Ser
Page 891 and 892:
Page 893 and 894:
Page 895 and 896:
CMS-1403-FC Note: The RUC reviewed
Page 897 and 898:
CMS-1403-FC C. Interim 2008 Codes 1
Page 899 and 900:
CMS-1403-FC national noncoverage de
Page 901 and 902:
CMS-1403-FC CPT codes for 2008. In
Page 903 and 904:
CMS-1403-FC associated work RVUs, t
Page 905 and 906:
CMS-1403-FC CPT 1 AMA RUC Work RVU
Page 907 and 908:
CMS-1403-FC # New CPT code. 1 All C
Page 909 and 910:
CMS-1403-FC ● 27218, Open treatme
Page 911 and 912:
CMS-1403-FC RVUs for G0412; 15.73 w
Page 913 and 914:
CMS-1403-FC Therefore, we disagree
Page 915 and 916:
CMS-1403-FC generally contractor pr
Page 917 and 918:
CMS-1403-FC In addition, we believe
Page 919 and 920:
CMS-1403-FC RVU for CPT code 93289
Page 921 and 922:
CMS-1403-FC time to better understa
Page 923 and 924:
CMS-1403-FC ● 93306, Echocardiogr
Page 925 and 926:
CMS-1403-FC Although not discussed
Page 927 and 928:
CMS-1403-FC for New and Revised 200
Page 929 and 930:
CMS-1403-FC item. In addition, the
Page 931 and 932:
CMS-1403-FC 90956, 90957, 90958, 90
Page 933 and 934:
CMS-1403-FC place of these two new
Page 935 and 936:
CMS-1403-FC beneficiary or any othe
Page 937 and 938:
CMS-1403-FC ● Adding the followin
Page 939 and 940:
CMS-1403-FC Tables 29 and 30 also i
Page 941 and 942:
CMS-1403-FC RADIOLOGY AND CERTAIN O
Page 943 and 944:
CMS-1403-FC 93320 Doppler echo exam
Page 945 and 946:
CMS-1403-FC index data, that the hi
Page 947 and 948:
CMS-1403-FC TABLE 32: Increase in t
Page 949 and 950:
CMS-1403-FC C. The Update Adjustmen
Page 951 and 952:
CMS-1403-FC end of the prior year a
Page 953 and 954:
CMS-1403-FC CY 2009, the statute re
Page 955 and 956:
CMS-1403-FC Actual08 = Estimated Ac
Page 957 and 958:
CMS-1403-FC 1848(f)(3)(C)(i) of the
Page 959 and 960:
CMS-1403-FC ● Screening mammograp
Page 961 and 962:
CMS-1403-FC payments while promotin
Page 963 and 964:
CMS-1403-FC E. Final Sustainable Gr
Page 965 and 966:
CMS-1403-FC included in the SGR (us
Page 967 and 968:
CMS-1403-FC that this figure will c
Page 969 and 970:
CMS-1403-FC physicians' services in
Page 971 and 972:
CMS-1403-FC imaging services, the M
Page 973 and 974:
CMS-1403-FC CY 2007. Table 42 illus
Page 975 and 976:
CMS-1403-FC year to the entire year
Page 977 and 978:
CMS-1403-FC the CF. Therefore, this
Page 979 and 980:
CMS-1403-FC estimate that CY 2009 R
Page 981 and 982:
CMS-1403-FC Table 44: Calculation o
Page 983 and 984:
CMS-1403-FC XI. Payment for Certain
Page 985 and 986:
CMS-1403-FC In the Competitive Acqu
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CMS-1403-FC glasses, hand magnifier
Page 989 and 990:
CMS-1403-FC Our interpretation of t
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CMS-1403-FC Response: We understand
Page 993 and 994:
CMS-1403-FC defines “eyeglass”
Page 995 and 996:
CMS-1403-FC this statutory exclusio
Page 997 and 998:
CMS-1403-FC advances in the use of
Page 999 and 1000:
CMS-1403-FC is paid for his or her
Page 1001 and 1002:
CMS-1403-FC XII. Provisions of the
Page 1003 and 1004:
CMS-1403-FC these RUC recommendatio
Page 1005 and 1006:
CMS-1403-FC services. We believe a
Page 1007 and 1008:
CMS-1403-FC Section 144(b) of the M
Page 1009 and 1010:
CMS-1403-FC rulemaking with respect
Page 1011 and 1012:
CMS-1403-FC (respectively) of this
Page 1013 and 1014:
CMS-1403-FC completing and submitti
Page 1015 and 1016:
CMS-1403-FC §424.516(d)(1). Additi
Page 1017 and 1018:
CMS-1403-FC to several associated i
Page 1019 and 1020:
CMS-1403-FC incentive payment for 2
Page 1021 and 1022:
CMS-1403-FC year of PQRI reporting)
Page 1023 and 1024:
CMS-1403-FC Based on the assumption
Page 1025 and 1026:
CMS-1403-FC these activities for th
Page 1027 and 1028:
CMS-1403-FC per hour, we estimate t
Page 1029 and 1030:
CMS-1403-FC Because of the large nu
Page 1031 and 1032:
CMS-1403-FC threshold, and hence al
Page 1033 and 1034:
CMS-1403-FC shoes, the regulation i
Page 1035 and 1036:
CMS-1403-FC with comment period for
Page 1037 and 1038:
CMS-1403-FC substance of State laws
Page 1039 and 1040:
CMS-1403-FC $20 million from what e
Page 1041 and 1042:
CMS-1403-FC ● Impact of Work RVU
Page 1043 and 1044:
CMS-1403-FC imaging services from t
Page 1045 and 1046:
CMS-1403-FC ● Impact of section 1
Page 1047 and 1048:
CMS-1403-FC management, could have
Page 1049 and 1050:
CMS-1403-FC Table 50 illustrates, f
Page 1051 and 1052:
CMS-1403-FC CPT/ HCPCS Mod Descript
Page 1053 and 1054:
CMS-1403-FC impact associated with
Page 1055 and 1056:
CMS-1403-FC The fourth column shows
Page 1057 and 1058:
CMS-1403-FC the CY 2007 claims. The
Page 1059 and 1060:
CMS-1403-FC 1059 4/This column show
Page 1061 and 1062:
CMS-1403-FC requirements is to allo
Page 1063 and 1064:
CMS-1403-FC This amendment of the e
Page 1065 and 1066:
CMS-1403-FC 4 minutes per call, lab
Page 1067 and 1068:
CMS-1403-FC e-prescribing and who m
Page 1069 and 1070:
CMS-1403-FC anti-markup provisions
Page 1071 and 1072:
CMS-1403-FC approximately $50 per h
Page 1073 and 1074:
CMS-1403-FC e-prescribing measure i
Page 1075 and 1076:
CMS-1403-FC we estimate that each e
Page 1077 and 1078:
CMS-1403-FC P. Prohibition Concerni
Page 1079 and 1080:
CMS-1403-FC that provides a calcula
Page 1081 and 1082:
CMS-1403-FC treatment) that occur a
Page 1083 and 1084:
CMS-1403-FC locality (+5.37 percent
Page 1085 and 1086:
CMS-1403-FC additional rental payme
Page 1087 and 1088:
CMS-1403-FC T. Competitive Acquisit
Page 1089 and 1090:
CMS-1403-FC Program; II.T. Electron
Page 1091 and 1092:
CMS-1403-FC which means that in 200
Page 1093 and 1094:
CMS-1403-FC List of Subjects 42 CFR
Page 1095 and 1096:
CMS-1403-FC For the reasons set for
Page 1097 and 1098:
CMS-1403-FC (1) Except as specified
Page 1099 and 1100:
CMS-1403-FC pressure, a visual acui
Page 1101 and 1102:
CMS-1403-FC (ii) A speech-language
Page 1103 and 1104:
CMS-1403-FC during the hours that t
Page 1105 and 1106:
CMS-1403-FC (i) Be certified as a n
Page 1107 and 1108:
CMS-1403-FC 14. Section 410.155 is
Page 1109 and 1110:
CMS-1403-FC prostate cancer screeni
Page 1111 and 1112:
CMS-1403-FC B. Amending the definit
Page 1113 and 1114:
CMS-1403-FC The revisions and addit
Page 1115 and 1116:
CMS-1403-FC or institution other th
Page 1117 and 1118:
CMS-1403-FC substantially all (whic
Page 1119 and 1120:
CMS-1403-FC psychiatric diagnostic
Page 1121 and 1122:
CMS-1403-FC repairing, maintaining,
Page 1123 and 1124:
CMS-1403-FC B. Deleting paragraph (
Page 1125 and 1126:
CMS-1403-FC during any period of me
Page 1127 and 1128:
CMS-1403-FC (c)(1). A. Revising the
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CMS-1403-FC * * * * * (b) * * * (2)
Page 1131 and 1132:
CMS-1403-FC assigned to such drug p
Page 1133 and 1134:
CMS-1403-FC 33. In §415.130(d), th
Page 1135 and 1136:
CMS-1403-FC (6) An ambulance provid
Page 1137 and 1138:
CMS-1403-FC §424.57 Special paymen
Page 1139 and 1140:
CMS-1403-FC Final adverse action me
Page 1141 and 1142:
CMS-1403-FC (b) Reporting requireme
Page 1143 and 1144:
CMS-1403-FC of Medicare billing pri
Page 1145 and 1146:
CMS-1403-FC (a) Physicians, nonphys
Page 1147 and 1148:
CMS-1403-FC * * * * * (g) Effective
Page 1149 and 1150:
CMS-1403-FC that meet the qualifica
Page 1151 and 1152:
CMS-1403-FC (3) Have equivalent tra
Page 1153 and 1154:
CMS-1403-FC §485.711 Condition of
Page 1155 and 1156:
CMS-1403-FC Subpart C--Conditions f
Page 1157 and 1158:
CMS-1403-FC Authority: Catalog of F
Page 1159 and 1160:
CMS-1403-FC Addendum B means that C
Page 1161 and 1162:
CMS-1403-FC which they are incident
Page 1163 and 1164:
CMS-1403-FC T = There are RVUs for
Page 1165 and 1166:
CMS-1403-FC ADDENDUM B: Relative Va
Page 1167 and 1168:
CMS-1403-FC Physi- cian Work Fully
Page 1169 and 1170:
Page 1171 and 1172:
Page 1173 and 1174:
Page 1175 and 1176:
Page 1177 and 1178:
Page 1179 and 1180:
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Page 1369 and 1370:
CMS-1403-FC CPT 1 / HCPCS Mod Statu
Page 1371 and 1372:
CMS-1403-FC CPT 1 / HCPCS Mod Statu
Page 1373 and 1374:
Page 1375 and 1376:
CMS-1403-FC Contractor Locality Loc
Page 1377 and 1378:
CMS-1403-FC ADDENDUM E: 2009 Geogra
Page 1379 and 1380:
CMS-1403-FC Work** PE MP Contractor
Page 1381 and 1382:
CMS-1403-FC 70492 Ct soft tissue ne
Page 1383 and 1384:
CMS-1403-FC 73201 Ct upper extremit
Page 1385 and 1386:
CMS-1403-FC 10780 10900 11020 11100
Page 1387 and 1388:
CMS-1403-FC 12420 12540 12580 12620
Page 1389 and 1390:
CMS-1403-FC 14060 14260 14484 14500
Page 1391 and 1392:
CMS-1403-FC 16820 16860 16940 16974
Page 1393 and 1394:
CMS-1403-FC 17980 18020 18140 18580
Page 1395 and 1396:
CMS-1403-FC 19804 20020 20100 20220
Page 1397 and 1398:
CMS-1403-FC 22500 22520 22540 22660
Page 1399 and 1400:
CMS-1403-FC 25020 25060 25180 25260
Page 1401 and 1402:
CMS-1403-FC 26980 27060 27100 27140
Page 1403 and 1404:
CMS-1403-FC 28700 28740 28940 29020
Page 1405 and 1406:
CMS-1403-FC 30860 30980 31020 31084
Page 1407 and 1408:
CMS-1403-FC 33140 33260 33340 33460
Page 1409 and 1410:
CMS-1403-FC 35300 35380 35644 35660
Page 1411 and 1412:
CMS-1403-FC 37340 37380 37460 37620
Page 1413 and 1414:
CMS-1403-FC 39300 39340 39380 39460
Page 1415 and 1416:
CMS-1403-FC 40580 40660 40900 40980
Page 1417 and 1418:
CMS-1403-FC 41940 41980 Sabana Gran
Page 1419 and 1420:
CMS-1403-FC 43340 43580 43620 43780
Page 1421 and 1422:
CMS-1403-FC 45940 46060 46140 46220
Page 1423 and 1424:
CMS-1403-FC 47940 48140 48260 48300
Page 1425 and 1426:
CMS-1403-FC 1425
Page 1427 and 1428:
CMS-1403-FC CBSA Code Nonurban Area
Page 1429 and 1430:
CMS-1403-FC HCPCS Descriptor 71260
Page 1431 and 1432:
Page 1433 and 1434:
Page 1435 and 1436:
Page 1437 and 1438:
CMS-1403-FC 78122 Blood volume 7813
Page 1439 and 1440:
CMS-1403-FC 96125 Cognitive test by
Page 1441 and 1442:
CMS-1403-FC 70240 X-ray exam, pitui
Page 1443 and 1444:
CMS-1403-FC 72120 X-ray exam of low
Page 1445 and 1446:
CMS-1403-FC 73720 Mri lwr extremity
Page 1447 and 1448:
CMS-1403-FC 76856 Us exam, pelvic,
Page 1449 and 1450:
CMS-1403-FC 78456 Acute venous thro
Page 1451 and 1452:
CMS-1403-FC 93320 Doppler echo exam
Page 1453 and 1454:
CMS-1403-FC A9571 Indium In-111 aut
Page 1455 and 1456:
CMS-1403-FC 77333 Radiation treatme
Page 1457 and 1458:
CMS-1403-FC C2638 Brachytx, strande
Page 1459:
CMS-1403-FC P3000 Screen pap by tec
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