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CMS-1403-FC TABLE 3: Equipment Items Needing Specialty Input for Pricing Code 2008/9 Description 2008/9 Price Primary *CPT Prior specialties code(s) Status associated with associated on item with item Table Commenter response and CMS Action 2009 Item Status refer to note(s) Camera mount-floor 2300 Dermatology 96904 Yes Specialty to submit, asap. A and D ED039 Cross slide attachment 500 Dermatology 96904 Yes Specialty to submit, asap. A and D plasma pheresis machine 37,900 Psychology Testing Equipment Strobe, 400watts (Studio)(2) Cryosurgery system ( for tumor ablation) 1 Workstation, dual, echocardiography EQ136 Infrared Coagulator (with hand applicator, includes light guide) Radiology, Dermatology Psychology 36481 G0341 96101 96102 Yes Revised description based on comments received that light source was not part of item. Documentation requested. 74 Yes Specialty to submit, asap. B 1500 Dermatology 96904 Yes Documentation requested. B Urology, Radiology, Interventional Radiology 50593 Yes New item 2008 A and D 85000 Cardiology 93351 No New item 2009, Specialty submitted $173,509 – CMS accept $85,000 E 3659.50 46606 46608 46610 46612 46930 No New price for 2009 with addition of light guide, Supply code, Eq136, descriptor changed to include the light guide. *CPT codes and descriptions only are copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. Note: Acceptable documentation includes detailed description (including system, kit or product components), source (multiple sources requested), and current pricing information. For most items, there will be multiple sources of documentation available – multiple products/models that can be used as acceptable substitutes in performing a procedure. We ask that documentation from multiple sources be submitted with verified prices of the various products which represent the price range. In these instances, only one specific item/model/product is available on the market for use in a given procedure, one source of documentation is required. However, CMS expects that all documentation reflect the market price for each product reflecting the manufacturer or vendor discounts, rebates, etc. Invoices from physician purchases are the preferred documentation. In cases where this is not possible, CMS may accept other documentation such as copies of catalog pages, hard copy from specific web pages, physician invoices, and typical or average sales price “quotes” (letter format okay) from manufacturers, vendors, or distributors. Unacceptable documentation includes phone numbers and addresses of manufacturer, vendors or distributors, web site links without pricing information, etc. A. Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors, or distributors are not acceptable documentation. B. No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly. C. Submitted price accepted. D. 2008/9 price, where specified, retained on an interim basis. Forward acceptable documentation promptly. E. See discussion in section V. of this final rule with comment period. Forward requested documentation promptly, for example, whether item is typical. B E

CMS-1403-FC TABLE 4: Practice Expense Supply Item Additions for CY 2009 Equip Supply Description Unit Unit *CPT code(s) Supply Comments Code Price associated with item Category NA Agent, neurolytic ml 64632 Pharmacy, Rx A, B and D NA IV infusion set, Sof-set (Minimed) Item 11.5 96369 and 96371 Hypodermic, IV B NA Strut, replacement, dynamic external Item 1151 20697 Accessory A NA Swab, patient prep, 1.5 ml (chloraprep) Item 1.04 93352 Pharmacy, NonRx B NA Tube, anaerobic culture item 62267 Lab A NA Tube, jejunsostomy item 97.50 49441, 49446, 49451 and 49452 Accessory A and C *CPT codes and descriptions only are copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. A. Price verification needed. Item(s) added to table of supplies requiring specialty input B. Request explanation/rationale as to why specific supply is necessary, how it differs from current PE database item, and why current PE item(s) cannot be used for procedure(s). C. CMS price correction. D. Also, see discussion in section V. of this final rule with comment period. Proxy in use on an interim basis: SH062 Sclerosing solution, inj 75

<strong>CMS</strong>-1403-FC<br />

TABLE 4: Practice Expense Supply Item Additions for<br />

CY 2009<br />

Equip Supply Description Unit Unit *CPT code(s)<br />

Supply Comments<br />

Code<br />

Price associated with item Category<br />

NA Agent, neurolytic ml 64632 Pharmacy, Rx A, B and D<br />

NA IV infusion set, Sof-set<br />

(Minimed)<br />

Item 11.5 96369 and 96371 Hypodermic, IV B<br />

NA Strut, replacement, dynamic<br />

external<br />

Item 1151 20697 Accessory A<br />

NA Swab, patient prep, 1.5 ml<br />

(chloraprep)<br />

Item 1.04 93352 Pharmacy, NonRx B<br />

NA Tube, anaerobic culture item 62267 Lab A<br />

NA Tube, jejunsostomy item 97.50 49441, 49446, 49451 and 49452 Accessory A and C<br />

*CPT codes and descriptions only are copyright 2009 American Medical Association. All Rights Reserved. Applicable<br />

FARS/DFARS apply.<br />

A. Price verification needed. Item(s) added to table of supplies requiring specialty input<br />

B. Request explanation/rationale as to why specific supply is necessary, how it differs from current PE database item, and why<br />

current PE item(s) cannot be used for procedure(s).<br />

C. <strong>CMS</strong> price correction.<br />

D. Also, see discussion in section V. of this final rule with comment period. Proxy in use on an interim basis: SH062 Sclerosing<br />

solution, inj<br />

75

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