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CMS-1403-FC
The RUC has created the 5-Year Review Identification
Workgroup to respond to these concerns regarding the
valuation of codes. The workgroup identified some
potentially misvalued codes through several vehicles,
namely, identifying codes with site of service anomalies,
high intra-service work per unit time (IWPUT), and services
with high volume growth.
In the proposed rule, we indicated we would address
the RUC’s recommendations from the February and April 2008
meetings for codes with site of service anomalies in the
CY 2009 PFS final rule with comment period in a manner
consistent with the way we address other RUC
recommendations and that the values for these services
would be published as interim values for CY 2009.
In addition to the RUC’s work, we believe that there
are certain steps we can take to help address the issue of
potentially misvalued services. A discussion of these
steps are outlined below.
1. Updating High Cost Supplies
In the CY 2009 PFS proposed rule (73 FR 38582), we
proposed a process to update high-cost supplies over $150
every 2 years. In order to obtain the typical price in the
marketplace, we outlined examples of acceptable
documentation and stated that we would not accept
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