Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006, 45764-46064 [05-15370]
Download as PDF
<![CDATA[
45764
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 405, 410, 411, 413, 414,
and 426
[CMS–1502–P]
RIN 0938–AN84
Medicare Program; Revisions to
Payment Policies Under the Physician
Fee Schedule for Calendar Year 2006
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
AGENCY:
SUMMARY: This proposed rule would
refine the resource-based practice
expense relative value units (PE RVUs)
and propose changes to payment based
on supplemental survey data for
practice expense and revisions to our
methodology for calculating practice
expense RVUs, as well as make other
proposed changes to Medicare Part B
payment policy. We are also proposing
policy changes related to revisions to
malpractice RVUs, in addition to
revising the list of telehealth services. In
this proposed rule, we also discuss
multiple procedure payment reduction
for diagnostic imaging, and several
coding issues.
We are proposing these changes to
ensure that our payment systems are
updated to reflect changes in medical
practice and the relative value of
services. This proposed rule also
discusses geographic locality changes;
payment for covered outpatient drugs
and biologicals; supplemental payments
to federally qualified health centers
(FQHCs); payment for renal dialysis
services; the national coverage decision
(NCD) process; coverage of screening for
glaucoma; private contracts; and
physician referrals for nuclear medicine
services and supplies to health care
entities with which they have financial
relationships.
In addition, we include discussions
on payment for teaching
anesthesiologists, the therapy cap, the
chiropractic demonstration and the
Sustainable Growth Rate (SGR).
DATES: Comment Date: Comments will
be considered if we receive them at one
of the addresses provided below, no
later than 5 p.m. on September 30, 2005.
ADDRESSES: In commenting, please refer
to file code CMS–1502–P. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
You may submit comments in one of
three ways (no duplicates, please):
1. Electronically. You may submit
electronic comments on specific issues
in this regulation to https://
www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in
Microsoft Word, WordPerfect, or Excel;
however, we prefer Microsoft Word.)
2. By mail. You may mail written
comments (one original and two copies)
to the following address ONLY: Centers
for Medicare & Medicaid Services,
Department of Health and Human
Services, Attention: CMS–1502–P, P.O.
Box 8017, Baltimore, MD 21244–8017.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments (one
original and two copies) to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–1502–P, Mail Stop C4–26–05,
7500 Security Boulevard, Baltimore, MD
21244–1850.
4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to one of the following
addresses. If you intend to deliver your
comments to the Baltimore address,
please call telephone number (410) 786–
7197 in advance to schedule your
arrival with one of our staff members.
Room 445–G, Hubert H. Humphrey
Building, 200 Independence Avenue,
SW., Washington, DC 20201; or 7500
Security Boulevard, Baltimore, MD
21244–1850.
(Because access to the interior of the
HHH Building is not readily available to
persons without Federal Government
identification, commenters are
encouraged to leave their comments in
the CMS drop slots located in the main
lobby of the building. A stamp-in clock
is available for persons wishing to retain
a proof of filing by stamping in and
retaining an extra copy of the comments
being filed.)
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
Submission of comments on
paperwork requirements. You may
submit comments on this document’s
paperwork requirements by mailing
your comments to the addresses
provided at the end of the ‘‘Collection
of Information Requirements’’ section in
this document.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
PO 00000
Frm 00002
Fmt 4701
Sfmt 4702
FOR FURTHER INFORMATION CONTACT:
Pam West (410) 786–2302 (for issues
related to practice expense).
Rick Ensor (410) 786–5617 (for issues
related to the non-physician workpool
and supplemental survey data).
Stephanie Monroe (410) 786–6864 (for
issues related to the geographic practice
cost index).
Craig Dobyski (410) 786–4584 (for
issues related to list of telehealth
services).
Ken Marsalek (410) 786–4502 (for
issues related to multiple procedure
reduction for diagnostic imaging
services and payment for teaching
anesthesiologists).
Henry Richter (410) 786–4562 (for
issues related to payments for end stage
renal disease facilities).
Angela Mason (410) 786–7452 or
Catherine Jansto (410) 786–7762 (for
issues related to payment for covered
outpatient drugs and biologicals).
Fred Grabau (410) 786–0206 (for
issues related to private contracts and
opt out provision).
David Worgo (410) 786–5919 (for
issues related to Federally Qualified
Health Centers).
Vadim Lubarsky (410) 786–0840 (for
issues related National Coverage
Decision timeframes).
Bill Larson (410) 786–7176 (for issues
related to coverage of screening for
glaucoma).
Diane Milstead (410) 786–3355 or
Gaysha Brooks (410) 786–9649 (for all
other issues).
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome
comments from the public on all issues
set forth in this rule to assist us in fully
considering issues and developing
policies. You can assist us by
referencing the file code CMS–1502–P
and the specific ‘‘issue identifier’’ that
precedes the section on which you
choose to comment.
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. CMS posts all electronic
comments received before the close of
the comment period on its public
website as soon as possible after they
have been received. Hard copy
comments received timely will be
available for public inspection as they
are received, generally beginning
approximately 3 weeks after publication
of a document, at the headquarters of
the Centers for Medicare & Medicaid
Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an
appointment to view public comments,
phone 1–800–743–3951.
This Federal Register document is
also available from the Federal Register
online database through GPO Access a
service of the U.S. Government Printing
Office. The Web site address is: https://
www.access.gpo.gov/nara/.
Information on the physician fee
schedule can be found on the CMS
homepage. You can access this data by
using the following directions:
1. Go to the CMS homepage (https://
www.cms.hhs.gov).
2. Place your cursor over the word
‘‘Professionals’’ in the blue areas near
the top of the page. Select ‘‘physicians’’
from the drop-down menu.
3. Under ‘‘Billing/Payment’’ select
‘‘Physician Fee Schedule’’.
To assist readers in referencing
sections contained in this preamble, we
are providing the following table of
contents. Some of the issues discussed
in this preamble affect the payment
policies, but do not require changes to
the regulations in the Code of Federal
Regulations. Information on the
regulation’s impact appears throughout
the preamble and is not exclusively in
section VI.
Table of Contents
I. Background
A. Introduction
B. Development of the Relative Value
System
C. Components of the Fee Schedule
Payment Amounts
D. Most Recent Changes to the Fee
Schedule
II. Provisions of the Proposed Rule
A. Resource-Based Practice Expense RVUs
1. Current Methodology
2. Practice Expense Proposals for Calendar
Year 2006
B. Geographic Practice Cost Indices
C. Malpractice Relative Value Units (RVUs)
D. Medicare Telehealth Services
E. Contractor Pricing of Unlisted Therapy
Modalities and Procedures
F. Payment for Teaching Anesthesiologists
G. End Stage Renal Disease (ESRD) Related
Provisions
1. Revised Pricing Methodology for
Separately Billable Drugs and Biologicals
Furnished by ESRD Facilities.
2. Adjustment to Account for Changes in
the Pricing of Separately Billable Drugs
and Biologicals and the Estimated
Increase in Expenditures for Drugs and
Biologicals
3. Proposed Revisions to Geographic
Designations and Wage Indexes Applied
to the End Stage Renal Disease
Composite Payment Rate Wage Index
4. Proposed Revisions to § 413.170 (Scope)
and § 413.174 (Prospective rates for
hospital-based and independent ESRD
facilities)
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
5. Proposed Revisions to the Composite
Payment Rate Exceptions Process
H. Payment for Covered Outpatient Drugs
and Biologicals
I. Private Contracts and Opt-out Provision
J. Multiple Procedure Reduction for
Diagnostic Imaging
K. Therapy Cap
L. Chiropractic Services Demonstration
M. Supplemental Payments to Federally
Qualified Health Centers (FQHCs)
Subcontracting with Medicare
Advantage Plans
N. National Coverage Decisions
Timeframes
O. Coverage of Screening for Glaucoma
P. Physician Referrals for Nuclear
Medicine Services and Suppliers to
Health Care Entities with Which They
Have Financial Relationships
Q. Sustainable Growth Rate
III. Collection of Information Requirements
IV. Response to Comments
V. Regulatory Impact Analysis
Regulation Text
Addendum A—Explanation and Use of
Addendum B
Addendum B—2006 Relative Value Units
and Related Information Used in
Determining Medicare Payments for 2006
Addendum C—Codes for Which we Received
Practice Expense Review Committee
(PERC) Recommendations on Practice
Expense Direct Cost Inputs.
Addendum D—2006 Geographic Practice
Cost Indices By Medicare Carrier and
Locality
Addendum E—Proposed 2006 Geographic
Adjustment Factors (GAFs)
Addendum F—ESRD Facilities Metropolitan
Statistical Areas (MSA)/Core-Based
Statistical Areas (CBSA) Crosswalk
Addendum G—List of CPT/HCPCS Codes
Used to Describe Nuclear Medicine
Designated Health Services Under Section
1877 of the Social Security Act
In addition, because of the many
organizations and terms to which we refer by
acronym in this proposed final rule, we are
listing these acronyms and their
corresponding terms in alphabetical order
below:
AADA American Academy of Dermatology
Association
AAH American Association of Homecare
ACC American College of Cardiology
ACG American College of Gastroenterology
ACR American College of Radiology
AFROC Association of Freestanding
Radiation Oncology Centers
AGA American Gastroenterological
Association
AMA American Medical Association
AMP Average manufacturer price
ASA American Society of Anesthesiologists
ASGE American Society of Gastrointestinal
Endoscopy
ASP Average sales price
ASTRO American Society for Therapeutic
Radiation Oncology
ATA American Telemedicine Association
AUA American Urological Association
AWP Average wholesale price
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act of
1999
PO 00000
Frm 00003
Fmt 4701
Sfmt 4702
45765
BES (Bureau of the Census’) Business
Expenditure Survey
BIPA Benefits Improvement and Protection
Act of 2000
BLS Bureau of Labor Statistics
BMI Body mass index
BNF Budget neutrality factor
BSA Body surface area
CAP College of American Pathologists
CBSA Core-Based Statistical Area
CF Conversion factor
CFR Code of Federal Regulations
CMA California Medical Association
CMS Centers for Medicare & Medicaid
Services
CNS Clinical nurse specialist
CPEP Clinical Practice Expert Panel
CPI Consumer Price Index
CPO Care Plan Oversight
CPT (Physicians’) Current Procedural
Terminology (4th Edition, 2002,
copyrighted by the American Medical
Association)
CRNA Certified Registered Nurse
Anesthetist
CT Computed tomography
CTA Computed tomographic angiography
CY Calendar year
DHS Designated health services
DME Durable medical equipment
DMERC Durable Medical Equipment
Regional Carrier
DSMT Diabetes outpatient self-management
training services
E&M Evaluation and management
EPO Erythopoeitin
ESRD End stage renal disease
FAX Facsimile
FI Fiscal intermediary
FQHC Federally qualified healthcare center
FR Federal Register
GAF Geographic adjustment factor
GAO General Accounting Office
GPCI Geographic practice cost index
HCPAC Health Care Professional Advisory
Committee
HCPCS Healthcare Common Procedure
Coding System
HHA Home health agency
HHS (Department of) Health and Human
Services
HOCM High Osmolar Contrast Media
HPSA Health professional shortage area
HRSA Health Resources Services
Administration (HHS)
IDTFs Independent diagnostic testing
facilities
IPF Inpatient psychiatric facility
IPPS Inpatient prospective payment system
IRF Inpatient rehabilitation facility
ISO Insurance Services Office
IVIG Intravenous immune globulin
JCAAI Joint Council of Allergy, Asthma,
and Immunology
JUA Joint underwriting association
LCD Local coverage determination
LTCH Long-term care hospital
LOCM Low Osmolar Contrast Media
MA Medicare Advantage
MCAC Medicare Coverage Advisory
Committee
MCG Medical College of Georgia
MedPAC Medicare Payment Advisory
Commission
MEI Medicare Economic Index
E:\FR\FM\08AUP2.SGM
08AUP2
45766
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
MMA Medicare Prescription Drug,
Improvement, and Modernization Act of
2003
MNT Medical nutrition therapy
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
NCD National coverage determination
NCQDIS National Coalition of Quality
Diagnostic Imaging Services
NDC National drug code
NECMA New England County Metropolitan
Area
NECTA New England City and Town Area
NP Nurse practitioner
NPP Nonphysician practitioners
OBRA Omnibus Budget Reconciliation Act
OIG Office of Inspector General
OMB Office of Management and Budget
OPPS Outpatient prospective payment
system
PA Physician assistant
PC Professional component
PE Practice Expense
PEAC Practice Expense Advisory
Committee
PERC Practice Expense Review Committee
PET Positron emission tomography
PFS Physician Fee Schedule
PLI Professional liability insurance
PPI Producer price index
PPO Preferred provider organization
PPS Prospective payment system
PRA Paperwork Reduction Act
PT Physical therapy
RFA Regulatory Flexibility Act
RIA Regulatory impact analysis
RN Registered nurse
RUC (AMA’s Specialty Society) Relative
(Value) Update Committee
RVU Relative value unit
SGR Sustainable growth rate
SMS (AMA’s) Socioeconomic Monitoring
System
SNF Skilled nursing facility
SNM Society for Nuclear Medicine
TA Technology assessment
TC Technical component
tPA Tissue-type plasminogen activator
UAF Update adjustment factor
WAC Wholesale acquisition cost
WAMP Widely available market price
I. Background
[If you choose to comment on issues in
this section, please include the caption
‘‘BACKGROUND’’ at the beginning of
your comments.]
A. Introduction
Since January 1, 1992, Medicare has
paid for physicians’ services under
section 1848 of the Social Security Act
(the Act), ‘‘Payment for Physicians’
Services.’’ The Act requires that
payments under the physician fee
schedule (PFS) be based on national
uniform relative value units (RVUs)
based on the resources used in
furnishing a service. Section 1848(c) of
the Act requires that national RVUs be
established for physician work, practice
expense (PE), and malpractice expense.
Prior to the establishment of the
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
resource-based relative value system,
Medicare payment for physicians’
services was based on reasonable
charges.
B. Development of the Relative Value
System
1. Work RVUs
The concepts and methodology
underlying the PFS were enacted as part
of the Omnibus Budget Reconciliation
Act (OBRA) of 1989, Pub. L. 101–239,
and OBRA 1990, (Pub. L. 101–508). The
final rule, published November 25, 1991
(56 FR 59502), set forth the fee schedule
for payment for physicians’ services
beginning January 1, 1992. Initially,
only the physician work RVUs were
resource-based, and the PE and
malpractice RVUs were based on
average allowable charges.
The physician work RVUs established
for the implementation of the fee
schedule in January 1992 were
developed with extensive input from
the physician community. A research
team at the Harvard School of Public
Health developed the original physician
work RVUs for most codes in a
cooperative agreement with the
Department of Health and Human
Services. In constructing the codespecific vignettes for the original
physician work RVUs, Harvard worked
with panels of experts, both inside and
outside the government and obtained
input from numerous physician
specialty groups.
Section 1848(b)(2)(A) of the Act
specifies that the RVUs for radiology
services are based on relative value
scale we adopted under section
1834(b)(1)(A) of the Act, (the American
College of Radiology (ACR) relative
value scale), which we integrated into
the overall PFS. Section 1848(b)(2)(B) of
the Act specifies that the RVUs for
anesthesia services are based on RVUs
from a uniform relative value guide. We
established a separate conversion factor
(CF) for anesthesia services, and we
continue to utilize time units as a factor
in determining payment for these
services. As a result, there is a separate
payment methodology for anesthesia
services.
We establish physician work RVUs for
new and revised codes based on
recommendations received from the
American Medical Association’s (AMA)
Specialty Society Relative Value Update
Committee (RUC).
2. Practice Expense Relative Value Units
(PE RVUs)
Section 121 of the Social Security Act
Amendments of 1994 (Pub. L. 103–432),
enacted on October 31, 1994, amended
PO 00000
Frm 00004
Fmt 4701
Sfmt 4702
section 1848(c)(2)(C)(ii) of the Act and
required us to develop resource-based
PE RVUs for each physician’s service
beginning in 1998. We were to consider
general categories of expenses (such as
office rent and wages of personnel, but
excluding malpractice expenses)
comprising practice expenses.
Section 4505(a) of the Balanced
Budget Act of 1997 (BBA) (Pub. L. 105–
33), amended section 1848(c)(2)(C)(ii) of
the Act to delay implementation of the
resource-based PE RVU system until
January 1, 1999. In addition, section
4505(b) of the BBA provided for a 4-year
transition period from charge-based PE
RVUs to resource-based RVUs.
We established the resource-based PE
RVUs for each physician’s service in a
final rule, published November 2, 1998
(63 FR 58814), effective for services
furnished in 1999. Based on the
requirement to transition to a resourcebased system for PE over a 4-year
period, resource-based PE RVUs did not
become fully effective until 2002.
This resource-based system was based
on two significant sources of actual PE
data: The Clinical Practice Expert Panel
(CPEP) data and the AMA’s
Socioeconomic Monitoring System
(SMS) data. The CPEP data were
collected from panels of physicians,
practice administrators, and
nonphysicians (for example, registered
nurses) nominated by physician
specialty societies and other groups.
The CPEP panels identified the direct
inputs required for each physician’s
service in both the office setting and
out-of-office setting. The AMA’s SMS
data provided aggregate specialtyspecific information on hours worked
and practice expenses.
Separate PE RVUs are established for
procedures that can be performed in
both a nonfacility setting, such as a
physician’s office, and a facility setting,
such as a hospital outpatient
department. The difference between the
facility and nonfacility RVUs reflects
the fact that a facility receives separate
payment from Medicare for its costs of
providing the service, apart from
payment under the PFS. The nonfacility
RVUs reflect all of the direct and
indirect practice expenses of providing
a particular service.
Section 212 of the Balanced Budget
Refinement Act of 1999 (BBRA) (Pub. L.
106–113) directed the Secretary to
establish a process under which we
accept and use, to the maximum extent
practicable and consistent with sound
data practices, data collected or
developed by entities and organizations
to supplement the data we normally
collect in determining the PE
component. On May 3, 2000, we
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
published the interim final rule (65 FR
25664) that set forth the criteria for the
submission of these supplemental PE
survey data. The criteria were modified
in response to comments received, and
published in the Federal Register (65
FR 65376) as part of a November 1, 2000
final rule. The PFS final rules published
in 2001 and 2003, respectively, (66 FR
55246 and 68 FR 63196) extended the
period during which we would accept
these supplemental data.
3. Resource-Based Malpractice RVUs
Section 4505(f) of the BBA amended
section 1848(c) of the Act to require us
to implement resource-based
malpractice RVUs for services furnished
on or after 2000. The resource-based
malpractice RVUs were implemented in
the PFS final rule published November
2, 1999 (64 FR 59380). The malpractice
RVUs were based on malpractice
insurance premium data collected from
commercial and physician-owned
insurers from all the States, the District
of Columbia, and Puerto Rico.
4. Refinements to the RVUs
Section 1848(c)(2)(B)(i) of the Act
requires that we review all RVUs no less
often than every five years. The first 5year review of the physician work RVUs
went into effect in 1997, published on
November 22, 1996 (61 FR 59489). The
second 5-year review went into effect in
2002, published on November 1, 2001
(66 FR 55246). The next scheduled 5year review is scheduled to go into
effect in 2007.
In 1999, the AMA’s RUC established
the Practice Expense Advisory
Committee (PEAC) for the purpose of
refining the direct PE inputs. Through
March of 2004, the PEAC provided
recommendations to CMS for over 7,600
codes (all but a few hundred of the
codes currently listed in the AMA’s
Current Procedural Terminology (CPT)
codes).
In the November 15, 2004, PFS final
rule (69 FR 66236), we implemented the
first 5-year review of the malpractice
RVUs (69 FR 66263).
5. Adjustments to RVUs are Budget
Neutral
Section 1848(c)(2)(B)(ii)(II) of the Act
provides that adjustments in RVUs for a
year may not cause total PFS payments
to differ by more than $20 million from
what they would have been if the
adjustments were not made. In
accordance with section
1848(c)(2)(B)(ii)(II) of the Act, if
adjustments to RVUs cause
expenditures to change by more than
$20 million, we make adjustments to
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
ensure that expenditures do not increase
or decrease by more than $20 million.
C. Components of the Fee Schedule
Payment Amounts
To calculate the payment for every
physician service, the components of
the fee schedule (physician work, PE,
and malpractice RVUs) are adjusted by
a geographic practice cost index (GPCI).
The GPCIs reflect the relative costs of
physician work, practice expenses, and
malpractice insurance in an area
compared to the national average costs
for each component.
Payments are converted to dollar
amounts through the application of a
CF, which is calculated by the Office of
the Actuary and is updated annually for
inflation.
The general formula for calculating
the Medicare fee schedule amount for a
given service and fee schedule area can
be expressed as:
Payment = [(RVU work x GPCI work)
+ (RVU PE x GPCI PE) + (RVU
malpractice x GPCI malpractice)] x CF.
D. Most Recent Changes to the Fee
Schedule
In the November 15, 2004 PFS final
rule (69 FR 66236), we refined the
resource-based PE RVUs and made other
changes to Medicare Part B payment
policy. These policy changes included—
• Supplemental survey data for PE;
• Updated GPCIs for physician work
and PE;
• Updated malpractice RVUs;
• Revised requirements for
supervision of therapy assistants;
• Revised payment rules for low
osmolar contrast media;
• Payment policies for physicians and
practitioners managing dialysis patients;
• Clarification of care plan oversight
CPO) requirements;
• Requirements for supervision of
diagnostic psychological testing
services;
• Clarifications to the policies
affecting therapy services provided
incident to a physician’s service;
• Requirements for assignment of
Medicare claims;
• Additions to the list of telehealth
services;
• Changes to payments for drug
administration services; and
• Several coding issues.
The November 15, 2004, final rule
also addressed the following provisions
of the Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA) (Pub. L. 108–173):
• Coverage of an initial preventive
physical examination.
• Coverage of cardiovascular
screening blood tests.
PO 00000
Frm 00005
Fmt 4701
Sfmt 4702
45767
• Coverage of diabetes screening tests.
• Incentive payment improvements
for physicians in physician shortage
areas.
• Changes to payment for covered
outpatient drugs and biologicals and
drug administration services.
• Changes to payment for renal
dialysis services.
• Coverage of routine costs associated
with certain clinical trials of category A
devices as defined by the Food and Drug
Administration.
• Coverage of hospice consultation
service.
• Indexing the Part B deductible to
inflation.
• Extension of coverage of
intravenous immune globulin (IVIG) for
the treatment in the home of primary
immune deficiency diseases.
• Revisions to reassignment
provisions.
• Payment for diagnostic
mammograms.
• Coverage of religious nonmedical
health care institution items and
services to the beneficiary’s home.
In addition, the November 15, 2004
PFS final rule finalized the calendar
year (CY) 2004 interim RVUs for new
and revised codes in effect during CY
2004 and issued interim RVUs for new
and revised procedure codes for CY
2005; updated the codes subject to the
physician self-referral prohibition;
discussed payment for set-up of portable
x-ray equipment; discussed the third 5year refinement of work RVUs; and
solicited comments on potentially
misvalued work RVUs.
In accordance with section
1848(d)(1)(E) of the Act, we also
announced that the PFS update for CY
2005 would be 1.5 percent; the initial
estimate for the sustainable growth rate
for CY 2005 is 4.3; and the CF for CY
2005 is $37.8975.
II. Provisions of the Proposed Rule
This proposed rule would affect the
regulations set forth at Part 405, Federal
Health Insurance for the Aged and
Disabled; Part 410, Supplementary
Medical Insurance (SMI) Benefits; Part
411, Exclusions from Medicare and
Limitations on Medicare Payment; Part
413, Principles of Reasonable Cost
Reimbursement, Payment for End-Stage
Renal Disease Services, Prospectively
Determined Payment Rates for Skilled
Nursing Facilities; 414, Payment for Part
B Medical and Other Health Services;
Part 426, Review of National Coverage
Determinations and Local Coverage
Determinations.
E:\FR\FM\08AUP2.SGM
08AUP2
45768
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
a. Data Sources
A. Resource-Based Practice Expense
(PE) RVUs
Based on section 1848(c)(1)(B) of the
Act practice expenses are the portion of
the resources used in furnishing the
service that reflects the general
categories of physician and practitioner
expenses (such as office rent and wages
of personnel, but excluding malpractice
expenses).
Section 121 of the Social Security
Amendments of 1994 (Pub. L. 103–432),
enacted on October 31, 1994, required
us to develop a methodology for a
resource-based system for determining
PE RVUs for each physician’s service.
Up until this point, physicians’ practice
expenses were based on historical
allowed charges. This legislation stated
that the revised PE methodology must
consider the staff, equipment, and
supplies used in the provision of
various medical and surgical services in
various settings beginning in 1998. The
Secretary has interpreted this to mean
that Medicare payments for each service
would be based on the relative PE
resources typically involved with
performing the service.
The initial implementation of
resource-based PE RVUs was delayed
until January 1, 1999, by section 4505(a)
of the BBA 1997. In addition, section
4505(b) of the BBA 1997 required the
new payment methodology be phased-in
over 4 years, effective for services
furnished in CY 1999, and fully
effective in CY 2002. The first step
toward implementation called for by the
statute was to adjust the PE values for
certain services for CY 1998. Section
4505(d) of BBA 1997 required that, in
developing the resource-based PE RVUs,
the Secretary must:
• Use, to the maximum extent
possible, generally accepted cost
accounting principles that recognize all
staff, equipment, supplies, and
expenses, not solely those that can be
linked to specific procedures.
• Develop a refinement method to be
used during the transition.
• Consider, in the course of notice
and comment rulemaking, impact
projections that compare new proposed
payment amounts to data on actual
physician PEs.
Beginning in CY 1999, Medicare
began the four year transition to
resource-based PE RVUs. In CY 2002,
the resource-based PE RVUs were fully
transitioned.
1. Current Methodology
The following sections discuss the
current PE methodology.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
There are two primary data sources
used to calculate PEs. The American
Medical Association’s (AMA)
Socioeconomic Monitoring System
(SMS) survey data are used to develop
the PEs per hour for each specialty. The
second source of data used to calculate
PEs was originally developed by the
Clinical Practice Expert Panels (CPEP).
The CPEP data include the supplies,
equipment and staff times specific to
each procedure.
The AMA developed the SMS survey
in 1981 and discontinued it in 1999.
Beginning in 2002, we incorporated the
1999 SMS survey data into our
calculation of the PE RVUs, using a 5year average of SMS survey data. (See
Revisions to Payment Policies and FiveYear Review of and Adjustments to the
Relative Value Units Under the
Physician Fee Schedule for Calendar
Year 2002 final rule, published
November 1, 2001 (66 FR 55246).) The
SMS PE survey data are adjusted to a
common year, 1995. The SMS data
provide the following six categories of
PE costs:
• Clinical payroll expenses, which
are payroll expenses (including fringe
benefits) for nonphysician personnel.
• Administrative payroll expenses,
which are payroll expenses (including
fringe benefits) for nonphysician
personnel involved in administrative,
secretarial or clerical activities.
• Office expenses, which include
expenses for rent, mortgage interest,
depreciation on medical buildings,
utilities and telephones.
• Medical material and supply
expenses, which include expenses for
drugs, x-ray films, and disposable
medical products.
• Medical equipment expenses,
which include expenses depreciation,
leases, and rent of medical equipment
used in the diagnosis or treatment of
patients.
• All other expenses, which include
expenses for legal services, accounting,
office management, professional
association memberships, and any
professional expenses not mentioned
above.
In accordance with section 212 of the
BBRA, we established a process to
supplement the SMS data for a specialty
with data collected by entities and
organizations other than the AMA (that
is, the specialty itself). (See the Criteria
for Submitting Supplemental Practice
Expense Survey Data interim final rule
with comment period, published on
May 3, 2000 (65 FR 25664).) Originally,
the deadline to submit supplementary
survey data was through August 1, 2001.
PO 00000
Frm 00006
Fmt 4701
Sfmt 4702
This deadline was extended in the
November 1, 2001 final rule through
August 1, 2003. (See the Revisions to
Payment Policies and Five-Year Review
of and Adjustments to the Relative
Value Units Under the Physician Fee
Schedule for Calendar Year 2002 final
rule, published on November 1, 2001
(66 FR 55246).) Then, to ensure
maximum opportunity for specialties to
submit supplementary survey data, we
extended the deadline to submit surveys
until March 1, 2005. (See the Revisions
to Payment Policies Under the
Physician Fee Schedule for Calendar
Year 2002 final rule, published on
November 7, 2003 (68 FR 63196).)
The CPEPs consisted of panels of
physicians, practice administrators, and
nonphysicians (registered nurses (RNs),
for example) who were nominated by
physician specialty societies and other
groups. There were 15 CPEPs consisting
of 180 members from more than 61
specialties and subspecialties.
Approximately 50 percent of the
panelists were physicians.
The CPEPs identified specific inputs
involved in each physician service
provided in an office or facility setting.
The inputs identified were the quantity
and type of nonphysician labor, medical
supplies, and medical equipment.
In 1999, the AMA’s RUC established
the Practice Expense Advisory
Committee (PEAC). Since 1999, and
until March 2004, the PEAC, a multispecialty committee, reviewed the
original CPEP inputs and provided us
with recommendations for refining
these direct PE inputs for existing CPT
codes. Through its last meeting in
March 2004, the PEAC provided
recommendations which we have
reviewed and accepted for over 7,600
codes. As a result of this scrutiny, the
current CPEP inputs differ markedly
from those originally recommended by
the CPEPs. The PEAC has now been
replaced by the Practice Expense
Review Committee (PERC), which acts
to assist the RUC in recommending PE
inputs.
b. Allocation of Practice Expenses to
Services
In order to establish PE RVUs for
specific services, it is necessary to
establish the direct and indirect PE
associated with each service. Our
current approach allocates aggregate
specialty practice costs to specific
procedures and, thus, is often referred to
as a ‘‘top-down’’ approach. The
specialty PEs are derived from the
AMA’s SMS survey and supplementary
survey data. The PEs for a given
specialty are allocated to the services
performed by that specialty on the basis
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
of the CPEP data and work RVUs
assigned to each CPT code. The specific
process is detailed as follows:
Step 1—Calculation of the SMS Cost
Pool for Each Specialty
The six SMS cost categories can be
described as either direct or indirect
expenses. The three direct expense
categories include clinical labor,
medical supplies and medical
equipment. Indirect expenses include
administrative labor, office expense, and
all other expenses. We combine these
indirect expenses into a single category.
The SMS cost pool for each specialty is
calculated as follows:
• The specialty PE per hour (PE/HR)
for each of the three direct and one
indirect cost categories from the SMS is
calculated by dividing the aggregate PE
per specialty by the specialty’s total
hours spent in patient care activities
(also determined by the SMS survey).
The PE/HR is divided by 60 seconds to
obtain the PE per minute (PE/MIN).
• Each specialty’s PE pools (for each
of the three direct and one indirect cost
categories) are created by multiplying
the PE/MIN for the specialty by the total
time the specialty spent treating
Medicare patients for all procedures
(determined using Medicare utilization
data). Physician time on a procedurespecific level is available through RUC
surveys of new or revised codes and
through surveys conducted as part of
the 5 year review process. For codes that
the RUC has not yet reviewed, the
original data from the Harvard resourcebased RVU system survey is used.
Physician time includes time spent on
the case prior to, during, and after the
procedure. The physician procedure
time is multiplied by the frequency that
each procedure is performed on
Medicare patients by the specialty.
• The total specialty-specific SMS PE
for each cost category is the sum, for
each direct and indirect cost category, of
all of the procedure-specific total PEs.
45769
Table 1 illustrates an example of the
calculation of the total SMS cost pools
for the three direct and one indirect cost
categories discussed in step 1. For this
specialty, PE/HR for clinical payroll
expenses is $9.30 per hour. The hourly
rate is divided by 60 minutes to obtain
the clinical payroll per minute for the
specialty.
The total clinical payroll for
providing hypothetical procedure 00001
for this specialty of $3,633,465 is the
result of taking the clinical payroll per
minute of $0.16; multiplying this by the
physician time for procedure 00001 (56
minutes); and multiplying the result by
the number of times this procedure was
provided to Medicare patients by this
specialty (418,602). The total amount
spent on clinical payroll in this
specialty is $667,457,018. This amount
is calculated by summing the clinical
payroll expenses of procedure 00001
and all of the other services provided by
this specialty.
TABLE 1.—CALCULATION OF SMS COST POOL
Clinical
payroll
(A)
Standard methodology
(a) PE/HR ...................................................................
(b) PE/Minute .............................................................
(c) Physician Time—00001 ........................................
(d) Number of Services ..............................................
(e) Subtotal ................................................................
(f) All Other Services .................................................
(g) Total—SMS Pool ..................................................
$9.30
$0.16
56
418,602
$3,633,465
$663,823,552
$667,457,018
Medical
supplies
(B)
$4.80
$0.08
56
418,602
$1,875,337
$342,618,608
$344,493,945
Medical
equipment
(C)
$7.40
$0.12
56
418,602
$2,891,144
$528,203,687
$531,094,831
Indirect
expenses
(D)
Total *
(E)
$46.50
$0.78
56
418,602
$18,167,327
$3,319,117,762
$3,337,285,089
$68.00
$1.13
56
418,602
$26,567,274
$4,853,763,609
$4,880,330,883
(b) = (a)/60
(e) = (b)*(c)*(d)
(g) = (e)+(f)
* Components may not add to totals due to rounding.
Step 2—Calculation of CPEP Cost Pool
CPEP data provide expenditure
amounts for the direct expense
categories (clinical labor, supplies and
equipment cost) at the procedure level.
Multiplying the CPEP procedure-level
PEs for each of these three categories by
the number of times the specialty
provided the procedure, produces a
total category cost, per procedure, for
that specialty. The sum of the total
expenses from each procedure results in
the total CPEP category cost for the
specialty.
For example, in Table 2, using CPEP
data, the clinical labor cost of procedure
00001 is $65.23. Under the methodology
described above in this step, this is
multiplied by the number of services for
the specialty (418,602), to yield the total
CPEP data clinical labor cost of the
procedure: $27,305,408. In this
example, the clinical labor cost for all
other services performed by this
specialty is $831,618,600. Therefore, the
entire clinical labor CPEP expense pool
for the specialty is $858,924,008. Step 2
is repeated to calculate the CPEP supply
and equipment costs.
TABLE 2.—CALCULATION OF CPEP COST POOL
Clinical
labor
(A)
Standard
methodology
(a) CPT 00001 .......................................................................................................................
(b) Allowed Services ..............................................................................................................
(c) Subtotal ............................................................................................................................
(d) All Other Services ............................................................................................................
(e) Total CPEP Pool ..............................................................................................................
Supplies
(B)
$65.23
418,602
$27,305,408
$831,618,600
$858,924,008
(c) = (a)*(b)
(e) = (c)+(d)
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00007
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
$52.49
418,602
$21,972,838
$389,921,779
$411,894,617
Equipment
(C)
$1,556.86
418,602
$651,704,875
$5,277,570,148
$5,929,275,023
45770
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Step 3—Calculation and Application of
Scaling Factors
This step ensures that the total of the
CPEP costs across all procedures
performed by the specialty equates with
the total direct costs for the specialty as
reflected by the SMS data. To
accomplish this, the CPEP data are
scaled to SMS data by means of a
scaling factor so that the total CPEP
costs for each specialty equals the total
SMS cost for the specialty. (The scaling
factor is calculated by dividing the
Step 4—Calculation of Indirect
Expenses
Indirect PEs cannot be directly
attributed to a specific service because
they are incurred by the practice as a
whole. Indirect costs include rent,
utilities, office equipment and supplies,
and accounting and legal fees. There is
not a single, universally accepted
approach for allocating indirect practice
costs to individual procedure codes.
Rather allocation involves judgment in
identifying the base or bases that are the
best measures of a practice’s indirect
costs.
specialty’s SMS pool by the specialty’s
CPEP pool.)
The unscaled CPEP cost per
procedure value, at the direct cost level,
is then multiplied by the respective
specialty scalar to yield the scaled CPEP
procedure value. The sum of the scaled
CPEP direct cost pool expenditures
equals the total scaled direct expense for
the specific procedure at the specialty
level.
In the Step 3 example shown in Table
3, the SMS total clinical labor costs for
the specialty is $667,457,018. This
amount divided by the CPEP total
clinical labor amount of $858,924,008
yields a scaling factor of 0.78. The CPEP
clinical labor cost for hypothetical
procedure 00001 is $65.23. Multiplying
the 0.78 scaling factor for clinical labor
costs by $65.23 yields the scaled clinical
labor cost amount of $50.69. Individual
scaling factors must also be calculated
for supply and equipment expenses.
The sum of the scaled direct cost values,
$50.69, $43.90 and $139.45,
respectively, equals the total scaled
direct expense of $234.04.
To allocate the indirect PEs to a
specific service, we use the following
methodology:
• The scaled direct expenses and the
converted work RVU (the work RVU for
the service is multiplied by $34.5030,
the 1995 CF) are added together, and
then multiplied by the number of
services provided by the specialty to
Medicare patients;
• The total indirect PEs per specialty
are calculated by summing the indirect
expenses for all other procedures
provided by that specialty.
In the Table 4, the physician work
RVU for procedure 00001 is 2.36.
Multiplying the work RVU by the 1995
CF of $34.5030 equals $81.43. The
physician work value is added to the
scaled total direct expense from Step 3
($234.04). The total of $314.47 is a
proxy for the indirect PE for the
specialty attributed to this procedure.
The total indirect expenses are then
multiplied by the number of services
provided by the specialty (418,602), to
calculate total indirect expenses for this
procedure of $132,055,728. The process
is repeated across all procedures
performed by the specialty, and the
indirect expenses for each service are
summed to arrive at the total specialty
indirect PE pool of $6,745,545,434.
TABLE 4.—CALCULATION OF INDIRECT EXPENSE
Physician
work*
(a) CPT 00001 .......................................................................................................................
(b) Allowed Services ..............................................................................................................
(c) Subtotal ............................................................................................................................
(d) All Other Services ............................................................................................................
(e) Total Indirect Expense .....................................................................................................
Total direct expense
Total
(A)
Standard methodology
(B)
(C)
$81.43
........................
........................
........................
........................
$234.04
........................
........................
........................
........................
$315.47
418,602
$132,055,728
$6,613,489,706
$6,745,545,434
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00008
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.000</GPH>
*Calculated by multiplying work RVU of 2.36 by 1995 conversion factor of $34.5030.
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Step 5—Calculation and Application of
Indirect Scaling Factors
Similar to the direct costs, the indirect
costs are scaled to ensure that the total
across all procedures performed by the
specialty equates with the total indirect
costs for the specialty as reflected by the
SMS data. To accomplish this, the
indirect costs calculated in Step 4
(Table 4) are scaled to SMS data. The
calculation of the indirect scaling
factors is as follows:
• The specialty’s total SMS indirect
expense pool is divided by the
specialty’s total indirect expense pool
calculated in Step 4 (Table 4), to yield
the indirect expense scaling factor.
• The unscaled indirect expense
amount, at the procedure level, is
multiplied by the specialty’s scaling
factor to calculate the procedure’s
scaled indirect expenses.
• The sum of the scaled indirect
expense amount and the procedure’s
direct expenses yields the total PEs for
the specialty for this procedure.
In table 5, to calculate the indirect
scaling factor for hypothetical procedure
Step 6—Weighted Average of RVUs for
Procedures Performed by More Than
One Specialty
45771
PE is calculated based on Medicare
frequency data of all specialties
performing the procedure as shown in
Table 6.
For codes that are performed by more
than one specialty, a weighted average
00001, divide the total SMS indirect
pool, $3,337,285,089 (calculated in Step
1—Table 1), by the total indirect
expense for the specialty across all
procedures of $6,745,545,434. This
results in a scaling factor of 0.49. Next,
the unscaled indirect cost of $315.47 is
multiplied by the 0.49 scaling factor,
resulting in scaled indirect cost of
$156.07. To calculate the total PEs for
the specialty for procedure 00001, the
scaled direct and indirect expenses are
added, totaling $390.12.
TABLE 6.—WEIGHT AVERAGING FOR ALL SPECIALTIES
Practice expense value
(a) Specialty Total Practice Expense ......................................................................................................................
(b) Weighted Avg.—All Other Specialties ...............................................................................................................
(c) Weighted Avg.—All Specialties ..........................................................................................................................
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
were not made. Budget neutrality for the
upcoming year is determined relative to
the sum of PE RVUs for the current year.
Although the PE RVUs for any
particular code may vary from year-toyear, the sum of PE RVUs across all
codes is set equal to the current year.
The budget neutrality factor (BNF) is
equal to the sum of the current year’s PE
RVUs, divided by the sum of the direct
PO 00000
Frm 00009
Fmt 4701
Sfmt 4702
(B)
$390.12
$929.87
$481.70
83
17
100
and indirect inputs across all codes for
the upcoming year. The BNF is applied
to (multiplied by) the scaled direct and
indirect expenses for each code to set
the PE RVU for the upcoming year.
In Table 7, the sum of the scaled
direct and indirect expenses for
hypothetical code 00001 ($481.70) is
multiplied by the BNF (0.02 in this
example) to yield a PE RVU of 10.60.
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.001</GPH>
Step 7—Budget Neutrality and Final
RVU Calculation
The total scaled direct and indirect
inputs are then adjusted by a budget
neutrality factor to calculate RVUs.
Section 1848(c)(2)(B)(ii)(II) of the Act
provides that adjustments in RVUs may
not cause total PFS payments to differ
by more than $20 million from what
they would have been if the adjustments
Percent of
total allowed
services
(A)
Standard Methodology
45772
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 7.—CALCULATE PE RVU
Total scaled
direct and indirect inputs
c. Other Methodological Issues:
Nonphysician Work Pool (NPWP)
As an interim measure, until we could
further analyze the effect of the topdown methodology on the Medicare
payment for services with no physician
work (including the technical
components (TCs) of radiation oncology,
radiology and other diagnostic tests), we
created a separate PE pool for these
services. However, any specialty society
could request that its services be
removed from the nonphysician work
pool. We have removed some services
from the nonphysician work pool if we
find that the requesting specialty
provides the service the majority of the
time.
NPWP Step 1—Calculation of the SMS
Cost Pool for Each Specialty
This step parallels the calculations
described above for the standard ‘‘topdown’’ PE allocation methodology. For
codes in the nonphysician work pool,
the direct and indirect SMS costs are set
equal to the weighted average of the PE/
HR for the specialties that provide the
services in the pool. Clinical staff time
Final PE RVU
(A)
(a) Code 00001 ............................................................................................................................
Budget neutrality factor
(B)
(C)
$481.70
0.02
10.60
is substituted for physician time in the
calculation. The clinical staff time for
the code is from CPEP data. Otherwise,
the calculation is similar to the method
described previously for codes with
physician time.
The following example in Table 8
illustrates this calculation for
hypothetical code 00002. In this
example, the average clinical payroll
PE/HR for all specialties in the
nonphysician work pool is $12.30 and
the clinical staff time for code 00002 is
116 minutes.
TABLE 8.—CALCULATE SMS COST POOLS FOR NONPHYSICIAN WORK POOL
Clinical payroll
Medical supplies
Medical equipment
Indirect expenses
Total*
(A)
Non-Physician work pool methodology (NPWP)
(B)
(C)
(D)
(E)
(a) NPWP—PE/HR ..............................................................
(b) NPWP—PE/Minute .........................................................
(c) Clinical Staff Time—00002 .............................................
(d) Number of Services ........................................................
(e) Total—NPWP ‘‘SMS’’ Pool .............................................
$12.30
0.21
116
105,095
$2,499,159
$7.40
0.12
116
105,095
$1,503,559
$3.20
0.05
116
105,095
$650,188
$46.30
0.77
116
105,095
$9,407,404
$69.00
1.15
116
105,095
$14,019,673
(b) = (a)/60
(e) = (b)*(c)*(d)
* Components may not add to totals due to rounding.
NPWP Step 2—Calculation of Chargebased PE RVU Cost Pool
The nonphysician work pool
calculation uses the 1998 (charge-based)
PE RVU value for the code, multiplied
by the 1995 CF (25.74 × $34.503 =
$888.11). The percentage of clinical
labor, supplies and equipment are the
percentage that each PE category
represents for all physicians relative to
the total PE for all physicians
(calculated from the SMS data) as
shown in Table 9.
TABLE 9.—CALCULATE CHARGE-BASED COST POOLS FOR NONPHYSICIAN WORK POOL
NPWP methodology
Clinical
Equipment
(A)
(a) CPT 00002—Charge Based Value ........................................................................................
(b) Percent Clinical, Supplies, Equipment ...................................................................................
(c) CPT 00002 .............................................................................................................................
(d) Number of—NPWP ................................................................................................................
(e) Total NPWP ‘‘CPEP’’ Pool .....................................................................................................
Supplies
(B)
(C)
$888.11
0.18
158.08
105,095
$16,613,742
$888.11
0.11
95.03
105,095
$4,386,775
$888.11
0.05
41.74
105,095
$9,986,912
(c) = (a)*(b)
(e) = (c)*(d)
NPWP Step 3—Calculation and
Application of Scaling Factors
After the total cost pools for each
specialty and code performed by the
specialty are calculated, the steps to
ensure the total costs for all of the
procedures performed by a specialty do
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
not exceed the total costs for the
specialty (scaling) are the same as those
described previously for codes with
physician work.
In Table 10 below, the SMS total
clinical labor costs is $2,499,159. This
amount divided by the charge-based
PO 00000
Frm 00010
Fmt 4701
Sfmt 4702
total clinical labor amount of
$16,613,742 yields a scaling factor of
0.15. The charge-based clinical labor
cost for hypothetical procedure 00002 is
$158.08 (from step 2—Table 2).
Multiplying the 0.15 scaling factor for
clinical labor costs by $158.08 yields the
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
45773
scaled clinical labor cost amount of
$23.78. Individual scaling factors must
be calculated for both supply and
equipment expenses. The sum of the
scaled direct cost values, $23.78, $32.57
and $2.72, respectively, equals the total
scaled direct expense of $59.07.
NPWP Step 4—Calculation of Indirect
Expenses
work, indirect expenses equal the sum
of the scaled direct expenses and the
converted work RVU). This amount is
then multiplied by the number of times
the procedure is performed.
In Table 11, the scaled total direct
expense from Step 3 (Table 3) ($408.79)
is also the proxy for the total indirect
expense attributed to the procedure. The
total indirect expense is multiplied by
the number of services (105,095), to
calculate total indirect cost for this
procedure of $6,207,961.
Because codes in the nonphysician
work pool do not have work RVUs,
indirect expenses are set equal to direct
expenses (for codes with physician
TABLE 11.—CALCULATION OF INDIRECT EXPENSES
Physician
work*
Total direct expense
Total
(A)
(B)
(C)
$
........................
........................
$59.07
........................
........................
(a) CPT 00002 .............................................................................................................................
(b) Allowed Services—NPWP .....................................................................................................
(c) Total NPWP Indirect Expense ...............................................................................................
NPWP Step 5—Calculation and
Application of Indirect Scaling Factors
Similar to the direct costs, the indirect
costs are scaled to ensure that the total
of the charge-based PE RVU costs across
all procedures equates with the total
indirect costs as reflected by the SMS
data for the NPWP. To accomplish this,
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
the charge-based data are scaled to SMS
data so the total charge-based costs
equal the total SMS costs.
In Table 12, to calculate the indirect
scaling factor for hypothetical procedure
00002, divide the total SMS indirect
expense, $9,407,404 (from Step 1—
Table 1), by the total charge-based
PO 00000
Frm 00011
Fmt 4701
Sfmt 4702
$59.07
105,095
$6,207,961
indirect expense of $6,207,961. This
results in a scaling factor of 1.51. Next,
the unscaled indirect charge-based cost
for procedure 00002 of $59.07 (from
step 4—Table 4) is multiplied by the
1.51 scaling factor, resulting in scaled
indirect costs for this procedure of
$89.19.
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.002</GPH>
NPWP methodology
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
NPWP Step 6—Budget Neutrality and
Final RVU Calculation
Similar to the calculation for codes
with physician work, the BNF is applied
to (multiplied by) the scaled direct and
indirect expenses for each code to set
the PE RVU for the upcoming year.
In Table 13, the sum of the scaled
direct and indirect expenses for
hypothetical code 00002 ($148.26) is
multiplied by the BNF (0.022 in this
example) to yield a PE RVU of 3.26.
2. PE Proposals for CY 2006
• Surveys Submitted in 2004
The following discussions outline the
specific PE related proposals for CY
2006.
As explained in the November 15,
2004 Physician Fee Schedule final rule
(69 FR 66242), we received surveys by
March 1, 2004 from the American
College of Cardiology (ACC), the
American College of Radiology (ACR),
and the American Society for
Therapeutic Radiation Oncology
(ASTRO). The data submitted by the
ACC and the ACR met our criteria.
However, as requested by the ACC and
the ACR, we deferred using their data
until issues related to the nonphysician
work pool could be addressed. We are
proposing to use the ACC and ACR
survey data in the calculation of PE
RVUs for 2006, but only as specified in
the proposals relating to a revised
methodology for establishing direct PE
RVUs, and a transition period for the
revised methodology, as described
below.
The survey data from ASTRO did not
meet the precision criteria established
for supplemental surveys, therefore, we
did not use it in the calculation of PE
RVUs for 2005.
a. Supplemental PE Surveys
The following discussions outline the
criteria for supplemental survey
submission as well as information we
have received for approval.
(1) Survey Criteria and Submission
Dates
In accordance with section 212 of the
BBRA, we established criteria to
evaluate survey data collected by
organizations to supplement the SMS
Total
survey data normally used in the
scaled diBudget
Final PE
rect and
neutrality
calculation of the PE component of the
RVU
indirect
factor
PFS. In the Payment Policies Under the
inputs
Physician Fee Schedule for Calendar
Year 2002 final rule, published
Code
00002
$148.26
0.022
3.26 November 7, 2003 (68 FR 63196), we
provided that, beginning in 2004,
supplemental survey data had to be
d. Facility/Non-facility Costs
submitted by March 1 to be considered
Procedures that can be performed in
for use in computing PE RVUs for the
a physician’s office as well as in a
following year. This allows us to
hospital have two PE RVUs; facility and publish our decisions regarding survey
non-facility. The non-facility setting
data in the proposed rule and provides
includes physicians’ offices, patients’
the opportunity for public comment on
homes, freestanding imaging centers,
these results before implementation.
and independent pathology labs.
To continue to ensure the maximum
Facility settings include hospitals,
opportunity for specialties to submit
ambulatory surgery centers, and skilled
supplemental PE data, we extended
nursing facilities (SNFs). The
until 2005 the period that we would
methodology for calculating the PE RVU accept survey data that meet the criteria
is the same for both facility and nonset forth in the November 2000 PFS
facility RVUs, but is calculated
final rule. The deadline for submission
independently to yield two separate PE
of supplemental data to be considered
RVUs. Because the PEs for services
in CY 2006 was March 1, 2005.
provided in a facility setting are
(2) Submission of Supplemental Survey
generally included in the payment to
Data
the facility (rather than the payment to
the physician under the fee schedule),
The following discussion outlines the
the PE RVUs are generally lower for
survey data submitted for CY 2004 and
services provided in the facility setting.
CY 2005.
TABLE 13.—BUDGET NEUTRALITY AND
FINAL RVU CALCULATION
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00012
Fmt 4701
Sfmt 4702
• Surveys Submitted in 2005
This year we received surveys from
the Association of Freestanding
Radiation Oncology Centers (AFROC),
the American Urological Association
(AUA), the American Academy of
Dermatology Association (AADA), the
Joint Council of Allergy, Asthma, and
Immunology (JCAAI), the National
Coalition of Quality Diagnostic Imaging
Services (NCQDIS) and a joint survey
from the American Gastroenterological
Association (AGA), the American
Society of Gastrointestinal Endoscopy
(ASGE) and the American College of
Gastroenterology (ACG)
We contract with the Lewin Group to
evaluate whether the supplemental
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.092</GPH>
45774
45775
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
survey data that are submitted meet our
criteria and to make recommendations
to us regarding their suitability for use
in calculating PE RVUs. (The Lewin
Group report on the 2005 submissions is
available on the CMS Web site at
https://www.cms.hhs.gov/physicians/pfs/
). The report indicated that, except for
the survey from NCQDIS, all met our
criteria and we are proposing to accept
these. The survey data submitted by the
NCQDIS on independent diagnostic
testing facilities (IDTFs) did not meet
the precision criterion of a 90 percent
confidence interval with a range of plus
or minus 15 percent of the mean (that
is, 1.645 times the standard error of the
mean, divided by the mean, is equal to
or less than 15 percent of the mean). For
the NCQDIS survey, the precision level
was calculated at 16.3 percent of the
mean PE/HR (weighted by the number
of physicians in the practice). However,
the Lewin Group has recommended that
we accept the data from NCQDIS. The
Lewin Group points out that PE data for
IDTFs do not currently exist, and
suggests that the need for data for the
specialty should be weighed against the
precision requirement.
We are proposing not to accept the
NCQDIS data to calculate the PE RVUs
for services provided by IDTFs. As just
noted, the NCQDIS data do not meet our
precision requirements. We established
the minimum precision standards
because we believe it is necessary to
ensure that the data used are valid and
reliable, and the consistent application
of the precision criteria is the best way
to accomplish that objective.
Section 303(a)(1) of the MMA added
section 1848(c)(2)(I) of the Act to require
us to use survey data submitted by a
specialty group where at least 40
percent of the specialty’s payments for
Part B services are attributable to the
administration of drugs in 2002 to
adjust PE RVUs for drug administration
services. The statute applies to surveys
that include expenses for the
administration of drugs and biologicals,
and are received by March 1, 2005 for
determining the CY 2006 PE RVUs.
Section 303(a)(1) of the MMA also
amended section 1848(c)(2)(B)(iv)(II) of
the Act to provide an exemption from
budget neutrality for any additional
expenditures resulting from the use of
these surveys. In the Changes to
Medicare Payment for Drugs and
Physician Fee Schedule Payments for
Calendar Year 2004 interim final rule
published January 7, 2004 (69 FR 1084),
we stated that the specialty of urology
meets the above criteria, along with
gynecology and rheumatology (69 FR
1094). Because we are accepting new
survey data from the AUA, we are
required to exempt, from the budget
neutrality adjustment any impacts of
accepting these data for purposes of
calculating PE RVUs for drug
administration services.
In addition, Lewin recommended
blending the radiation oncology data
from this year’s AFROC survey data
with last year’s ASTRO survey data to
calculate the PE/HR. According to the
Lewin Group, the goal of the AFROC
survey was to represent the population
of freestanding radiation oncology
centers only. In order to develop an
overall average for the radiation
oncology PE pool, the Lewin Group
recommended we use the AFROC
survey for freestanding radiation
oncology centers, and the hospital-based
subset of last year’s ASTRO survey. We
agree that this blending of the AFROC
and ASTRO data is a reasonable way to
calculate an average PE/HR that fully
reflects the practice of radiation
oncology in all settings. Therefore, we
are proposing to use the new PE/HR
calculated in this manner for radiation
oncology.
We propose to use the following PE/
HR figures (deflated to 1995 values to be
consistent with the SMS data):
TABLE 14.—PRACTICE EXPENSE PER HOUR FIGURES
Specialty
Clinical staff
Admin. staff
14.8
38.3
35.6
18.4
27.9
48.2
15.4
18.6
34.5
18.9
27.9
35.2
39.8
23.2
Radiology .................................................
Cardiology ................................................
Radiation Oncology ..................................
Urology .....................................................
Dermatology .............................................
Allergy/Immunology ..................................
Gastroenterology ......................................
The deadline to submit supplemental
PE surveys was March 1, 2005. As
discussed in detail below, we are
proposing to revise our methodology to
calculate direct PE RVUs from the
current top-down cost allocation
methodology to a bottom-up
methodology. Although we would
continue to use the SMS data and the
incorporated supplemental survey data
for indirect PEs, we are not proposing to
extend the deadline for submitting
supplemental survey data at this time.
Instead, we are inviting comment on the
most appropriate way to proceed to
ensure the indirect PEs per hour are
accurate and consistent across
specialties.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Office expense
Medical
supplies
16.5
35.7
28.5
35.3
49.4
47
26.8
(3) Revisions to the PE Methodology
Since 1997, when we first proposed a
resource-based PE methodology, we
have had several major goals for this
payment system. One has been to
encourage the maximum input from the
medical community regarding our PE
data and methodology. We have worked
closely with the PEAC, PERC, RUC and
the Health Care Professional Advisory
Committee (HCPAC) which are all
multi-specialty groups that allow the
medical community to participate by
making recommendations to us on the
PE direct inputs. We also extended the
deadline for the submission of
supplementary PE surveys to ensure
that specialties had the opportunity to
submit new aggregate PE data. In
addition, we have had scores of
PO 00000
Frm 00013
Fmt 4701
Sfmt 4702
6.5
16.5
4
16.7
12.4
17.3
4.8
Medical
equipment
13.1
12.2
20.1
7.5
7.2
4.8
3.3
Other
26.8
19.1
21.2
15.9
20
22.4
11.5
Total
96.3
156.3
128.3
121.7
152.1
179.6
85
meetings with physician, practitioner
and industry groups, and have made
many modifications to our methodology
in response to their comments and
input. We look forward to continuing to
work with the medical community as
we strive to further improve our PE
methodology.
We also have had three specific goals
for the resource-based PE methodology
itself. The following goals have also
been supported in numerous comments
we have received from the medical
community:
• To ensure that the PE payments
reflect, to the greatest extent possible,
the actual relative resources required for
each of the services on the PFS. This
could only be accomplished by using
E:\FR\FM\08AUP2.SGM
08AUP2
45776
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
the best available data to calculate the
PE RVUs.
• To develop a payment system for
PE that is understandable and at least
somewhat intuitive, so that specialties
could generally predict the impacts of
changes in the PE data.
• To stabilize the PE payments so that
there are not large fluctuations in the
payment for given procedures from
year-to-year.
We believe that we have consistently
made a good faith effort to ensure
fairness in our PE payment system by
using the best data available at any one
time. The change from the originally
proposed ‘‘bottom-up’’ to the ‘‘topdown’’ methodology came about
because of a concern that the resource
input data developed in 1995 by the
CPEP were less reliable than the
aggregate specialty cost data derived
from the SMS process. The adoption of
the top-down approach necessitated the
creation of the nonphysician work pool.
The nonphysician work pool is a
separate pool created to allocate PEs for
codes that have only a technical (rather
than professional) component, or codes
that are not performed by physicians. In
the Physician Fee Schedule (CY 2000);
Payment Policies and Relative Value
Unit Adjustment final rule, published
November 2, 1999 (64 FR 59379), we
indicated that ‘‘the purpose of this pool
was only to protect the (TC) services
from the substantial decreases * * *
until further refinement could take
place * * *’’ (64 FR 59406).
However, the situation has now
changed. The PEAC/PERC/RUC has
completed the refinement of the original
CPEP data and we believe that the
refined PE inputs now, in general,
accurately capture the relative direct
costs of performing PFS services. On the
other hand, although we have now
accepted supplementary survey data
from 13 specialties, we have not
received updated aggregate cost data
from most specialties. Thus, we believe
that, in the aggregate, the refined CPEP
data represent, more reliably, the
relative direct costs PE inputs for
physician services.
The major specialties comprising the
nonphysician work pool (radiology,
radiation oncology and cardiology) have
submitted supplemental survey data
that we are proposing to accept. (See the
discussion on supplementary surveys
above.) Now that we have representative
aggregate PE data for these specialties,
the continued necessity and equity of
treating these technical services outside
the PE methodology applied to other
services is questionable.
We have also taken steps to make our
complex top-down PE methodology
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
more understandable. For example, we
eliminated the somewhat arcane
‘‘linking’’ of direct cost input data when
more than one CPEP panel reviewed a
service and did away with the confusing
and unhelpful distinction between
procedure-specific and indirect
equipment. However, we acknowledge
that most in the medical community
would find our current methodology, as
described above, neither clear nor
intuitive. For example, because of the
need to scale the CPEP/RUC inputs to
the SMS PEs under our top-down
methodology, the PE RVUs for a
procedure do not necessarily change
proportionately with changes in the
direct inputs. This raises the question as
to what would now be the most
straightforward and intuitive
methodology for calculating the direct
PE RVUs.
Due to the ongoing refinement by the
RUC of the direct PE inputs, we had
expected that the PE RVUs would
necessarily fluctuate from year-to-year,
frustrating temporarily our efforts to
reach the goal of stabilizing the PE
portion of the PFS. At the same time, it
became apparent that certain aspects of
our methodology exacerbated the yearly
fluctuations. For example, the need to
scale the CPEP costs to equal the SMS
costs meant that any changes in the
direct PE inputs for one service often
leads to unexpected results for other
services where the inputs had not been
altered. In addition, the services priced
by the nonphysician work pool
methodology have proved to be
especially vulnerable to any change in
the pool’s composition. We understand
the need for stable PE RVUs, so that
physicians and other practitioners can
anticipate from year-to-year what the
relative payments will be for the
services they perform. Now, that the
CPEP/RUC refinement of existing
services is virtually complete, this
appears to be an opportunity for us to
propose a way to provide stability to the
PE RVUs.
Therefore, consistent with our goals of
using the most appropriate data,
simplifying our methodology, and
increasing the stability of the payment
system, we are proposing the following
changes to our PE methodology:
• Use a Bottom-Up Methodology To
Calculate Direct PE Costs
Instead of using the top-down
approach to calculate the direct PE
RVUs, where the aggregate CPEP/RUC
costs for each specialty are scaled to
match the aggregate SMS costs, we
propose to adopt a bottom-up method of
determining the relative direct costs for
each service. Under this method, the
PO 00000
Frm 00014
Fmt 4701
Sfmt 4702
direct costs would be determined by
summing the costs of the resources—the
clinical staff, equipment and supplies—
typically required to provide the
service. The costs of the resources, in
turn, would be calculated from the
refined CPEP/RUC inputs in our PE
database.
• Eliminate the Nonphysician Work
Pool
Now that we have new survey data for
the major specialties that comprise the
nonphysician work pool, we would
eliminate the pool and calculate the PE
RVUs for the services currently in the
pool by the same methodology used for
all other services. This would allow the
use of the refined CPEP/RUC data to
price the direct costs of individual
services, rather than utilizing the pre1998 charge-based PE RVUs.
• Utilize the Current Indirect PE RVUs,
Except for Those Services Affected by
the Accepted Supplementary Survey
Data
As described previously, the SMS and
supplementary survey data are the
source for the specialty-specific
aggregate indirect costs used in our PE
calculations. We then allocate to
particular codes on the basis of the
direct costs allocated to a code and the
work RVUs. Although we now believe
the CPEP/RUC data are preferable to the
SMS data for determining direct costs,
we have no information that would
indicate that the current indirect PE
methodology is inaccurate. We also are
not aware of any alternative approaches
or data sources that we could use to
calculate more appropriately the
indirect PE, other than the new
supplementary survey data, which we
propose to incorporate into our PE
calculations. Therefore, we propose to
use the current indirect PEs in our
calculation incorporating the new
survey data into the codes performed by
the specialities submitting the surveys.
We would welcome any suggestions that
would assist us in further refinement of
this indirect PE methodology. For
example, we are considering whether
we should continue to accept
supplementary survey data or whether it
would be preferable and feasible to have
an SMS-type survey of only indirect
costs for all specialties, or whether a
more formula-based methodology
independent of the SMS data should be
adopted, perhaps using the specialtyspecific indirect-to-total cost percentage
as a basis of the calculation. For a prior
discussion of many of the issues
associated with allocating indirect costs,
we would refer the reader to the
Physician Fee Schedule (CY 2000);
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Payment Policies and Relative Value
Unit Adjustment proposed rule,
published June 5, 1998 (63 FR 30823).
• Transition the Resulting Revised PE
RVUs over a Four-Year Period
A complete analysis of the impacts of
these changes is contained in the impact
analysis in section V. of this proposed
rule. We are concerned that, when
combined with an expected negative
update factor for CY 2006, the shifts in
some of the PE RVUs resulting from our
proposals could cause some measure of
financial stress on medical practices.
Therefore, we are proposing to
transition the proposed PE changes over
a 4-year period. This would also give
ample opportunity for us, as well as the
medical specialties and the RUC, to
identify any anomalies in the PE data,
to make any further appropriate
revisions, and to collect additional data,
as needed prior to the full
implementation of the proposed PE
changes.
During the transition period, the PE
RVUs will be calculated on the basis of
a blend of RVUs calculated using our
proposed methodology described above
(weighted by 25 percent during CY
2006, 50 percent during CY 2007, 75
percent during CY 2008, and 100
percent thereafter), and the current CY
2005 PE RVUs for each existing code.
We believe that implementing these
proposed changes will meet our goals to
produce a more accurate, more intuitive
and more stable PE methodology.
Now that the direct PE inputs have
been refined, we believe that the
proposed CPEP/RUC direct input data
are superior to the specialty-specific
SMS PE/HR data for the purposes of
determining the typical direct PE
resources required to perform each
service on the PFS. First, we have
received recommendations on the
procedure-specific inputs from the
multi-specialty PEAC that were based
on presentations from the relevant
specialties after being closely
scrutinized by the PEAC using
standards and packages agreed to by all
involved specialties. Second, the refined
CPEP/RUC data are more current than
the SMS data for the majority of
specialties. Third, for direct costs, it
appears more accurate to assume that
the costs of the clinical staff, supplies
and equipment are the same for a given
service, regardless of the specialty that
is performing it. This assumption does
not hold true under the top-down direct
cost methodology, where the specialtyspecific scaling factors create widely
differing costs for the same service.
We also would argue that the
proposed methodology is less confusing
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
and more intuitive than the current
approach. First, the nonphysician work
pool would be eliminated and all
services would be priced using one
methodology, eliminating the
complicated calculations needed to
price nonphysician work pool services.
Second, the method for calculation of
direct costs can now be described in
sentences rather than paragraphs. Third,
any revisions made to the direct inputs
would now have predictable results.
Changes in the direct practice inputs for
a service would proportionately change
the PE RVUs for that service without
significantly affecting the PE RVUs for
unrelated services.
The proposed methodology would
also create a system that would be
significantly more stable from year-toyear than the current approach.
Specialties should no longer experience
the wide fluctuations in payment for a
given service due to an aberrant direct
cost scaling factor. Direct PEs should
only change for a service if it is further
refined or when prices are updated,
while indirect PEs should change only
when there are changes in the mix of
specialties performing the service or
with the use of any future new survey
data for indirect costs.
We recognize that there are still some
outstanding issues that need further
consideration, as well as input from the
medical community. For example,
although we believe that the elimination
of the nonphysician work pool would
be, on the whole, a positive step, some
practitioner services, such as audiology
and medical nutrition therapy, would be
significantly impacted by the proposed
change. In addition, there are still
services, such as the ESRD visit codes,
for which we have no direct input
information. Also, as mentioned above,
we do not have current SMS or
supplementary survey data to calculate
the indirect costs for most specialties.
Further, we do not yet have accurate
utilization for the new drug
administration codes that were created
in response to the MMA provision on
drug administration. Therefore, we are
not proposing to change the RVU for
these services at this time, but to
include them under our proposed
methodology in next year’s rule when
we have appropriate data. The proposed
transition period would give us the
opportunity to work with the affected
specialties to collect the needed survey
or other data or to determine whether
further revisions to our PE methodology
are needed.
We, therefore, welcome all comments
on these proposed changes, particularly
those concerning additional
modifications to the indirect PE
PO 00000
Frm 00015
Fmt 4701
Sfmt 4702
45777
methodology that might help us further
our intended goals.
(4) PE Recommendations on CPEP
Inputs for CY 2006
Since 1999, the PEAC, an advisory
committee of the AMA’s RUC, provided
us with recommendations for refining
the direct PE inputs (clinical staff,
supplies, and equipment) for existing
CPT codes. The PEAC held its last
meeting in March 2004 and the AMA
established a new committee, PERC, to
assist the RUC in recommending PE
inputs.
The PERC completed refinement of
approximately 200 remaining codes at
its meetings held in September 2004
and February 2005. (A list of these
codes can be found in Addendum C of
this proposed rule.)
We have reviewed the PERCsubmitted recommendations and
propose to adopt nearly all of them. We
have worked with the AMA staff to
correct any typographical errors and to
make certain that the recommendations
are in line with previously accepted
standards.
The complete PERC recommendations
and the revised PE database can be
found on our Web site. (See the
‘‘Supplementary Information’’ section of
this proposed rule for directions on
accessing our Web site.)
We disagreed with the PERC
recommendation for clinical labor time
for CPT code 36522, Extracorporeal
Photophoresis. In last year’s Revisions
to Payment Policies Under the
Physician Fee Schedule for Calendar
Year 2005 final rule, published
November 15, 2004 (69 FR 66236) we
assigned, on an interim basis, 223
minutes of total clinical labor for the
service period based on the typical
treatment time of approximately 4
hours. The PERC, however,
recommended 122 minutes total clinical
labor time for the service period, which
allows for 90 minutes of nurse ‘‘intra
service’’ time for the performance of the
procedure (the society originally
proposed 180 minutes). We believe that
135 minutes is a more appropriate
estimation of the clinical staff time
actually needed for the intra time, as it
more closely approximates the time
assigned to the other procedures in this
family of codes, including CPT codes
36514, 36515, and 36516. Therefore, we
are proposing a total clinical labor time
of 167 minutes for the service period.
The PERC/RUC also recommended
that no inputs be assigned to several
codes because the services were not
performed in the office setting.
However, our utilization data shows
that four of these codes (CPT codes
E:\FR\FM\08AUP2.SGM
08AUP2
45778
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
15852, 76975, 78350, and 86585) are
currently priced in the office and are
performed with sufficient frequency in
the office to warrant this. Therefore, we
are proposing not to accept the PERC/
RUC recommendations for these
services at this time, but are requesting
comments from the relevant specialties
as to whether the recommendations
should be accepted.
(5) Payment for Splint and Cast
Supplies
In the Physician Fee Schedule (CY
2000); Payment Policies and Relative
Value Unit Adjustment final rule,
published November 2, 1999 (64 FR
59379) and the Physician Fee Schedule
(CY 2002); Payment Policies and
Relative Value Units Five-Year Review
and Adjustments final rule, published
November 1, 2000 (66 FR 55245), we
removed cast and splint supplies from
the PE database for the CPT codes for
fracture management and cast/strapping
application procedures. Because casting
supplies could be separately billed
using Healthcare Common Procedure
Coding System (HCPCS) codes that were
established for payment of these
supplies under section 1861(s)(5) of the
Act, we did not want to make duplicate
payment under the PFS for these items.
However, in limiting payment of these
supplies to the HCPCS codes Q4001
through Q4051, we unintentionally
prohibited remuneration for these
supplies when they are not used for
reduction of a fracture or dislocation,
but rather, are provided (and covered) as
incident to a physician’s service under
section 1861(s)(2)(A) of the Act.
Because these casting supplies are
covered either through sections
1861(s)(5) of the Act or 1861(s)(2)(A) of
the Act, we are proposing to eliminate
the separate HCPCS codes for these
casting supplies and to again include
these supplies in the PE database. This
will allow for payment for these
supplies whether based on section
1861(s)(5) of the Act or section
1861(s)(2)(A) of the Act, while ensuring
that no duplicate payments are made. In
addition, by bundling the cost of the
cast and splint supplies into the PE
component of the applicable procedure
codes under the PFS, physicians will no
longer need to bill Q-codes in addition
to the procedure codes to be paid for
these materials.
Because these supplies were removed
from the PE database prior to the
refinement of these services by the
PEAC, we are proposing to add back the
original CPEP supply data for casts and
splints to each applicable CPT code. For
this reason, it is imperative that the
relevant medical societies review the
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
‘‘Direct Practice Expense Inputs’’ on our
Web site at https://www.cms.hhs.gov/
physicians/pfs (under the supporting
documents for the 2006 proposed rule)
and provide us with feedback regarding
the appropriateness of the type and
amount of casting and splinting
supplies. We are also requesting specific
information about the amount of casting
supplies needed for the 10-day and 90day global procedures, because these
supplies may not be required at each
follow-up visit; therefore, the number of
follow-up visits may not reflect the
typical number of cast changes required
for each service.
The following cast and splint supplies
have been reincorporated as direct
inputs: fiberglass roll, 3 inch and 4 inch;
cast padding, 4 inch; webril (now
designated as cast padding, 3 inch); cast
shoe; stockingnet/stockinette, 4 inch
and 6 inch; dome paste bandage; cast
sole; elastoplast roll; fiberglass splint;
ace wrap, 6 inch; and kerlix (now
designated as bandage, kerlix, sterile,
4.5 inch) and malleable arch bars. The
cast and splint supplies have been
added to the following CPT codes:
23500 through 23680, 24500 through
24685, 25500 through 25695, 26600
through 26785, 27500 through 27566,
27750 through 27848, 28400 through
28675, and 29000 through 29750.
Because we are proposing to pay for
splint and cast through the PE
component of the PFS, we would no
longer make separate payment for these
items using the HCPCS Q-codes.
(6) Miscellaneous PE Issues
In this section, we discuss our
specific proposals related to PE inputs.
• Supply Items for CPT Code 95015
We are proposing to change the
supply inputs for CPT code 95015,
intracutaneous (intradermal) tests,
sequential and incremental, with drugs,
biologicals or venoms, immediate type
reaction, specify number of tests, based
on comments received from the JCAAI.
The society reports that ‘‘venom’’ is the
most typical test substance used when
performing this service and that
‘‘antigen’’, currently listed in the PE
database, is never used. The JCAAI also
suggests that the appropriate venom
quantity should be 0.3 ml (instead of the
0.1 ml now listed) because of the
necessity to use all five venoms (honey
bee, yellow jacket, yellow hornet, white
face hornet and wasp) to perform this
sensitivity testing; that is, 1 ml of each
venom type for a total of 5 ml of venom.
The diluted venoms are sequentially
administered until sensitivity is shown,
beginning with the lowest concentration
of venom and subsequently
PO 00000
Frm 00016
Fmt 4701
Sfmt 4702
administering increasing concentrations
of each venom. The JCAAI states that
the typical number of tests per session
is approximately 17, consistent with the
RUC-approved vignette, which
represents 0.3 ml of venom per test
when divided into the total of 5 ml of
venom needed to perform the entire
service. We accept the specialty’s
argument and propose to change the test
substance in CPT code 95015 to venom,
at $10.70(from single antigen, at $5.18)
and the quantity to 0.3 ml (from 0.1 ml).
• Flow Cytometry Services
In the November 15, 2004 final rule
(69 FR 66236), we solicited comments
on the interim RVUs and PE inputs for
new and revised codes, including flow
cytometry services. Based on comments
received and additional discussions
with representatives from the society
representing independent laboratories,
we are proposing to revise the PE inputs
for the flow cytometry CPT codes 88184
and 88185.
The specialty society indicated that a
cytotechnologist is the typical clinical
staff type to perform the intra portion of
this service for both codes. They also
provided us with a list of six additional
equipment items, along with
documented prices, and with the
minutes in use for each service. All six
equipment items are necessary to
perform the flow cytometry services
described in CPT code 88184, while
only two (the computer and printer) are
needed for CPT code 88185. For
supplies, the society believes the
antibody cost currently reflected in the
PE database is too low, and so they
provided us with an average antibody
cost of $8.50, derived from a survey of
laboratories performing these services.
Using the vignette for the myeloid/
lymphoid panel to represent the typical
service, this average cost was based on
the cost of the total number of
antibodies that are required to report the
typical number of reported markers.
Based on this information, we are
proposing to change the following direct
inputs used for PE:
+ Clinical Labor: Change the staff type
in the service (intra)period in both CPT
codes 88184 and 88185 to
cytotechnologist, at $0.45 per minute
(currently lab technician, at $0.33 per
minute).
+ Supplies: Change the antibody cost
for both CPT codes 88184 and 88185 to
$8.50 (from $3.544).
+ Equipment: Add a computer,
printer, slide strainer, biohazard hood,
and FACS wash assistant to CPT code
88184. Add a computer and printer to
the equipment for CPT code 88185.
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
• Low Osmolar Contrast Media (LOCM)
and High Osmolar Contrast Media
(HOCM)
HOCM and LOCM are used to
enhance images produced by various
types of diagnostic radiological
procedures. In the November 15, 2004
final rule (69 FR 66356), we eliminated
the criteria for the payment of LOCM
that had been included at § 414.38.
Effective January 1, 2005, providers can
be paid for either LOCM or HOCM when
used with procedures requiring contrast
media. Payment for LOCM is made
through the use of separate Q-codes,
while payment for HOCM is currently
included as part of the PE component
under the PFS. Effective January 1,
2006, we will no longer include
payment for HOCM under the PFS.
When HOCM is used, Q-codes that have
been established specifically for HOCM
will be used for payment.
We have reviewed the PE database
and are proposing to remove the
following two supply items which we
have identified as HOCM from the PE
database:
+ Conray inj. iothalamate 43
percent(supply item #SH026, deleted
from 64 procedures).
+ Diatrizoate sodium 50 percent
(supply item #SH0238, deleted from 74
procedures).
In reviewing the PE database we also
identified 5 CPT codes (specifically CPT
codes 42550, 70370, 93508, 93510 and
93526) that include omnipaque as a
supply item. Since omnipaque is
actually a type of LOCM that is
separately billable, we are proposing to
remove this supply item from these five
CPT codes.
• Imaging Rooms
We include standardized ‘‘rooms’’ for
certain services in our PE equipment
database, rather than listing each item
separately. We received pricing
information from the ACR for the
following rooms that are included in the
database. We have accepted most of the
proposed items that meet the $500
threshold for equipment and are
proposing to include the items in each
specific room, as follows:
+ Basic Radiology Room: $127,750 (xray machine @ $125,550 and camera @
$2,200). The recommended viewbox
was not included because most codes
assigned this room have also been
assigned an alternator (automated film
viewer) or a 4-panel viewbox.
+ Radiographic-Flouroscopic Room:
$367,664 (Radiographic machine @
$365,464 and camera @ $2,200). The
recommended viewbox was not
included because most codes assigned
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
this room have also been assigned an
alternator (automated film viewer) or a
4-panel viewbox.
+ Mammography Room: $168,214
(mammography unit @ $124,900;
reporting system @ $16,690;
mammography phantom @ $674;
densitometer @ $3,660; sensitometer @
$2,750; desktop PC for monitoring @
$1,840; and processor @ $17,700.
Separately listed equipment items
(densitometer, mammography reporting
system, sensitometer, mammography
phantom, desktop computer, and the
film processor) that duplicated items
included in the mammography room
were removed from the codes assigned
the room, eliminating the reporting
system, sensitometer and phantom from
the PE database.
+ Computed tomography (CT) Room:
$1,284,000 (16-slice CT scanner with
power injector and monitoring system)
+ Magnetic Resonance (MR) Room:
$1,605,000 (1.5T MR scanner with
power injector and monitoring system)
• Equipment Pricing for Select
Services and Procedures from the
November 15, 2004 final rule (69 FR
66236).
Equipment pricing for certain
radiology services was received and
supported with sufficient
documentation from the ACR. We have
accepted the following equipment
prices as shown in table 15.
TABLE 15
CAD processor (CPT 76082–83)
Collimator, cardiofocal set (CPT
78206–07,
78647,
78803,
78807) .......................................
Densitometer/DPA (CPT 78351) ..
Detector Probe (CPT 78455) .......
IVAC Injection Pump, single channel (CPT 78206–07, 78647,
78803, 78807) ...........................
Computer workstation/MRA includes: Includes 2 monitors,
volume viewer, advanced x-ray
analysis, data export, CD–RW,
DICOM Print, 2 GB RAM (CPT
71555, 72159, 72198, 73225,
73727, 74185) ...........................
$115,000
45779
Plasma pheresis machine with UV light
source (CPT 36522)—$65,000
We received comments from the
American Academy of Ophthalmology
that included documentation from two
sources for the pricing of the EMG botox
machine used in CPT code 92265 and
we are proposing to accept $16,188 as
the average price for this equipment.
• Supply Item for In Situ Hybridization
Codes (CPT 88365, 88367, and 88368)
We received comments from the
College of American Pathologists (CAP)
regarding the number of DNA probes
assigned to the in situ hybridization
codes, CPT codes 88365, 88367, and
88368. Currently, CPT codes 88365 and
88368 have 1.5 probes assigned, while
CPT code 88367 has only .75 of a probe
assigned. CAP requested that we also
assign 1.5 probes to CPT code 88367,
and the comment provided justification
for this request. We accept the CAP
rationale and propose to change the
probe quantity for CPT code 88367 to
1.5.
• Supply Item for Percutaneous
Vertebroplasty Procedures (CPT codes
22520 and 22525)
The Society for Interventional
Radiology provided us with
documentation for the price of the
vertebroplasty kit used in CPT codes
22520 and 22525. We propose to accept
a new price of $696 for this supply,
currently listed as $660.50, a
placeholder price from last year’s final
rule.
• Clinical Labor for G-codes Related to
Home Health and Hospice Physician
8,543 Supervision, Certification and
150,000 Recertification
19,995
It has come to our attention that four
G-codes related to home health and
3,000 hospice physician supervision,
certification and recertification, G0179,
180, 181, and 182, are incorrectly
valued for clinical labor. These codes
are cross-walked from CPT codes 99375
and 99378, which underwent PEAC
122,000 refinement for the 2004 fee schedule.
However, we did not apply the new
refinements to these specific G-codes at
We accepted the documentation
that time, and are proposing to revise
supplied from the American College of
Obstetricians and Gynecologists (ACOG) the PE database to reflect the new
values.
to price the following equipment for
which we assigned an average price
• Programmers for Implantable
from the three sources, as follows:
Neurostimulators and Intrathecal Drug
Infusion Pumps
Ultrasound color Doppler transducers
and vaginal probe (CPT 59070, 59074,
We received comments from the
76818–19, 76825–28)—$157,897
neurological division of Medtronic
For CPT 36522, extracorporeal
Incorporated, the manufacturer of
photopheresis, we received and
programmers for implantable
accepted equipment pricing information neurostimulators and intrathecal drug
specific to this procedure, as follows:
infusion pumps, that the equipment
PO 00000
Frm 00017
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
45780
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
costs for these programmers are not a
direct expense for the physicians
performing the programming of these
devices. The manufacturer furnishes
these devices without cost because the
programming device is considered a
‘‘necessary, ancillary item to the
neurostimulator and drug pump and can
only be used to program these devices.’’
As such, we are proposing to remove the
two programmers from the PE database:
EQ208 for medication pump from 2
codes (CPT 62367 and 62368) and
EQ209 for the neurostimulator from 8
codes (CPT 95970–97979). We are
asking for comments from the specialty
societies performing these services to let
us know if this proposal reflects typical
practice.
• Pricing of New Supply and
Equipment Items
As part of last year’s rulemaking
process, we reviewed and updated the
prices for equipment items in our PE
database and assigned a unique
identifier to each equipment item with
the first two elements corresponding to
one of seven categories. It has come to
our attention that we have assigned the
same category identifier (ELXXX) for
both ‘‘lanes/rooms’’ as well as
‘‘laboratory equipment’’. To correct this,
we are assigning laboratory equipment
items the new category identifier
‘‘EPXXX’’, but the specific numbers
associated with each item will remain
the same. Supply items were reviewed
and updated in the rulemaking process
for the 2004 PFS. During subsequent
meetings of both the PEAC (now
referred to as the PERC) and the RUC,
supply and equipment items were
added that were not included in the
pricing updates. The following two
tables (Table 16: Proposed Practice
Expense Supply Items and Table 17:
Proposed Practice Expense Equipment
Items) list the additional supply and
equipment items for 2006 and the
proposed associated prices that we will
use in the PE calculation.
TABLE 16.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2006
Supply
code
Supply description
Unit
SJ071 ...........
SL186 ...........
SL187 ...........
SG093 ..........
SJ072 ...........
SG094 ..........
SG095 ..........
SG096 ..........
ACD–A anticoagulant .........................................
Antibody, flow cytometry (each test) ..................
Balance salt solution (BSS), sterile, 15cc ..........
Bandage, Dome paste, 3in .................................
Brush, disposable applicator ..............................
Cast, padding 3in x 4yd (Webril) ........................
Cast, sole ............................................................
Casting tape, fiberglass 3in x 4 yds ...................
item ....
item ....
ml .......
item ....
item ....
item ....
item ....
item ....
1.22
14.74
9.2
SD216 ..........
item ....
217.00
SK102 ..........
SB049 ..........
SK103 ..........
SD217 ..........
SJ073 ...........
Catheter, balloon, esophageal or rectal (graded
distention test).
Communication book/treatment notebook ..........
Condom, Diapulse, Asepticap ............................
Cork sheet, 1cm x 1cm ......................................
Diaphragm fitting set ..........................................
DMV remover .....................................................
SL188 ...........
SL189 ...........
SL190 ...........
SL191 ...........
SC088 ..........
SK104 ..........
SL192 ...........
SL193 ...........
SL194 ...........
SA089 ..........
EM fixative, karnovsky’s .....................................
Ethanol, 100% ....................................................
Ethanol, 70% ......................................................
Ethanol, 85% ......................................................
Fistula set, dialysis, 17g .....................................
Foil, aluminum, 10cm x 10cm ............................
Formamide ..........................................................
Glycolic acid, 20–50% ........................................
Hemo-De ............................................................
Kit, boston original system .................................
ml .......
ml .......
ml .......
ml .......
item ....
item ....
ml .......
ml .......
ml .......
kit .......
SL195 ...........
SL196 ...........
SA090 ..........
SL197 ...........
SL198 ...........
SJ074 ...........
SL199 ...........
SH092 ..........
SJ075 ...........
SF044 ..........
Kit, FISH paraffin pretreatment ..........................
Kit, HER–2/neu DNA Probe ...............................
Kit, moulage (implantech) ...................................
Label for blood tube ...........................................
Label, vial ...........................................................
Lens cleaner .......................................................
Lithium carbonate, saturated ..............................
LMX 4% anesthetic cream .................................
Methoxsalen, 10ml vial .......................................
Micro air burr ......................................................
kit .......
kit .......
kit .......
item ....
item ....
ounce
ml .......
gm ......
item ....
item ....
20.85
105.00
75.00
0.004
0.003
SC089 ..........
SJ076 ...........
SG092 ..........
SJ077 ...........
SL200 ...........
Needle, Vacutainer .............................................
Nose pads ..........................................................
Packing, gauze, plain, 1 in (5 yd uou) ...............
Screws, spectacles .............................................
Sodium bicarbonate spray, 8 oz ........................
Splint, fiberglass, 4in x 15in ...............................
Stain, eosin .........................................................
Temple tips .........................................................
Tissue conditioner, coesoft .................................
Tray, scoop, fast track system ...........................
Tube, gastrostomy ..............................................
Vacutainer ...........................................................
item ....
item ....
item ....
item ....
item ....
item ....
ml .......
pair .....
item ....
item ....
item ....
item ....
0.32
SL201 ...........
SJ078 ...........
SL202 ...........
SA091 ..........
SC090 ..........
SC091 ..........
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00018
item
item
item
item
item
Fmt 4701
Unit
price
6.58
8.5
14.95
....
....
....
....
....
0.69
0.086
0.003
0.003
0.003
0.22
0.008
4.5
1.6
49.5
0.14
16.5
0.044
1.00
750.00
Sfmt 4702
5.9
*CPT code(s) associated with
item
Supply category
36514, 36515, 36516
88184, 88185
92265
29580
17360
18 codes
29355, 29425, 29440
29065, 29075, 29105, 29365,
29405, 29425
91120, 91040
Pharmacy, NonRx.
Lab.
Lab.
Wound care, dressings.
Pharmacy, NonRx.
Wound care, dressings.
Wound care, dressings.
Wound care, dressings.
92510
G0329
88355
57170
92311, 92312, 92313, 92314,
92315, 92317, 92316, 92310
88355, 88356
88365, 88367, 88368
88367, 88368, 88365
88368, 88367, 88365
36522
88355
88368, 88365, 88367
17360
88368, 88367, 88365
92311, 92315, 92310, 92313,
92313, 92314, 92317, 92316
88367, 88368, 88365
88367, 88368
19396
36516, 36515, 36514
88355
92342, 92313, 92340, 92341
88355, 88356
96567
36522
28755, 28750, 28740, 28760
Office supply, grocery.
Gown, drape.
Office supply, grocery.
Accessory, Procedure.
Pharmacy, NonRx.
36514, 36515, 36516
92370
57180
92370
17360
29125
88356, 88355
92370
42280
31730
43760
36514, 36515, 36516
E:\FR\FM\08AUP2.SGM
08AUP2
Accessory, Procedure.
Lab.
Lab.
Lab.
Lab.
Hypodermic, IV.
Office supply, grocery.
Lab.
Lab.
Lab.
Kit, Pack, Tray.
Lab.
Lab.
Kit, Pack, Tray.
Lab.
Lab.
Pharmacy, NonRx.
Lab
Pharmacy, Rx.
Pharmacy, NonRx.
Cutters, closures, cautery
Hypodermic, IV.
Pharmacy, NonRx.
Wound care, dressings.
Pharmacy, NonRx.
Lab.
Wound care, dressings.
Lab.
Pharmacy, NonRx.
Lab.
Kit, Pack, Tray.
Hypodermic, IV.
Hypodermic, IV.
45781
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 16.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2006—Continued
Supply
code
Supply description
Unit
Unit
price
SL203 ...........
SL204 ...........
Vial, 10 ml, plastic (¥70 degree storage) .........
Vial, kimble sample, non sterile glass, 20 ml .....
item ....
item ....
*CPT code(s) associated with
item
1.016
0.708
88355
88356, 88355
Supply category
Lab.
Lab.
*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
TABLE 17.—PROPOSED PRACTICE EXPENSE EQUIPMENT ITEM ADDITIONS FOR 2006
Equip
code
EQ269
EP044
EP045
EP046
Equipment description
..........
..........
..........
..........
Unit
price
Life
5
7
7
10
3000
7330
7107
16552
EP047 ..........
EP048 ..........
0EQ270 ........
EP049 ..........
EQ271 ..........
Blood pressure monitor, ambulatory ................
Centrifuge, cytospin .........................................
Chamber, hybridization ....................................
Freezer, ultradeep (¥70 degrees) ..................
Light assembly, photophoresis ........................
Loader, FACS ..................................................
Microfuge, benchtop ........................................
Plasma pheresis machine w/ UV light .............
Oven, isotemp (lab) .........................................
Radiuscope ......................................................
7
7
6
10
7
22500
2410
65000
2383
EP050
EQ272
EP051
EP052
EP053
EP054
Scanner, AutoVysion .......................................
Sleep diagnostic system, attended ..................
Slide warmer ....................................................
Ultrasonic nebulizer .........................................
Wash assistant, FACS .....................................
Water bath, FISH procedures (lab) .................
5
5
7
10
7
7
135000
46799
568
1000
38000
2111
..........
..........
..........
..........
..........
..........
*CPT code(s) associated with
item
93786, 93784, 93788
88184
88368, 88365, 88367
88355
36522
88184
88368, 88367, 88365
36522
88368, 88367, 88365
92315, 92317, 92316, 92310,
92314, 92313, 92312, 92311
88367
95805
88368, 88365, 88367
89220
88184
88367, 88365
Equipment category
OTHER EQUIP.
LABORATORY.
LABORATORY.
LABORATORY.
OTHER EQUIP.
LABORATORY.
LABORATORY.
OTHER EQUIP.
LABORATORY.
OTHER EQUIP.
LABORATORY.
OTHER EQUIP.
LABORATORY.
LABORATORY.
LABORATORY.
LABORATORY.
*CPT codes and descriptions only are copyright 2004 American medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
• Supply and Equipment Items
Needing Specialty Input
We have identified certain supply and
equipment items for which we were
unable to verify the pricing information
(see Table 18: Supply Items Needing
Specialty Input for Pricing and Table 19:
Equipment Items Needing Specialty
Input for Pricing). During last year’s
rulemaking, we listed both supply and
equipment items for which pricing
documentation was needed from the
medical specialty societies and, for
many of these items, we received
sufficient documentation in the form of
catalog listings, vendor websites, and
invoices. We have accepted the
documented prices for many of these
items and have already incorporated
them into the PE database. The items
listed on Tables 18 and 19 represent the
outstanding items from last year and
new items added from the RUC
recommendations. Therefore, we are
requesting that commenters, particularly
specialty organizations, provide pricing
information on items in these tables
along with documentation to support
the recommended price.
TABLE 18.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING
Primary specialties associated with item
*CPT code(s) associated with
item
Cardiology ...................
93784, 93786, 93788
See Note A.
Item ....
Dermatology ................
17360
See Note A.
Item ....
Audiology, ENT ...........
92510
See Note A.
Item ....
Pathology ....................
88355
See Note A.
Item ....
92310–92317
See Note A.
Item ....
Item ....
Optometry,
Opthalmology.
Ob-gyn ........................
Neurology ....................
See Note A.
See Note A.
Item ....
Dermatology ................
57170
95812–13, 95816, 95819,
95822, 95950, 95954, 95956
36522
Item ....
Pathology ....................
88355
See Note A.
Dermatology ................
Ob-Gyn ........................
17360
19396
See Note A.
See Note A.
92313, 92341, 92342
See Note A.
Code
2005 Description
Unit
SK105 ..........
Blood pressure recording form, average.
Brush, disposable applicator.
Communication book/
treatment notebook.
Cork sheet, 1 cm x 1
cm.
DMV remover ..............
Item ....
Diaphragm fitting set ...
Electrode, EEG, tin cup
(12 pack uou).
Fistula set, dialysis,
17g.
Foil, aluminum, 10 cm
x 10 cm.
Glycolic acid, 20–50%
Kit, moulage
(implantech).
Lens cleaner ...............
SJ072 ...........
SK102 ..........
SK103 ..........
SJ073 ...........
SD217 ..........
SD053 ..........
SC088 ..........
SK104 ..........
SL193 ...........
SA090 ..........
SJ074 ...........
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
ml .......
Item ....
Unit
Price
0.31
75.00
oz .......
PO 00000
Optometry,
Opthalmology.
Frm 00019
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
Status of item
See Note A
45782
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 18.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING—Continued
Primary specialties associated with item
*CPT code(s) associated with
item
ml .......
Pathology ....................
88355, 88356
See Note A.
Item ....
Item ....
Item ....
Podiatry, Orthopedics ..
Optometry ...................
Ob-Gyn ........................
28740, 28750, 28755, 28760
92370
57180
See Note A.
See Note A.
See Note A.
Gastroenterology .........
Cardiology ...................
Radiation Oncology .....
Dermatology ................
91052
93501, 93508, 93510, 93526
77333
17360
See
See
See
See
42280
See Note A.
31730
See Note A.
93501, 93508, 93510, 93526
See Note A.
Code
2005 Description
Unit
SL199 ...........
Lithium carbonate,
saturated.
Micro air burr ...............
Nose pads ...................
Packing, gauze, plain,
1 in (5yd uou).
Pentagastrin ................
Pressure bag ...............
Sealant spray ..............
Sodium bicarbonate
spray, 8 oz.
Tissue conditioner,
coesoft.
Tray, scoop, fast track
system.
Tubing, sterile, nonvented (fluid administration).
SF044 ...........
SJ076 ...........
SG092 ..........
SH087 ..........
SD140 ..........
SL119 ...........
SL200 ...........
SL203 ...........
SA091 ..........
SD213 ..........
ml .......
Item ....
oz .......
Item ....
Unit
Price
8.925
Item ....
Tray ...
750.00
Maxillofacial Surgery
ENT.
ENT .............................
Item ....
1.99
Cardiology ...................
Status of item
Note
Note
Note
Note
A.
A.
A.
A.
*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).
TABLE 19.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS
Code
2005 Description
EQ269 .........
Ambulatory blood pressure
monitor.
cortical bipolar-biphasic
stimulating equipment.
Cryo-thermal unit .................
EQ089 .........
EQ091 .........
ER025 ..........
EQ100 .........
EQ101 .........
EQ008 .........
EQ112 .........
EQ122 .........
ER029 ..........
EQ124 .........
EQ131 .........
ER036 ..........
......................
ER045 ..........
ER008 ..........
......................
EQ208 .........
EQ209 .........
EQ212 .........
EP055 ..........
EQ271 .........
EQ220 .........
EQ221 .........
VerDate jul<14>2003
Price
Primary specialties associated with item
* CPT
code(s) associated
with item
Status of item
3,000.00
Cardiology ...........................
93784, 93786, 93788
See Note A.
........................
Neurosurger, neurology ......
95961, 95962
See Note A.
........................
Anesthesia ...........................
64620
22,500.00
Radiology ............................
78350
10,000.00
........................
Nephrology ..........................
anesthesia, GP, podiatry .....
90940
97020
8,250.00
Cardiology, IM .....................
93278
See Notes A and
C.
See Notes A and
C.
See Note A.
See Notes A and
C.
See Note A.
25,000.00
Physical therapy ..................
G0329
See Note A.
35,000.00
27,500.00
ob-gyn, radiology .................
Radiology ............................
76818, 76819
329 codes
950.00
125,000.00
250,000.00
Neurology, NP .....................
FP, IM, EM ..........................
radiation oncology ...............
95923
99183
77620
See Note A.
See Notes A and
B.
See Note A.
See Note A.
See Note A.
........................
Dermatology ........................
36522
See Note A.
140,000.00
radiation oncology ...............
77401
See Note A.
5,000.00
radiation oncology ...............
77334
plasma pheresis machine w/
37,900.00
UV light source.
Programmer, for implanted
1,975
medication pump (spine).
Programmer,
1,975
neurostimulator (w-printer).
pulse oxymetry recording
3,660.00
software (prolonged monitoring).
Slide Stainer ........................
9,291.00
Radiuscope ......................... ........................
remote monitoring service
9,500.00
(neurodiagnostics).
review master ......................
23,500.00
radiology, dermatology ........
36481, G0341
See Notes A and
B.
See Note A.
anesthesiology, physical
medicine.
neurology, neuro surgery,
anesthesiology.
Pulmonary disease, IM .......
62367 and 62368
See Note D.
95970, 95971, 95972, 95973,
95974, 95975, 95978, 95979
94762
See Note D.
Pathology ............................
ophthalmology, optometry ...
Neurology ............................
88184
92310—92317
95955
See Note A.
See Note A.
See Note A.
95805, 95807–11, 95816,
95822, 95955–56
See Note A.
densitometry unit, whole
body, SPA.
dialysis access flow monitor
diathermy, microwave .........
ECG signal averaging system.
electromagnetic therapy machine.
fetal monitor software ..........
film alternator (motorized
film viewbox).
generator, constant current
hyperbaric chamber ............
hyperthermia system,
ultrasound, intracavitary.
Light assembly,
photopheresis.
orthovoltage radiotherapy
system.
OSHA ventilated hood ........
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00020
pulmonary disease, neurology.
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
See Note A.
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
45783
TABLE 19.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS—Continued
Code
2005 Description
Price
Primary specialties associated with item
EF022 ..........
table, cystoscopy .................
........................
Urology ................................
EQ253 .........
29,900.00
EQ261 .........
ultrasound, echocardiography digital acquisition
(Novo Microsonics,
TomTec).
vacuum cart .........................
........................
anesthesia ...........................
64620
EP054 ..........
Wash assistant, FACS ........
38,000.00
pathology .............................
88184
ob-gyn, cardiology, pediatrics.
* CPT
code(s) associated
with item
52204–24, 52265–75,
52310–17, 52327–32
76825–28, 93303–12, 93314,
93320, 93325, 93350
Status of item
See Note A.
See Note A.
See Notes A and
C
See Note A.
*CPT
codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
Notes:
A. Additional information required. Need detailed description (including system components as specified), source, and current pricing information.
B. Proposed deletion as indirect expense.
C. Item may no longer be available.
D. Proposed deletion as supplied to physicians at no cost.
B. Geographic Practice Cost Indices
(GPCIs)
[If you choose to comment on issues in
this section, please include the caption
‘‘GPCIs’’ at the beginning of your
comments.]
Section 1848(e)(1)(A) of the Act
requires us to develop separate GPCIs to
measure resource cost differences
among localities compared to the
national average for each of the three fee
schedule components. While requiring
that the practice expense and
malpractice GPCIs reflect the full
relative cost differences, section
1848(e)(1)(A)(iii) of the Act requires that
the physician work GPCIs reflect only
one-quarter of the relative cost
differences compared to the national
average.
Section 1848(1)(E) of the Act, as
amended by section 412 of the MMA,
established a floor of 1.0 for the work
GPCI for any locality where the GPCI
would otherwise fall below 1.0. This 1.0
work GPCI floor was used for purposes
of payment for services furnished on or
after January 1, 2004 and before January
1, 2007. This 1.0 floor will remain in
effect in 2006.
Section 602 of the MMA added
section 1848(e)(1)(G) of the Act, which
sets a floor of 1.67 for the work, practice
expense, and malpractice GPCIs for
services furnished in Alaska between
January 1, 2004 and December 31, 2005
for any locality where the GPCI would
otherwise fall below 1.67. Effective
January 1, 2006, this provision will end
and the proposed 2006 GPCIs for Alaska
will be 1.017 for physician work, 1.103
for PE, and 1.029 for malpractice.
Payment Localities
In the August 15, 2004 PFS rule
proposed rule, we discussed the issue of
changes to the GPCI payment localities
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
(69 FR 47504). In that proposed rule, we
noted that we look for the support of a
State medical society as the impetus for
changes to existing payment localities.
Because the GPCIs for each locality are
calculated using the average of the
county-specific data from all of the
counties in the locality, removing highcost counties from a locality will result
in lower GPCIs for the remaining
counties. Therefore, because of this
redistributive impact, we have
refrained, in the past, from making
changes to payment localities unless the
State medical association provides
evidence that any proposed change has
statewide support.
In the November 15, 2004 PFS final
rule, we discussed a ‘‘placeholder’’
proposal submitted to us in comments
received from the California Medical
Association (CMA) (69 FR 66263). The
proposal described in CMA’s comment
would move any county with a countyspecific geographic adjustment factor
(GAF) that is at least 5 percent greater
than its locality GAF to its own
individual county payment locality.
(The GAF is the weighted average of the
GPCIs for each locality. The GPCIs are
weighted by the same weighting factors
applied to physician work, practice
expense, and malpractice in the
Medicare Economic Index (MEI) used to
update the CF.) However, in order to
minimize reductions in the 2005 GAF of
the Rest of California locality that would
otherwise result from removal of the
data for these high-cost counties, the
CMA proposed maintaining Rest of
California locality payments at the 2004
level by redistributing payments from
the existing (and newly created)
payment localities.
On October 21, 2004, the CMA Board
of Trustees voted without objection to
support the placeholder proposal with
the amendment that the redistribution
PO 00000
Frm 00021
Fmt 4701
Sfmt 4702
of payments designed to maintain 2004
levels of payment for the Rest of
California payment locality would occur
for two years only, in 2005 and 2006.
However, we determined that we do not
have the authority under section 1848(e)
of the Act to modify the GPCIs of some
localities in a State solely in order to
offset higher payments to other
localities.
After the publication of the November
15, 2004 PFS final rule, the CMA
submitted a proposal for a
demonstration project that was the same
as its proposal discussed in that final
rule. There were several aspects of the
proposal that made implementation
problematic for us under our
demonstration authority. For example,
physicians whose payments would
decrease under the demonstration could
challenge the validity of a new locality
configuration established without
providing them the opportunity to
comment through the regulatory process
(as is our normal process for making
locality changes). In particular,
physicians who are not members of
county medical societies or the CMA
did not agree to participate in the
proposed demonstration, and some of
them may have challenged its
implementation.
Also, the Medicare PFS currently uses
identical GPCIs to pay for services
provided in an area by both physicians
and nonphysician providers such as
podiatrists, optometrists, physical
therapists, and nurse practitioners
(NPs). Changing the locality
configuration for medical doctors and
doctors of osteopathic medicine, but not
for other professionals, would have
some peculiar results that were not
addressed in the CMA proposal. For
example, in areas where the GPCIs
would be reduced under the
demonstration, some practitioners not
E:\FR\FM\08AUP2.SGM
08AUP2
45784
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
participating under the demonstration
(such as physical therapists) could be
paid more than physicians in the same
locality. Conversely, where the GPCIs
would be increased under the
demonstration, there would likely be
complaints from the nonphysician
practitioners (NPP) not included in the
demonstration.
Nonetheless, we do recognize the
potential impact of wide variations in
the practice costs within a single
payment locality. In last year’s PFS final
rule, we noted that we received many
comments from physicians and
individuals in Santa Cruz County
expressing the opinion that Santa Cruz
County should be removed from the
Rest of California payment locality and
placed in its own payment locality. The
county-specific GAF of Santa Cruz
County is 10 percent higher than the
Rest of California locality GAF. Santa
Cruz County is adjacent to Santa Clara
County and San Mateo County. Santa
Clara and San Mateo Counties have two
of the highest GAFs in the nation. The
published 2006 GAF for the Rest of
California payment locality is 24
percent less than the GAFs of Santa
Clara and San Mateo.
Sonoma County is also part of the
Rest of California payment locality. The
county-specific GAF of Sonoma County
is 8 percent higher than the Rest of
California locality GAF. Sonoma County
is bordered by Marin County and Napa
County. Using published 2006 values,
the payment locality that includes
Marin and Napa counties has the fourth
highest GAF in the nation, and is 13
percent higher than the GAF of the Rest
of California payment locality.
We recognize that changing
demographics over time may lead to
payment disparities in particular
circumstances. We rely upon State
medical societies to identify and resolve
these disparities because there are
redistributive impacts within a State
when new localities are created (or
existing ones reconfigured). Yet we also
recognize that CMS is ultimately
responsible for establishing fee schedule
areas. We have considered a number of
alternative locality configurations
including—
• The CMA approach which
calculates county-specific GAFs, and
compares them to their locality GAF
and designating any county with a GAF
at least 5 percent higher than its locality
GAF as a new locality;
• An approach that sorts counties by
descending GAFs and compares the
highest county to the second highest
county. If the difference between these
two counties is 5 percent or less, they
are included in the same locality. The
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
third highest county GAF is then
compared to the highest county GAF
and so on, until the next county GAP is
not within 5 percent of the highest
county GAF. At that point, the county
GAF that is more than 5 percent lower
than the highest county GAF becomes
the comparison for the next lowest
county GAF, to create a second locality.
This process is repeated down
throughout all of the counties;
• An approach that compares the
county with the highest GAF to the
statewide average, removing counties
that are 5 percent or more than the
statewide average; and
• An approach that uses Metropolitan
Statistical Ares defined by the Office of
Management and Budget.
However, because these
reconfigurations would result in
significant redistributions across most
California counties, we are simply
proposing that Santa Cruz and Sonoma
Counties (the two counties with the
most significant disparity between the
assigned Rest of California GAF and the
county-specific GAF) be removed from
the Rest of California payment locality
and that each would be its own payment
locality. We invite comments regarding
this proposal and possible alternative
approaches to address this issue. We are
particularly interested in whether the
CMA supports this approach.
If implemented, our proposal would
change the 2006 GPCIs and GAFs for
Santa Cruz County, Sonoma County and
the Rest of California. The Santa Cruz
GAF would be 1.119, a value 10 percent
above the 2005 Rest of California GAF.
The Sonoma County GAF would be
1.098, a value 8 percent above the 2005
Rest of California GAF. The Rest of
California GAF would be 1.011, a value
0.01 percent below the 2005 Rest of
California GAF. We would note that the
2006 Rest of California GAF published
in the November 15, 2004 PFS final rule
(69 FR 66695) was 1.017. This
represents the second year of the
transition to the new GPCIs and GAFs
incorporating updated data (69 FR
66260). The proposed 2006 Rest of
California GAF of 1.011 fully reflects
incorporating the updated data.
The issue of payment locality
designation in light of changing
economic and population trends will be
of importance to us for the foreseeable
future. We are interested in other
solutions to the problem, and will work
with anyone who presents an idea or
makes a suggestion that will help
resolve the problems associated with the
designation and revision of payment
localities.
PO 00000
Frm 00022
Fmt 4701
Sfmt 4702
C. Malpractice Relative Value Units
(RVUs)
[If you choose to comment on issues in
this section, please include the caption
‘‘Malpractice RVUs’’ at the beginning of
your comments.]
As discussed in the Revisions to
Payment Policies Under the Physician
Fee Schedule for Calendar Year 2005
final rule, published November 15, 2004
(69 FR 66236), we revised the resourcebased malpractice expense RVUs using
specialty-specific malpractice premium
data because those data represent the
actual malpractice expense to the
physician and are widely available.
Based upon discussions with the
medical community, we concluded that
the primary determinants of malpractice
liability costs are physician specialty,
level of surgical involvement, and the
physician’s malpractice history.
Malpractice premium data were
collected for the 20 Medicare physician
specialties with the largest share of
malpractice RVUs. We collected data
based on premiums for a $1 million/$3
million mature claims-made policy (a
policy covering claims made, rather
than services provided during the policy
term). We collected premium data from
all 50 States, Washington, DC, and
Puerto Rico. Data were collected from
commercial and physician-owned
insurers and from joint underwriting
associations (JUAs). The premium data
collected represented at least 50 percent
of total physician malpractice premiums
paid in each State. For a more detailed
description of the methodology utilized
in the development of resource based
malpractice RVUs, refer to the
November 15, 2004 final rule.
1. Five Percent Specialty Threshold
As discussed in the November 15,
2004 final rule, we are concerned that
the malpractice RVUs could be
inappropriately inflated or deflated due
to aberrant data based upon incorrectly
reported specialty classifications.
Therefore, we examined the impact of
establishing a minimum percentage
threshold for any procedure performed
by any specialty before the risk factor of
that specialty is included in the
malpractice RVU calculation of a
particular code.
We conducted an analysis excluding
data for any specialty that performs less
than 5 percent of a particular service or
procedure from the malpractice RVU
calculation for that service or procedure.
The purpose of applying the minimum
threshold was to identify and remove
from the data specialties listed
infrequently as performing a certain
procedure. The assumption was that the
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
infrequent instances of these specialties
in our data represent aberrant
occurrences and removing the
associated risk factor from the
malpractice RVU calculation would
improve accuracy and stability of the
RVUs.
We excluded evaluation and
management (E&M) services from the
analysis. Medicare claims data show
that E&M codes are performed by
virtually all physician specialties.
Therefore, in the case of E&M codes, it
is likely that even the low relative
percentages of performance by some
specialties would accurately represent
the provision of the service by those
specialties.
For all services other than E&M
services, we believe removing data
attributable to specialties that occur in
our data less than 5 percent of the time
would most appropriately balance the
objective to identify aberrant data
(claims with a specialty identified that
is highly unlikely to have performed a
particular procedure) while including
specialties that perform a procedure a
small percentage of the time. We believe
a higher threshold would result in the
removal of data for specialties actually
performing the procedure, while a lower
threshold would likely fail to remove
some aberrant data, particularly for lowvolume codes (fewer than 100
occurrences, where each claim represent
1 or more percentage points).
The overall impact of removing the
risk factor for specialties that occur less
than 5 percent of the time in our data
for a procedure is minimal. There is no
impact on the malpractice RVUs for
over 5,280 codes, and there is an impact
of less than 1 percent on the malpractice
RVUs for over 1,300 additional codes.
Only 16 codes decrease by at least 0.1
RVUs, with the biggest decrease being a
negative 0.28 impact on the malpractice
RVU for CPT code 17108, Destruction of
skin lesions, from a current RVU of 0.82
to a proposed RVU of 0.54.
Conversely, there are 219 codes for
which RVUs increase by at least 0.1, the
largest increase being a positive 0.81
RVU increase for CPT code 61583,
Craniofacial approach, skull, from a
current RVU of 8.32 to a proposed RVU
of 9.13. Among codes whose
malpractice RVUs would increase under
our proposal, 646 have increases of less
than 1 percent. The impact analysis
section of this proposed rule examines
the effects of this proposed change by
specialty.
2. Specialty Crosswalk Issues
Malpractice insurers generally use
five-digit codes developed by the
Insurance Services Office (ISO), an
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
advisory body serving property and
casualty insurers, to classify physician
specialties into different risk classes for
premium rating purposes. ISO codes
classify physicians not only by
specialty, but in many cases also by
whether or not the specialty performs
surgical procedures. A given specialty
could thus have two ISO codes, one for
use in rating a member of that specialty
who performs surgical procedures and
another for rating a member who does
not perform surgery.
Medicare uses its own system of
specialty classification for payment and
data purposes. Therefore, to calculate
the malpractice RVUs, it was necessary
to map Medicare specialties to ISO
codes and insurer risk classes. For some
physician specialties, NPP, and other
entities (for example, IDTFs) paid under
the PFS, there was not a clear ISO
assignment available. In these instances,
we crosswalked these unassigned
specialties to the most approximate
existing ISO codes and risk classes
based upon their relationship to those
specialties for which we did have clear
ISO crosswalks. The crosswalks we used
to establish the 2005 malpractice RVUs
were displayed in the November 15,
2004 PFS final rule (69 FR 66268). In
most instances, when an appropriate
crosswalk could not be identified we
utilized the average for all physicians
category, which is a weighted average of
all specialty premium data.
Differences among specialties in
malpractice premiums are a direct
reflection of the malpractice risk
associated with the services performed
by a given specialty. The relative
differences in national average
premiums between various specialties
can be expressed as a specialty risk
factor. These risk factors are an index
calculated by dividing the national
average premium for each specialty by
the national average premium for
nephrology, which is the specialty with
the lowest average premium among the
20 specialties for which data were
collected.
We stated in the November 15, 2004
PFS final rule that we would continue
to work with the AMA RUC’s
Professional Liability Insurance (PLI)
Workgroup to address any potential
inconsistencies that may still exist in
our methodology. Based upon this
commitment, the RUC PLI Workgroup
has forwarded various
recommendations for our consideration.
The RUC developed its
recommendations based upon
comments submitted to them by
physician specialty organizations.
The RUC PLI Workgroup provided all
specialty societies and the HCPAC with
PO 00000
Frm 00023
Fmt 4701
Sfmt 4702
45785
the opportunity to submit comments on
the crosswalks listed in the November
15, 2004 final rule. Based on the
comments, the Workgroup believes the
risk factors assigned to certain
professions overestimate the insurance
premiums for these professions. We
crosswalked clinical psychology,
licensed clinical social work, and
psychology to the nonsurgical risk factor
for psychiatry (risk factor of 1.11). We
crosswalked occupational therapy to
occupational medicine (risk factor of
1.11). The PLI Workgroup recommends
crosswalking these professions to
allergy and immunology, with a risk
factor of 1.00 (although the Workgroup
suggests the actual risk factor for these
professions may be below the risk factor
for allergy and immunology and
encourages the collection of malpractice
premium data for these professions).
The Workgroup also believes that
opticians and optometrists should be
assigned this risk factor of 1.0, as
opposed to being crosswalked to
ophthalmology (nonsurgical risk factor
of 1.24, surgical risk factor of 2.31). The
Workgroup further suggests that it
would be more appropriate to assign the
risk factor of 1.0 to the chiropractic and
physical therapy specialties rather than
their current crosswalk to physical
medicine and rehabilitation
(nonsurgical and surgical risk factors of
1.26). The Workgroup felt that these
specialties will not incur PLI premiums
in excess of the current base premiums
associated a risk factor of 1.0.
We examined the risk factors assigned
to these professions, and agree that the
PLI associated with them should reflect
the lowest physician specialty risk
factor (absent actual premium data for
these professions). Therefore, we
propose assigning these specialties a
risk factor of 1.00. We invite comment
from representatives of the affected
specialties and others regarding the
appropriateness of this proposal, as well
as other specialty crosswalks and
suggestions for reliable sources of actual
malpractice premium data for
nonphysician groups.
The RUC PLI Workgroup also felt that
a number of professions that were
assigned to the average for all
physicians risk factor should be
removed from the calculation of
malpractice RVUs altogether. The PLI
Workgroup believes that it would be
more appropriate to exclude data from
the following professions: Certified
clinical nurse specialist (CNS), clinical
laboratory, multispecialty clinic or
group practice, NP, physician assistant
(PA), and physiological laboratory
(independent). In calculating the
malpractice RVUs applicable for 2005,
E:\FR\FM\08AUP2.SGM
08AUP2
45786
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
34 Medicare specialties were excluded
from the calculation because they could
not be otherwise assigned or
crosswalked. The RUC recommends the
above specialties and professions be
similarly excluded. We agree and
propose to establish malpractice RVUs
based upon the mix of specialties
exclusive of the above specialties and
professions.
The PLI Workgroup also made the
following recommendations that we are
not accepting: Certified registered nurse
anesthetists (CRNAs) should be
crosswalked to anesthesiology which is
2.84 rather than to the ‘‘all physicians’’
which is 3.04; colorectal surgeons
should be crosswalked to general
surgery (the current risk factor is based
on actual data); and gynecologists and
oncologists (currently 5.63) should be
crosswalked to surgical oncology
(currently 6.13). We believe the current
crosswalks we are using for these
specialties appropriately reflect the
types of services they provide. However,
we would welcome comments on these
proposals as well.
3. Cardiac Catheterization and
Angioplasty Exception
In response to a comment received on
our proposed methodology at the time,
in the November 2, 1999 final rule (64
FR 59384), we applied surgical risk
factors to the following cardiology
catheterization and angioplasty codes:
92980 to 92998 and 93501 to 93536.
This exception was established because
these procedures are quite invasive and
more akin to surgical than nonsurgical
procedures.
In the November 15, 2004 final rule
(69 FR 66275), we discussed changes in
those codes that would fall under the
exception. Based on a recommendation
by the RUC, we revised the list of codes
to which this exception applies. The
RUC’s PLI Workgroup requests that we
correct a clerical error made by the RUC
in identifying those codes that would
fall under the exception. We agree with
the RUC PLI Workgroup
recommendation and propose that the
following CPT codes be added to the
existing list of codes under the
exception: 92975; 92980 to 92998; and
93617 to 93641.
4. Dominant Specialty for Low-Volume
Codes
The final recommendation from the
PLI Workgroup is to use the dominant
specialty approach for services or
procedures with fewer than 100
occurrences. The Workgroup supplied a
list of 1,844 services for our review and
recommends that we utilize only the
dominant specialty in calculating the
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
final malpractice RVUs for these
services. The PLI Workgroup worked in
conjunction with various specialty
organizations to identify the dominant
specialty that performs each service.
We recognize and appreciate the
efforts of the Workgroup to review these
codes. We have considered the data that
was presented to us and the argument
for using the dominant specialty to
establish the malpractice RVUs for these
1,844 codes.
We have previously registered our
concerns with the dominant specialty
approach. We believe that basing
payment on all specialties that perform
a particular service ensures that the
actual PLI costs of all specialties are
included in the calculation of the
malpractice RVUs. Therefore, we do not
believe it would appropriate, even for
these low-volume services, to include
only the dominant specialty if other
specialties regularly provide the service.
However, as noted previously in our
proposal to remove data for specialties
that make up less than 5 percent of the
total volume for that service, we also
recognize the need to take steps to
minimize the risk that aberrant data
would inappropriately skew the
malpractice RVU calculation. We
believe that, for most services, the
proposal to remove specialties making
up less than 5 percent of the
occurrences will ensure that aberrant
data are removed. Yet for those services
with especially low volumes, the
malpractice RVUs may be especially
susceptible to the influence of aberrant
data in only a very few cases (but more
than 5 percent, that is, 2 cases in a
service with 20 occurrences). We will
continue to evaluate ways to ensure
these low-volume services are not
skewed by a few occurrences of aberrant
data, but we are concerned that
including only the dominant specialty
performing these services would
exclude data from other specialties that
are actually performing them.
We are not proposing to adopt this
methodology at this time. We would
note that low volume procedures or
services are not necessarily performed
by only one specialty. As noted above,
we would distinguish between
excluding data presumed to be
erroneous from data reflecting
utilization by specialties that perform a
service but are not the dominant
specialty. However, we acknowledge
that there may be instances where
aberrant data exist that would not be
identified and removed by our proposed
5 percent threshold discussed
previously. We will continue to work
with the RUC PLI Workgroup examine
this issue in the future.
PO 00000
Frm 00024
Fmt 4701
Sfmt 4702
D. Medicare Telehealth Services
[If you choose to comment on issues in
this section, please include the caption
‘‘TELEHEALTH’’ at the beginning of
your comments.]
1. Requests for Adding Services to the
List of Medicare Telehealth Services
Section 1834(m) of the Act defines
telehealth services as professional
consultations, office and other
outpatient visits, and office psychiatry
services identified as of July 1, 2000 by
CPT codes 99241 through 99275, 99201
through 99215, 90804 through 90809,
and 90862. In addition, the statute
requires us to establish a process for
adding services to or deleting services
from the list of telehealth services on an
annual basis.
In the December 31, 2002 Federal
Register (67 FR 79988), we established
a process for adding or deleting services
to the list of Medicare telehealth
services. This process provides the
public an ongoing opportunity to submit
requests for adding services. We assign
any request to make additions to the list
of Medicare telehealth services to one of
the following categories:
• Category #1: Services that are
similar to office and other outpatient
visits, consultation, and office
psychiatry services. In reviewing these
requests, we look for similarities
between the proposed and existing
telehealth services for the roles of, and
interactions among, the beneficiary, the
physician (or other practitioner) at the
distant site and, if necessary, the
telepresenter. We also look for
similarities in the telecommunications
system used to deliver the proposed
service, for example, the use of
interactive audio and video equipment.
• Category #2: Services that are not
similar to the current list of telehealth
services. Our review of these requests
includes an assessment of whether the
use of a telecommunications system to
deliver the service produces similar
diagnostic findings or therapeutic
interventions as compared with the
face-to-face ‘‘hands on’’ delivery of the
same service. Requestors should submit
evidence showing that the use of a
telecommunications system does not
affect the diagnosis or treatment plan as
compared to a face-to-face delivery of
the requested service.
Since establishing the process, we
have added the psychiatric diagnostic
interview examination and ESRD
services with 2 to 3 visits per month and
4 or more visits per month to the list of
Medicare telehealth services (although
we require at least one visit a month by
a physician, CNS, NP, or PA to examine
the vascular access site).
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Requests for adding services to the list
of Medicare telehealth services must be
submitted and received no later than
December 31st of each CY to be
considered for the next proposed rule.
For example, requests submitted before
the end of CY 2004 are considered for
the CY 2006 proposed rule. For more
information on submitting a request for
an addition to the list of Medicare
telehealth services, visit our Web site at
https://www.cms.hhs.gov/physicians/
telehealth.
2. Submitted Requests for Addition to
the List of Telehealth Services
We received the following public
requests for additional approved
services in CY 2004: (1) Diabetes
outpatient self-management training
services and medical nutritional
therapy; and (2) modification of the
definition of an interactive
telecommunications system for
purposes of furnishing a telehealth
service. The following is a discussion of
the requests submitted in CY 2004.
a. Medical Nutrition Therapy and
Diabetes Self-Management Training
The American Telemedicine
Association (ATA) and an individual
practitioner submitted a request to add
medical nutrition therapy (MNT) (as
represented by HCPCS codes G0270,
G0271 and 97802 through 97804) and
diabetes outpatient self-management
training services (DSMT) (as defined by
HCPCS codes G0108 and G0109). The
requestors believe that MNT and DSMT
are similar to the services currently on
the list of Medicare telehealth services
and, therefore, should be added to the
list of Medicare telehealth services.
CMS Review
Section 1861(s)(2) of the Act
authorizes coverage and payment of
MNT for certain beneficiaries who have
diabetes or a renal disease. Individual
MNT typically involves obtaining a
nutrition history, counseling, the
formulation of a treatment plan,
implementation of a treatment plan
through discussion with the patient, and
follow-up with the patient. These
components would be comparable to
E&M office or other outpatient visits
which are currently Medicare telehealth
services. Additionally, the interactive
dynamic of individual MNT is similar
in nature to an E&M office visit because
the nutrition professional is able to have
a direct one-on-one discussion with the
beneficiary and the beneficiary is able to
ask immediate questions regarding his
or role in following the treatment plan.
Therefore, we propose to add individual
MNT as represented by HCPCS codes
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
G0270, 97802 and 97803 to the list of
Medicare telehealth services.
Practitioners Who May Furnish Medical
Nutrition Therapy Services
Section 1834(m) of the Act specifies
that practitioners defined in section
1842(b)(18)(C) of the Act may receive
payment for furnishing telehealth
services at the distant site. Effective
January 1, 2002, section 1842(b)(18)(C)
of the Act includes a registered dietitian
or nutrition professional as a Medicare
practitioner. As a condition of Medicare
Part B payment, the statute allows only
a registered dietitian or nutrition
professional to furnish medical
nutrition therapy services (subject to
referral made by the treating physician)
for the purpose of managing diabetes or
renal disease. Medicare practitioners
who are not a licensed or certified
registered dietitian or other nutrition
professional, as defined in § 410.134,
may not furnish and receive payment
for MNT services.
We propose to revise § 410.78 and
§ 414.65 to include individual MNT as
a Medicare telehealth service.
Additionally, since a certified registered
dietitian or other nutrition professional
are the only practitioners permitted by
law to furnish MNT, we propose to
revise § 410.78 to add a registered
dietitian and nutrition professional as
defined in § 410.134 to the list of
practitioners that may furnish and
receive payment for a telehealth service.
Group Medical Nutritional Therapy
(MNT)
We believe that group counseling
services have a different interactive
dynamic between the physician or
practitioner at the distant site and
beneficiary at the originating site as
compared to the current list of Medicare
telehealth services. We do not currently
have other group counseling services as
telehealth services and do not believe
that group MNT falls within the first
category of requests. Category 1 requests
must be similar to the current list of
Medicare telehealth services in order to
be added to the list.
For instance, office and other
outpatient visits, consultation and the
current office psychiatry services
involve an individual professional
encounter between the physician or
practitioner and beneficiary. Through
direct discussion with the beneficiary,
the physician or practitioner provides
patient counseling regarding diagnostic
test results, recommendations for
further studies, prognosis, treatment
options, and other follow-up
instructions. In this interactive
dynamic, the patient is able to ask
PO 00000
Frm 00025
Fmt 4701
Sfmt 4702
45787
immediate questions and the physician
or practitioner is able to discern
whether the beneficiary understands his
or her responsibilities in following the
treatment plan. However, group therapy
services do not allow for the same
degree of direct patient interaction as
compared with individual therapy
services.
As such, we were not able to conclude
that the roles of and interaction among
the physician or practitioner at the
distant site and beneficiary at the
originating site are similar to the
existing Medicare telehealth services.
Furthermore, the requestors did not
submit comparative analyses illustrating
that the use of a telecommunications
system is an adequate substitute for the
face-to-face delivery of group MNT
services (which is a requirement for
category 2). Therefore, we propose to
not add group MNT (as described by
HCPCS codes G0271 and 97804) to the
list of Medicare telehealth services.
However, we invite specific public
comments on whether the use of an
interactive telecommunications system
is clinically adequate for furnishing
group MNT. Additionally, if the
requestors were to submit data showing
that the use of a telecommunications
system does not change the diagnosis or
treatment plan as compared to face-toface delivery, we would consider
approving group MNT as a category 2
service.
Diabetes Outpatient Self-Management
Training Services (DSMT)
The DSMT benefit, described at
section 1861(qq) of the Act, is a
comprehensive diabetes training
program (one component of which is
MNT). We consider DSMT as a category
2 request because the major portion of
DSMT is furnished in the group setting
and, as explained above, we believe
group therapy has a different interactive
dynamic than the current list of
Medicare telehealth services.
Additionally, the statute requires the
training content for DSMT to include
teaching beneficiaries the skills
necessary for the self-administration of
injectable drugs. We question the merits
of providing beneficiary training to
administer insulin injections via
telehealth. For example, teaching a
patient how to inject insulin requires
consideration and instruction regarding
factors such as the type of needle to be
used, the anatomic location of the
injection, the injection technique, and
possible complications of the injection,
all of which we believe, absent evidence
to the contrary, require the physical
presence of the teaching practitioner.
E:\FR\FM\08AUP2.SGM
08AUP2
45788
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
These components are typically not
part of the services currently on the list
of telehealth services and the requestor
did not provide any comparative
analyses illustrating that the use of a
telecommunications system is an
adequate substitute for the in-person,
collaborative, skill-based training
required for DSMT services. Therefore,
we propose to not add DSMT (as
described by HCPCS codes G0108 and
G0109) to the list of Medicare telehealth
services.
b. Definition of an Interactive
Telecommunications System
The Medical College of Georgia (MCG)
requested that we modify our definition
of an interactive telecommunications
system for purposes of furnishing a
telehealth consultation. The MCG uses
an interactive audio and one-way, realtime video telecommunications system,
over an internet-based protocol, to
furnish consultations for acute ischemic
stroke patients. The physician at the
distant site (typically a neurologist) can
see the patient; however, the patient and
physician (or practitioner) in the
emergency room who is with the patient
cannot see the neurologist. Under this
model, the neurologist at the distant site
examines the stroke patient in real-time
video and reviews CT scans and other
critical laboratory data to assess the
stroke patient’s suitability for tissuetype plasminogen activator (tPA)
treatment. The requestor noted that the
use of tPA treatment is restricted to 3
hours after onset of stroke, and argued
that rapid evaluation by a neurologist
for stroke patients located in outlying
rural hospitals is crucial. The requestor
believes that the use of an interactive
two-way video system does not provide
added benefit to the consulting
neurologist, would be unnecessarily
cumbersome, and noted that the use of
one-way video currently prohibits
billing as a telehealth consultation.
CMS Review
As noted previously, consultations are
included on the list of approved
telehealth services. However, as a
condition of payment, § 410.78 of the
regulations requires the use of an
interactive two-way audio and video
telecommunications system to furnish a
telehealth consultation. The use of oneway video does not meet the current
interactive telecommunications system
requirements for telehealth services and,
therefore, the requestor cannot bill for a
consultation service based on the model
described above.
We have concerns with modifying our
definition of an interactive
telecommunications system to permit
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
one-way video in place of an interactive
two-way video system. The use of an
interactive audio and video
telecommunications system permitting
two-way real-time interaction between
the physician or practitioner at the
distant site and the beneficiary and
telepresenter (if necessary) at the
originating site is a substitute for the
face-to-face examination requirements
of a consultation under Medicare.
We are concerned that the use of oneway video may not be clinically
adequate for the evaluation of certain
types of patients. Since telehealth
services are intended as a substitute for
services that traditionally require a faceto-face interaction between a physician
(or practitioner) and a patient, we
believe that the use of a two-way video
communication is much less of a
departure from this standard than a oneway video communication, because the
face-to-face interaction between a
physician and a patient allows two-way
interactive communication, both
verbally and physically. We are
concerned that, without two-way video,
communication of many subtle but
important nuances of the interaction
between the physician at the distant site
and patient or clinical staff at the
originating site would be lost, leading to
reduced diagnostic accuracy and the
possibility of unfavorable medical
outcomes.
However, we recognize that a timely
neurological evaluation is critical for
determining suitability for tPA
treatment. Given the potential for
adverse affects, such as the increased
risk of bleeding, the decision to
administer tPA (or not to administer) is
crucial in determining the course of
management for the stroke patient.
Therefore, we are currently reviewing
the definition of an interactive
telecommunications system and request
specific public comments regarding the
added clinical value of two-way
interactive video as compared to oneway video for the purpose of furnishing
telehealth services. We are also
interested in receiving comments as to
whether an interactive audio and oneway video telecommunications system
that permits the physician at the distant
site to examine the patient in real-time
is clinically adequate for a broad range
of specialty consultations.
c. Definition of a Telehealth Originating
Site
Section 418 of the MMA required the
Health Resources Services
Administration (HRSA) within the
Department of Health and Human
Services (HHS), in consultation with
CMS, to conduct an evaluation of
PO 00000
Frm 00026
Fmt 4701
Sfmt 4702
demonstration projects under which
SNFs, as defined in section 1819(a) of
the Act, are treated as originating sites
for Medicare telehealth services. The
MMA also required HRSA to submit a
report to the Congress that would
include recommendations on
‘‘mechanisms to ensure that permitting
a SNF to serve as an originating site for
the use of telehealth services or any
other service delivered via a
telecommunications system does not
serve as a substitute for in-person visits
furnished by a physician, or for inperson visits furnished by a PA, NP or
CNS, as is otherwise required by the
Secretary.’’ This report is currently
under development.
The MMA provides us with the
authority to include a SNF as a
Medicare telehealth originating site
under section 1834(m) of the Act
effective January 1, 2006, if the
Secretary concludes in the report that it
is advisable to do so and that
mechanisms could be established to
ensure that the use of a
telecommunications system does not
substitute for the required in-person
physician or practitioner SNF visits. We
will review and consider the
recommendations of the report to
determine whether to add SNFs to the
list of approved originating sites. We are
also soliciting public comments on this
topic.
E. Contractor Pricing of Unlisted
Therapy Modalities and Procedures
[If you choose to comment on issues in
this section, please include the caption
‘‘CODING—CONTRACTOR PRICING’’
at the beginning of your comments.]
We recognize that there may be
services or procedures performed that
have no specific CPT codes assigned. In
these situations, it is appropriate to use
one of the CPT codes designated for
reporting unlisted procedures. These
unlisted codes do not typically have
RVUs assigned to them.
For services coded using these
unlisted codes, the provider includes a
description of specific procedures that
were furnished. The contractor uses this
information to determine an appropriate
valuation.
Currently, there are two unlisted CPT
codes with assigned RVUs, CPT 97039,
Unlisted modality (specify and time if
constant attendance), and 97139
Unlisted therapeutic procedure. Given
the variability of the services that could
be provided using these nonspecific
codes, use of assigned RVUs may not
accurately reflect the resources actually
associated with the provided services.
This may result in an inappropriate
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
payment (overpayment or
underpayment) for the service provided.
Other unlisted services that are under
the PFS are contractor priced. To make
the pricing methodology consistent with
our policy for other unlisted services,
and to more appropriately match
payments with the actual resources
expended to deliver the services
provided, we propose to have the
contractors value CPT codes 97039 and
97139.
F. Payment for Teaching
Anesthesiologists
[If you choose to comment on issues in
this section, please include the caption
‘‘TEACHING ANESTHESIOLOGISTS’’
at the beginning of your comments.]
The following discussion summarizes
the current policy for the payment for
services provided by teaching
anesthesiologists and solicits public
comments on possible revisions to the
current payment policy.
1. Payment for Anesthesia Services
Anesthesia services are paid under
the PFS, but on a different basis than
other physician services. Payments for
anesthesia services are calculated using
a ‘‘base unit’’ that is specific to the
anesthesia code plus the anesthesia time
units. As noted in our regulations at
§ 414.46(a)(1), the base unit reflects all
activities other than anesthesia time and
includes the usual pre-operative and
post-operative care. Anesthesia time
units are computed (in 15 minute
increments) from the actual elapsed
time for the anesthesia procedure.
Anesthesia services may be personally
performed by the anesthesiologist, or
the anesthesiologist may medically
direct qualified individuals involved in
up to four concurrent anesthesia cases.
Qualified individuals can include
anesthesiologist assistants (AAs),
certified registered nurse anesthetists
(CRNAs), interns, or residents, and,
under certain circumstances, student
nurse anesthetists. When the
anesthesiologist medically directs an
anesthesia case, the payment for the
physician’s medical direction service is
50 percent of the allowance otherwise
recognized if the anesthesiologist
personally performed the service. The
physician would have to fulfill each of
the medical direction criteria in
§ 415.110(a) to bill under the medical
direction policy.
2. Teaching Physician Payment Policy
Under the teaching physician
payment policy for complex surgery, the
full fee schedule payment can be made
for the services of the teaching
physician as long as the teaching
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
physician is present with the resident
for the critical or key portions of the
service. In order to bill for two
overlapping surgeries, the teaching
surgeon must be present during the key
or critical portions of both operations.
Beginning in 1994, the teaching
physician payment policy has been
applied to anesthesiologists only when
the teaching anesthesiologist is involved
in one anesthesia case with a resident.
If the teaching physician is involved
with two concurrent cases, then the
rules for ‘‘medical direction’’ of
anesthesia apply.
In August 2002, we released a
Medicare Carriers Manual transmittal
relating to the involvement of a nonmedically directed teaching CRNA with
two student nurse anesthetists. The new
policy allowed the teaching CRNA to be
paid for his or her involvement with
two concurrent cases with student nurse
anesthetists, but not at the full fee level.
If a teaching CRNA is involved with two
concurrent cases with student nurse
anesthetists, payment may be based on
the base unit plus the time of each case
that the teaching CRNA is present with
the student nurse anesthetist. To bill the
base unit, the teaching CRNA must be
present with the student nurse
anesthetist throughout the pre- and
post-anesthesia care.
In the Revisions to Payment Policies
Under the Physician Fee Schedule for
Calendar Year 2004 final rule, published
November 7, 2003 (68 FR 63196–63395),
we revised § 414.46 of our regulations to
allow teaching anesthesiologists to bill
in a similar manner to teaching CRNAs
for the teaching anesthesiologist’s
involvement in two concurrent cases
involving residents. This policy took
effect for services furnished on or after
January 1, 2004. This was intended as
an alternative to the ‘‘medical direction’’
payment policy applicable to concurrent
cases involving teaching
anesthesiologists and residents.
Under this policy, teaching
anesthesiologists can bill and be paid
the full fee schedule for the base unit
portion of the payment if they are
present with the resident during the preand post-anesthesia care included in the
base units. Teaching anesthesiologists
can also bill and be paid the full fee
schedule amount for anesthesia time
based on the amount of time the
physician is present with the resident
during each of the two concurrent cases.
Payment to a teaching anesthesiologist
for two concurrent cases involving
residents under this policy would be
greater than under the medical direction
payment policy. However, if the
teaching anesthesiologist is not present
with the resident during the pre- and
PO 00000
Frm 00027
Fmt 4701
Sfmt 4702
45789
post-anesthesia care for both concurrent
cases, the physician could only bill the
cases as ‘‘medically directed.’’
Despite the higher level of payment
available under this policy, the
American Society of Anesthesiologists
(ASA) has informed us that it is not
aware of any teaching anesthesia
programs that have arranged their
practices to meet the conditions
necessary to bill under the revised
policy. The ASA suggests that the
teaching physician regulations for
teaching anesthesiologists should be
similar to those for teaching surgeons
for overlapping complex surgery
procedures. The ASA thinks that
anesthesia is similar to complex surgery
in terms of critical periods, overlap, and
availability of teaching physicians.
However, the critical portions of the
teaching anesthesia service and the
critical portions of the teaching surgeon
service are not the same. The ASA
believes that inadequate payment levels
have contributed to the loss of teaching
anesthesiologists and an inability to
recruit new faculty.
We are requesting comments on a
teaching physician policy for
anesthesiologists that could build on the
policy announced in the November 7,
2003 PFS final rule, but provide the
appropriate revisions that would allow
it to be more flexible for teaching
anesthesia programs. We would also be
interested in receiving data and studies
relevant to this issue as well as any
offsetting savings that could be made to
account for any potential costs that
could be incurred if there was a policy
change.
G. End Stage Renal Disease (ESRD)
Related Provisions
On November 15, 2004, we published
the Revisions to Payment Policies Under
the Physician Fee Schedule for Calendar
Year 2005 final rule in the Federal
Register (69 FR 66319), revising
payments to ESRD facilities in
accordance with provisions of the
MMA. This final rule implemented
section 1881(b) of the Act, as amended
by section 623 of the MMA, which
directed the Secretary to make a number
of revisions to the composite rate
payment system, as well as payment for
separately billable drugs furnished by
ESRD facilities. Changes that were
implemented January 1, 2005 included
a revision to payments for drugs billed
separately by ESRD facilities whereby
the top ten ESRD drugs are paid based
on acquisition costs (as determined by
the Office of Inspector General (OIG))
and other separately billed drugs are
paid average sales price (ASP) +6
percent.
E:\FR\FM\08AUP2.SGM
08AUP2
45790
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Also, in accordance with section 623
of the MMA, an adjustment of 8.7
percent was made to the composite
payment rate to account for the
difference between previous payments
for separately billed drugs and
biologicals and the revised pricing that
took effect January 1, 2005. As required
by section 623 of the MMA, we are
proposing to update this add-on
adjustment to reflect changes in ESRD
drug utilization. In addition, we are
proposing to revise the add-on
adjustment to reflect the methodology
we will be using for ESRD drugs.
Section 623 of the MMA also required
the establishment of basic case-mix
adjustments to the composite payment
rate for a limited number of patient
characteristics. The November 15, 2004
final rule implemented three categories
of patient characteristic adjustments
(age, low body mass index (BMI), and
body surface area (BSA)) that were
implemented April 1, 2005. We are
proposing to maintain these categories
and patient characteristics as
established in the November 15, 2004
final rule (69 FR 66238).
Also, section 1881(b)(12) of the Act as
amended by section 623 of the MMA
provided authority to revise the
geographic adjustment applied to the
composite payment rate. Accordingly,
we are proposing to revise the
geographic classifications and wage
indexes currently in effect for adjusting
composite rate payments. As required
by section 623 of the MMA, these
proposed changes will be phased in
over time.
In addition, we are proposing
revisions to the regulations applicable to
the composite rate exceptions process to
reflect section 623 of the MMA
provisions that restrict exceptions to
pediatric facilities.
1. Revised Pricing Methodology for
Separately Billable Drugs and
Biologicals Furnished by ESRD
Facilities
[If you choose to comment on issues in
this section, please include the caption
‘‘ESRD-Pricing Methodology’’ at the
beginning of your comments.]
In the Revisions to Payment Policies
under the Physician Fee Schedule for
Calendar Year 2005 final rule, published
on November 15, 2004, we determined
that for CY 2005, payment for the top 10
separately billable ESRD drugs billed by
freestanding facilities would be based
on the acquisition cost of the drug, as
determined by the OIG, updated by the
Producer Price Index (PPI). The
remaining separately billable ESRD
drugs would be paid at the ASP +6
percent for freestanding facilities. We
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
also determined that hospital-based
facilities would continue cost
reimbursement for all drugs with the
exception of erythopoeitin (EPO) which
would be paid the acquisition cost, as
determined by the OIG, updated by the
PPI.
As discussed in section II.H. of this
proposed rule, for CY 2006, we are
proposing that payment for a drug
furnished in connection with renal
dialysis services and separately billed
by freestanding renal dialysis facilities
will be based on section 1874A of the
Act. We are also proposing to update the
payment allowances quarterly based on
the ASP reported to us by drug
manufacturers. For CY 2006, we are
proposing to continue cost
reimbursement for hospital-based
facilities; while, proposing to pay for
EPO in hospital-based facilities at the
ASP +6 percent.
2. Adjustment to Account for Changes
in the Pricing of Separately Billable
Drugs and Biologicals, and the
Estimated Increase in Expenditures for
Drugs and Biologicals.
[If you choose to comment on issues in
this section, please include the caption
‘‘ESRD—Drugs and Biologicals’’ at the
beginning of your comments.]
Section 623(d) of the MMA, added
section 1881(b)(12) of the Act which
contains two provisions that describe
how the drug add-on adjustment will be
implemented in the ESRD payment
system. First, that the add-on
adjustment reflects the difference
between payment methodology for
separately billed drugs under the drug
price in effect in CY 2004 and current
drug pricing and, second, the aggregate
payments for CY 2005 must equal
aggregate payments absent this MMA
provision.
In the November 15, 2004 final rule
(69 FR 66322), we described in detail
the methodology that we used for
developing the drug add-on adjustment
to the composite rate to account for the
difference between estimated drug
payments under the average wholesale
price (AWP) payment system and the
acquisition costs as determined by the
OIG. This adjustment was developed so
that aggregate spending for composite
rate plus separately billed drugs would
remain budget neutral for CY 2005.
Section 1881(b)(12) of the Act also
contains two provisions related to
adjustments to payments for drugs and
biologicals for CY 2006. First, section
1881(b)(12)(C)(ii) of the Act provides
that we recalculate the add-on
adjustment to reflect the drug pricing
methodology applied by the Secretary
under section 1881(b)(13)(A)(iii) of the
PO 00000
Frm 00028
Fmt 4701
Sfmt 4702
Act. That is, we must compute the drug
add-on adjustment based on the
difference between estimated payments
using the AWP payment methodology
and the proposed new payment
methodology using ASP +6 percent.
In addition, section 1881(b)(12)(F) of
the Act requires that, beginning in 2006,
we establish an annual update
adjustment to reflect estimated growth
in expenditures for separately billable
drugs and biologicals furnished by
ESRD facilities. This update would be
applied only to the drug add-on portion
of the composite rate. In order to meet
both requirements, we are proposing to
develop the CY 2006 drug add-on
adjustment in two steps.
First, we would recalculate the CY
2005 add-on adjustment to reflect the
difference in drug payments using 95
percent AWP pricing and payments
using ASP +6 pricing. This calculation
would replace the current 8.7 percent
adjustment and would be budget neutral
to CY 2005 payments. The next step
would be to develop a proposed annual
update methodology that we would use
in CY 2006 to reflect the estimated
growth in drug expenditures each year.
As mentioned above, this update would
be applied only to the drug add-on
portion of the composite payment rate.
The following sections discuss the
recomputation of the drug add-on
adjustment followed by a discussion of
the update of the adjustment for CY
2006.
a. Proposed Recalculation of the CY
2005 Drug Add-on Adjustment
For CY 2006, we are proposing to use
the same method that we used to
develop the drug add-on adjustment for
CY 2005 to recalculate the adjustment to
reflect the proposed revision to the
ESRD drug payment methodology from
acquisition costs to ASP +6 percent.
That is, we propose to calculate the
spread based on the difference in
aggregate payments between estimated
payment based on AWP pricing and
estimated payment based on ASP +6
pricing. As discussed in detail below,
we propose to use pricing data from the
second quarter of CY 2005. All of the
data used to develop the proposed addon adjustment will be updated for the
final rule, as more current data,
including ASP data, will be available.
(1) Historical Drug Expenditure Data
To develop the drug add-on
adjustment we used historical total
aggregate payments for separately billed
ESRD drugs for half of CY 2000 and all
of CY 2001, CY 2002 and CY 2003. For
EPO, these payments were broken down
according to type of ESRD facility
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
45791
prior to the implementation of the MMA
drug payment provisions. In CY 2005,
AWP rates
we estimate payments for these syringes
for the secwill amount to $1.6 million for hospitalDrugs
ond quarter
based facilities and $26.8 million for
of 2005
(2) ASP +6 Percent Prices
independent facilities. For CY 2005, we
We obtained the ASP +6 percent
Iron_sucrose ...........................
$0.66 estimate that total spending, after the
prices, for the second quarter of CY
Levocarnitine ..........................
$36.75 deduction of payments for syringes, will
2005, as shown in the following table.
Paricalcitol ..............................
$5.37 reach $246 million for Epogen provided
For purposes of this proposed rule, we
Sodium_ferric_glut ..................
$8.23 in hospital-based facilities, and $2.850
Alteplase, Recombinant ..........
$38.82 million for drugs provided in
have used the latest ASP pricing
Vancomycin ............................
$5.55
available, which are second quarter
independent facilities ($1.960 million
prices. For the final rule, we will have
for Epogen and $890 million for other
* Statutory rate.
prices for all 4 quarters of CY 2005 and
drugs). We note that all other drugs
(4) Dialysis Treatments
plan to develop prices representing the
provided in hospital-based ESRD
average CY 2005 ASP payments for the
We updated the number of dialysis
facilities continue to be paid at cost.
drugs listed in Table 20 below.
treatments by the actuarial projected
(6) Add-On Calculation and Budget
growth in the number of ESRD
Neutrality
TABLE 20.
beneficiaries. Since Medicare covers a
maximum of three treatments per week,
For each of the top 10 drugs (as
Second quar- utilization growth is limited, and,
Drugs
ter ASP +6
explained below), we calculated the
therefore, any increase in the number of
percent
percent by which ASP +6 percent is
treatments should be due to beneficiary
projected to be less than payment
Epogen ...................................
$9.25 enrollment. In CY 2005, we estimate
amounts under the 95 percent of AWP
Calcitriol ..................................
$0.86 there will be a total of 34.5 million
pricing system for CY 2005. For Epogen,
Doxercalciferol ........................
$2.78 treatments performed. We note that this
this amount is 7.5 percent. We applied
Iron_dextran ............................
$11.22
represents the most current actuarial
Iron_sucrose ...........................
$0.37
this 7.5 percent figure to the total
projection and differs slightly from the
Levocarnitine ..........................
$11.12
aggregate drug payments for Epogen in
Paricalcitol ..............................
$3.97 projection published in the November,
hospital-based facilities, resulting in a
15, 2004 final rule. (69 FR 66323)
Sodium_ferric_glut ..................
$4.73
difference of $18 million.
Alteplase, Recombinant ..........
$30.09
We then calculated a weighted
Vancomycin ............................
$3.19 (5) Drug Payments
average of the percentages by which
We updated the total aggregate
ASP +6 percent would be below 95
(3) Estimated Medicare Payments Using Epogen drug payments for both
percent of AWP payment prices, for the
hospital-based and independent
95 Percent of AWP
top 10 ESRD drugs for independent
facilities by using historical trend
In order to estimate AWP payments
facilities. We weighted these
factors. For CY 2004 and CY 2005, the
we used the first quarter 2005 AWP
percentages by using the CY 2005
CY 2003 payment level was increased
prices and updated them to the second
estimated Medicare payment amounts
quarter by applying, for drugs other than each year by trend factor of 9.0 percent.
Using the 9 percent growth factor for
for the top 10 drugs. This procedure
EPO, an estimated AWP quarterly
Epogen, we updated the aggregate
resulted in a weighted average payment
growth of approximately 0.74 percent
spending for separately billable drugs,
reduction of 12 percent. We note that in
(annual growth factor of 3 percent). This
other than EPO, for independent
the previous calculation for the CY 2005
growth factor is based on historical
facilities. Aggregate payments in this
add-on adjustment, we had used CY
trends of AWP pricing (for all drugs) for
2002 values from the OIG. (See Table 22
the year 1997–2003. We did not increase category show extremely varied growth
between 2000 and 2003, and, for this
for the calculated drug weights, and
the payment rate for Epogen since
reason, we felt that trend analysis was
Table 23 for the percentage by which
payment was maintained at $10.00 per
not sufficient. Therefore, we believe it
ASP prices are lower than AWP prices.)
thousand units prior to MMA. (See
would be reasonable to correlate the
The CY 2003 data projected forward to
Table 21.)
growth of Epogen and separately
CY 2005 indicated a significant drop in
billable drugs in an independent
payments for drugs other than Epogen
TABLE 21.
facility, since Epogen constitute the
that are provided in an independent
largest amount of drugs dispensed in an facility. This trend, which we expect
AWP rates
independent facility. Additionally, we
for the secwill continue when we obtain CY 2004
Drugs
ond quarter
deducted 50 cents for each
historical data for the final rule,
of 2005
administration of Epogen from the total
decreases the weights of the drugs, other
than Epogen and increases the weight of
Epogen ...................................
$10.00 * Epogen spending for both hospitalEpogen. The overall effect is to lower
Calcitriol ..................................
$1.40 based and independent facilities, to
the weighted average by several
Doxercalciferol ........................
$3.11 account for spending on syringes that
Iron_dextran ............................
$18.04 were included in the EPO payments
percentage points.
(hospital-based versus independent).
We also used the number of dialysis
treatments performed by these two types
of facilities over the same period.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
TABLE 21.—Continued
Frm 00029
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
45792
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 22.
CY 2005 estimated drug
payments as
a percentage
of total drug
expenditures
(percent)
Drugs
Epogen .........................................................................................................................................................................
Calcitriol .......................................................................................................................................................................
Doxercalciferol .............................................................................................................................................................
Iron_dextran .................................................................................................................................................................
Iron_sucrose ................................................................................................................................................................
Levocarnitine ................................................................................................................................................................
Paricalcitol ....................................................................................................................................................................
Sodium_ferric_glut .......................................................................................................................................................
Alteplase, Recombinant ...............................................................................................................................................
Vancomycin .................................................................................................................................................................
CY 2002 OIG
drug payments as a
percentage of
total drug expenditures
(percent)
78.83
0.13
1.74
0.38
0.71
0.89
17.37
0.53
0.18
0.24
67.85
1.22
1.28
0.65
5.00
1.68
15.90
6.03
0.19
0.20
* Compared to the $10.00 statutory price.
TABLE 23.
Drugs
Percent by
which ASP+6
percent rates
are below 95
percent of
AWP prices
(except EPO)
(percent)
b. Calculation of the Proposed CY 2006
Update to the Drug Add-On Adjustment
* 7.5
This section describes the approach
38.7
that we are proposing to use to update
10.6
37.8 the drug add-on adjustment.
Epogen ...................................
Calcitriol ..................................
Doxercalciferol ........................
Iron_dextran ............................
Iron_sucrose ...........................
Levocarnitine ..........................
Paricalcitol ..............................
Sodium_ferric_glut ..................
Alteplase, Recombinant ..........
Vancomycin ............................
45.1
69.7
26.0
42.6
22.5
42.6
* Compared to the $10.00 statutory price.
We estimate that these ten drugs
represent nearly 92 percent of total CY
2005 drug payments to independent
facilities. To account for the drug spread
related to the 8 percent of drug
expenditures for which we do not have
pricing data, we applied the weighted
average to 100 percent of aggregate drug
spending projections for independent
facilities, producing a projected
difference of $343 million. The
weighted average is applied to 100
percent of drug spending projections for
independent facilities to account for the
drug spread related to the 8 percent of
drugs expenditures for which we do not
have pricing data.
We combined the CY 2005 figures of
$18 million for the hospital-based
facilities and $343 million for the
independent facilities, for a total of $362
million. We distributed this over a total
projected 34.5 million treatments
resulting in a revised CY 2005 add-on to
the per treatment composite rate of 8.1
percent. By making this adjustment to
the composite rate, we estimate that the
aggregate payments to both independent
VerDate jul<14>2003
20:18 Aug 05, 2005
and hospital-based ESRD facilities
would be budget neutral with respect to
drug payments for CY 2005, as required
by the MMA. We note that this 8.1
percent adjustment replaces the current
8.7 percent adjustment for CY 2005 in
our calculations.
Jkt 205001
(1) Drug Payments and Dialysis
Treatments
Similar to the process discussed in
the previous section, we updated the
total aggregate Epogen drug payments
for each hospital-based and
independent facility using historical
trend factors. For CY 2006, the payment
level was increased from CY 2005 by a
trend factor of 9.0 percent.
We also updated aggregate spending
for separately billable drugs, other than
EPO, for independent facilities using the
9 percent growth factor for Epogen. As
discussed earlier, payments in this
category have shown extremely varied
growth in recent history and historical
data between CY 2002 and CY 2003
showed a significant drop in aggregate
spending. We felt it was reasonable to
use trend analysis and correlate the
growth of Epogen and other separately
billable drugs. We expect that we will
have further data for the final rule. This
procedure resulted in projected
expenditures of $268 million for Epogen
provided in hospital-based facilities and
$3.107 million for drugs provided in
independent facilities ($2.137 million
for Epogen and $970 million for other
drugs). These numbers include an
estimated reduction for the 50 cent
payment for syringes of $1.6 million for
hospital-based facilities and $27.5
million for independent facilities. We
PO 00000
Frm 00030
Fmt 4701
Sfmt 4702
also updated the projected number of
dialysis treatments using CMS actuarial
enrollment projections. This resulted in
a projected 35.4 million treatments for
CY 2006.
(2) Adjustment to Composite Rate AddOn
We then applied the 9 percent growth
between projected CY 2005 and CY
2006 aggregate drug expenditures to the
CY 2005 expected drug spread figures of
$18 million for Epogen provided in
hospital-based facilities and $343
million for drugs provided in
independent facilities. This resulted in
an incremental increase in the drug
spread in CY 2006 of $2 million for
Epogen provided in hospital-based
facilities and $31 million for drugs
provided in independent facilities. We
distributed the combined $33 million
over 35.4 million projected treatments,
resulting in an additional 0.7 percent
addition to the CY 2005 add-on of 8.1
percent.
(3) Proposed Drug Add-On Adjustment
for CY 2006
With the recalculated CY 2005 add-on
to the per treatment composite rate
being 8.1 percent and with the
additional increment for expenditures
in CY 2006 being 0.7 percent, we
combine them to produce one drug addon adjustment for CY 2006 that would
be 8.9 percent.
(4) Add-On for Spread for Drugs
Furnished in Hospital-Based Facilities
In its June 2005 Report to Congress,
MedPAC recommended that payment
differences be eliminated for separately
billed drugs furnished in independent
and hospital-based facilities and that all
these drugs be paid under the ASP +6
percent system. While we agree with
MedPAC that paying the same rates in
both settings would be the preferable
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
policy, we have not proposed this
policy because data on dosing units for
drugs furnished by hospital-based
facilities are not available. This data is
needed to estimate the drug payments
using ASP +6 percent pricing. That is a
key component of the calculation of the
drug add-on adjustment. In their report,
MedPAC acknowledges these data
issues and recommends that CMS take
steps to collect data on acquisition costs
and payment per unit for drugs
provided in hospital-based ESRD
facilities. We are currently examining
approaches for obtaining these data.
However, we seek comment about a
potential method to estimate the drug
add-on amount for drugs furnished in
hospital-based facilities, and we seek
comment about alternative estimation
methodologies, data, or both.
One estimation approach could be an
approach where the pricing spread for
drugs other than EPO furnished in
hospital based facilities would be
assumed to be the same as for those
drugs in independent facilities. This
aggregate approach would assume that
the add-on amount for drugs other than
EPO furnished in hospital-based
facilities results in the same relative
amount of drugs furnished as for those
drugs in independent facilities. Using
aggregate ratios, the drug add-on
amounts calculated for drugs other than
EPO furnished in independent facilities
might be extrapolated for drugs other
than EPO furnished in hospital-based
facilities.
Use of this approach could allow
calculation of a reasonable estimate of
aggregate drug add-on amount for drugs
other than EPO furnished in hospitalbased facilities until the time that data
becomes available to more accurately
calculate the drug add-on adjustment.
This approach would allow payment of
all drugs furnished in hospital-based
facilities under the ASP +6 percent
payment methodology, achieve
consistent payments for ESRD
separately billed drugs regardless of
setting, and provide a reasonable
estimation of the drug add-on amount
needed to adjust the composite rates for
drugs other than EPO furnished in
hospital-based facilities. We seek
comment about this potential method to
estimate spread for drugs furnished in
hospital-based facilities, as well as
alternative estimation methodologies,
data, or both.
3. Proposed Revisions to Geographic
Designations and Wage Indexes Applied
to the ESRD Composite Payment Rate
[If you choose to comment on issues in
this section, please include the caption
‘‘ESRD-Composite Payment Rate Wage
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Index’’ at the beginning of your
comments.]
Because of the significance of labor
costs in determining the total cost of
care, the prospective payment systems
(PPSs) which we administer
traditionally have used a wage index to
account for differences in area wage
levels. The labor-related shares of costs
used to develop the composite rates
were 36.78 percent for hospital-based
facilities and 40.65 percent for
independent facilities. The current
composite payment rates are calculated
using a blend of two wage indexes, one
based on hospital wage data for fiscal
years ending in CY 1982, and the other
developed from CY 1980 data from the
Bureau of Labor Statistics (BLS). The
wage indexes are calculated for each
urban and rural area based on 1980 U.S.
Census definitions of metropolitan
statistical areas (MSAs) or their
equivalents, and areas outside of MSAs
in each State, respectively. (51 FR
29411)
Section 4201(a)(2) of OBRA 1990
(Pub. L. 101–508) froze the composite
payment rates, and the basis for their
calculation, at the level in effect as of
September 30, 1990 (except for
subsequent statutory updates that did
not affect the data used to calculate
wage indexes). The OBRA 1990
restriction on revising the ESRD
composite payment rates has had
another effect. ESRD facilities located in
counties classified as rural based on the
1980 Census, but which subsequently
are classified as urban, are still
considered rural for purposes of
determining whether urban or rural
composite payment rates apply. The
rural rates are generally lower than
those for urban ESRD facilities.
In addition, restrictions also apply to
the wage index values used to compute
the ESRD composite payment rates.
Payments to facilities in areas where
labor costs fall below 90 percent of the
national average, or exceed 130 percent
of that average, are not adjusted beyond
the 90 percent or 130 percent level. (See
the Prospective Reimbursement for
Dialysis Services and Approval of
Special Purpose Renal Dialysis
Facilities final rule (48 FR 21254) and
the Composite Rates and Methodology
for Determining the Rates final notice
(51 FR 29404)). This effectively means
that ESRD facilities located in areas
with wage index values less than 0.9000
are paid more than they would
otherwise receive if we fully adjusted
for area wage differences. Conversely,
facilities in locales with wage index
values greater than 1.3000 are paid less
than they would receive if we fully
PO 00000
Frm 00031
Fmt 4701
Sfmt 4702
45793
adjusted the rates based on actual wage
levels.
Section 1881(b)(12)(D) of the Act, as
amended by section 623(d) of the MMA,
gave the Secretary the discretionary
authority to revise the current wage
index. That provision also requires that
any revised measure be phased-in over
a multiyear period. In the November 15,
2004 final rule establishing new casemix adjusted composite payment rates
(69 FR 66332), we stated that we were
deferring replacing the current wage
index pending further assessment. We
have completed our review, and believe
that modernizing the current ESRD
wage index is a matter of some urgency.
After further analysis we are proposing
to use OMB’s revised geographic
definitions announced in OMB Bulletin
No. 03–04, issued June 6, 2003. These
new definitions are known as CoreBased Statistical Areas (CBSAs). In
conjunction with the CBSAs, we are
also proposing to recalculate the ESRD
wage indexes based on acute care
hospital wage and employment data for
FY 2002, as reported to us in connection
with the development of the wage index
used in the inpatient hospital
prospective payment system (IPPS). In
addition, we are also proposing to
update the labor portion of the ESRD
composite rate to which the wage index
is applied. The basis for our proposed
revisions to the current ESRD composite
rate wage index to reflect these changes
is set forth in the following sections.
a. Current Urban and Rural Locales
Based on MSAs
We currently adjust the labor-related
share of the composite payment rates to
account for differences in area wage
levels using a wage index which is a
blend of two wage index values, one
based on hospital wage data from FY
1982, and the other developed from
1980 hospital data from the BLS. The
hospital and BLS proportions of the
blended wage index are 40 percent and
60 percent, respectively. The hospital
and BLS wage index values used to
compute the blended wage index were
published in the Federal Register on
August 15, 1986 (51 FR 29412).
The use of a blended wage index
results from our effort to transition
ESRD facilities from composite payment
rates using a wage index based on BLS
data, to one developed from hospital
wage and employment data obtained
from Medicare cost reports (‘‘the
hospital wage index’’). A major
limitation of the BLS wage index was its
inability to distinguish area differences
in the use of part-time hospital workers.
In order to mitigate the impact of
changes in facility payment rates as a
E:\FR\FM\08AUP2.SGM
08AUP2
45794
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
result of our adoption of the new
hospital wage index, we began a fiveyear phase-in of the new measure.
During the phase-in period, we had
intended to use a weighted wage index,
under which the BLS portion would
decrease 20 percent and the share
represented by the hospital wage index
would increase 20 percent each year.
During the second year of the phase-in,
for which the hospital and BLS portions
of the wage index were 40 percent and
60 percent, respectively, the wage index
was frozen as a result of the OBRA 1990
prohibition on composite payment rate
revisions.
The wage indexes are calculated for
each urban and rural area. In general, an
urban area is a MSA or New England
County Metropolitan Area as defined by
OMB based on 1980 U.S. Census
definitions. A rural area consists of all
counties within each State outside of an
urban area. The counties which
comprise the urban locales currently
used to compute the wage index values
incorporated in the urban composite
payment rates were last published in the
Federal Register on May 30, 1986 (51
FR 19738–19739). Although OMB has
revised the definitions of the MSAs
since that time, the composite payment
rate urban/rural designations have not
been changed due to the prohibition on
revising the ESRD payment
methodology established under section
4201(a)(2) of OBRA 1990. More current
MSAs are used in connection with
several other non-acute care Medicare
PPSs that we administer, including
those for SNFs, long-term care hospitals
(LTCHs), inpatient psychiatric facilities
(IPFs), home health agencies (HHAs),
and inpatient rehabilitation facilities
(IRFs).
b. Revision of Geographic
Classifications
On June 6, 2003, OMB issued Bulletin
03–04 that announced new geographic
area designations based on the 2000
Census. The bulletin established revised
definitions for the nation’s MSAs,
designated county based Metropolitan
Divisions within the MSAs that have a
single core with a population of at least
2.5 million, created two new sets of
statistical areas (Micropolitan Statistical
Areas and Combined Statistical Areas),
and defined New England City and
Town Areas. The bulletin may be
accessed on the Internet at: https://
www.whitehouse.gov/omb/bulletins/
bo3–04.html.
Section 623 of the MMA gave the
Secretary the authority to revise the
geographic areas used to develop the
wage indexes currently reflected in the
composite payment rates, removing the
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
OBRA 1990 restriction. Although we
published revised composite payment
rates in the November 15, 2004 final
rule implementing MMA mandated
revisions to those rates, we did not
propose revising the wage indexes, or
the geographic areas on which they are
based at that time. For reasons
discussed below, we are proposing to
use OMB’s list of geographic
designations for purposes of adjusting
the urban and rural composite payment
rates. Facilities located in counties
within MSAs or Metropolitan Divisions
within CBSAs would be considered
urban, while facilities located in
micropolitan counties or other counties
outside of the CBSAs would be
classified as rural. We point out that
these are the same urban and rural
definitions used in connection with the
Medicare IPPS, and are discussed in the
August 11, 2004 final rule establishing
the IPPS FY 2005 payment rates (69 FR
49026).
c. Core-Based Statistical Areas (CBSAs)
OMB reviews its metropolitan area
definitions preceding each decennial
census. As explained in the August 11,
2004 IPPS final rule (69 FR 49026),
OMB chartered the Metropolitan
Standards Review Committee to
examine the metropolitan area
standards and develop
recommendations for possible changes
to those standards. Three notices related
to the review of the standards, providing
an opportunity for public comment on
the recommendations of the Committee,
were published in the Federal Register
on December 21, 1998 (63 FR 70526),
October 20, 1999 (64 FR 56628), and
August 22, 2000 (65 FR 51060).
In the December 27, 2000 Federal
Register (65 FR 82228), OMB published
a notice announcing its new standards.
According to that notice, OMB defines
a CBSA beginning in 2003 as ‘‘a
geographic entity associated with at
least one core of 10,000 or more
population, plus adjacent territory that
has a high degree of social and
economic integration with the core as
measured by commuting ties.’’ The
standards designate and define two
categories of CBSAs: MSAs and
Micropolitan Statistical Areas (65 FR
82235).
According to OMB, MSAs are based
on urbanized areas of 50,000 or more
population, and Micropolitan Statistical
Areas (referred to hereafter as
Micropolitan Areas) are based on urban
clusters with at least 10,000, but less
than 50,000 population. Counties that
do not fall within CBSAs are deemed
‘‘Outside CBSAs’’. Previously OMB
defined MSAs around areas with a
PO 00000
Frm 00032
Fmt 4701
Sfmt 4702
minimum core population of 50,000,
and smaller areas were ‘‘Outside
MSAs’’. On June 6, 2003 OMB
announced the new CBSAs, consisting
of MSAs and the new Micropolitan
Areas based on the results of the 2000
Census.
d. Adoption of MSAs as Urban Areas for
Composite Payments
In its June 6, 2003 announcement,
OMB cautioned that its new
metropolitan area definitions ‘‘should
not be used to develop and implement
Federal, State, and local nonstatistical
programs and policies without full
consideration of the effects of using
these definitions for these purposes.
These areas should not serve as a
general purpose geographic framework
for nonstatistical activities, and they
may or may not be suitable for use in
program funding formulas.’’
We point out that Medicare’s PPSs,
including the ESRD composite payment
rate, historically have used the
metropolitan area definitions developed
by OMB. While the hospital IPPS is the
most significant of these, the OMB
geographic designations are also used to
define labor market areas for purposes
of recognizing area differences in labor
costs under the SNF, inpatient
rehabilitation, IPFs, and home health
PPSs. In discussing the adoption of the
OMB geographic designation for the
IPPS area labor adjustment, the FY 1985
IPPS proposed rule published July 3,
1984 (49 FR 27426) noted as follows:
[i]n administering a national payment
system, we must have a national
classification system built on clear, objective
standards. Otherwise the program becomes
increasingly difficult to administer because
the distinction between rural and urban
hospitals is blurred. We believe that the MSA
system (developed by OMB) is the only one
that currently meets the requirements for use
as a classification system in a national
payment program. The MSA classification
system is a statistical standard developed for
use by Federal agencies in the production,
analysis, and publication of data on
metropolitan areas. The standards have been
developed with the aim of producing
definitions that will be as consistent as
possible for all MSAs nationwide.
The logic represented in the statement
above still applies today. The process
used by OMB to develop the geographic
designations resulted in the creation of
geographic locales that we believe also
reflect the characteristics of unified
labor market areas. The CBSAs contain
a core population plus adjacent areas
that reflect a high degree of social and
economic integration. This integration is
measured by commuting patterns, thus
demonstrating that the areas likely draw
workers from the same general locale. In
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
addition, the CBSAs reflect the most upto-date information, based on the 2000
Census. OMB reviews its metropolitan
area definitions preceding each
decennial census to ensure
consideration of the most recent
population changes. Finally, in the
context of the IPPS, we have reviewed
alternative methods for determining
geographic areas for purposes of the
wage index. In each case, we have
concluded that it was preferable to
retain the independently developed
OMB designations rather than replace
them with alternatives. (See the August
11, 2004 final IPPS rule at 69 FR 49027–
49028.)
Aside from the long established
precedent of using OMB geographic
designations to adjust for differing area
wage levels in the PPSs that we
administer, we also point out that the
Congress has recognized the propriety of
the OMB definitions in distinguishing
among geographic areas for making
Medicare payments. For example,
section 1886(d)(2)(D) of the Act defines
an ‘‘urban area’’ as ‘‘an area within a
MSA (as defined by the OMB) or within
a similar area as the Secretary has
recognized.’’ Similarly, in the sections
of the Act governing the guidelines to be
used by the Medicare Geographic
Classification Review Board for hospital
reclassification, the Congress directed
the Secretary to create guidelines for
‘‘determining whether the county in
which the hospital is located should be
treated as being a part of a particular
[MSA]’’. (See sections 1886(d)(10)(A)
and (D)(i)(II) of the Act.) The Congress
has accepted the use of MSAs as a
reasonable basis for dividing the nation
into labor market areas for purposes of
Medicare payments. Accordingly, we
are proposing to revise the ESRD
composite payment system labor market
areas based on OMB’s geographic
designations. Facilities located in
counties within MSAs (including those
in the MSA category of CBSA) would be
classified as urban. We are proposing
that facilities located in Micropolitan
Areas (the other category of CBSA) or in
other counties outside of CBSAs in each
State, would be considered rural.
e. Revised OMB Geographic Areas
In the following sections we discuss
the classification of facilities located in
New England MSAs, within
Metropolitan Divisions of MSAs, and
our proposed treatment of the CBSA
classification of Micropolitan Areas.
(1) New England MSAs
Under the current composite payment
system, urban areas in New England
reflect county-based locales known as
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
New England County Metropolitan
Areas (NECMAs), rather than MSAs. We
use NECMAs in New England to
provide consistency in labor market
definitions compared to the MSAs used
in the rest of the country, which are also
based on counties. Under the new
CBSAs, OMB has defined MSAs and
Micropolitan Areas in New England on
the basis of counties. OMB has also
established a new classification, New
England City and Town Areas
(NECTAs), which are similar to the
previous New England MSAs, but
which are not used in the geographic
area revisions proposed in this proposed
rule.
In the interest of consistency among
all urban labor market areas, we are
proposing to use the county-based
definitions for all MSAs in the nation.
As a result of the 2000 Census, we now
have county-based MSAs in New
England. We believe that adopting
county-based definitions for all urban
areas in the country provides
consistency and stability, and
minimizes administrative complexity in
the Medicare program. We point out
that our use of MSAs in New England
comports with the implementation of
the CBSA designations under the IPPS
for New England urban locales. (See the
August 11, 2004 Federal Register, 69 FR
49208.) Accordingly, under the revised
composite payment rates discussed in
this proposed rule, we are proposing to
use New England MSAs along with
MSAs in the rest of the nation to define
urban areas. As a result, urban locales
in New England would no longer be
based on NECMAs.
(2) Metropolitan Divisions
Under OMB’s new CBSA
designations, a Metropolitan Division is
a county or group of counties within a
CBSA that contains a core population of
at least 2.5 million, representing an
employment center, plus adjacent
counties associated with the main
county or counties through commuting
ties. A county qualifies as a main county
if 65 percent or more of its employed
residents work within the county, and
the ratio of the number of jobs located
in the county to the number of
employed residents is at least 75
percent. A county qualifies as a
secondary county if at least 50 percent,
but less than 65 percent, of its employed
residents work within the county, and
the ratio of the number of jobs located
in the county to the number of
employed residents is at least 75
percent. After all the main and
secondary counties are identified and
grouped, each additional county that
already has qualified for inclusion in
PO 00000
Frm 00033
Fmt 4701
Sfmt 4702
45795
the MSA falls within the Metropolitan
Division associated with the main or
secondary county or counties with
which the county at issue has the
highest employment interchange
measure. Counties in a Metropolitan
Division must be contiguous (See the
December 27, 2000 Federal Register,
Standards for Defining Metropolitan and
Micropolitan Statistical Areas, (65 FR
82236)).
Under the CBSA definitions, there are
11 MSAs containing Metropolitan
Divisions: Boston; Chicago; Dallas;
Detroit; Los Angeles; Miami; New York;
Philadelphia; San Francisco; Seattle;
and Washington, DC. We believe that
these MSAs may be too large to
accurately reflect the local labor costs
prevailing within each of these areas.
For example, the Chicago-NapervilleJoliet IL-IN-WI MSA consists of 14
counties classified among 3
Metropolitan Divisions: ChicagoNaperville-Joliet IL (8 counties); Lake
County-Kenosha County IL-WI (2
counties); and Gary IN (4 counties).
Similarly, the New York-Newark-Edison
NY-NJ-PA MSA consists of 23 counties
classified among 4 Metropolitan
Divisions: New York-Wayne-White
Plains NY-NJ (11 counties); NewarkUnion NJ-PA (6 counties); Edison NJ (4
counties); and Suffolk County-Nassau
County NY (2 counties). Accordingly,
for the 11 MSAs with Metropolitan
Divisions, we are proposing to use the
Metropolitan Division as the urban area
for purposes of constructing the wage
index and applying revised composite
payment rates.
We believe that the proposed use of
Metropolitan Divisions would result in
a more accurate adjustment accounting
for local variation in labor costs within
each of the 11 MSAs with those
Divisions. We are proposing to
recognize each county-based
Metropolitan Division within the 11
affected MSAs as a separate urban area
for purposes of applying revised
composite payment rates. Each
Metropolitan Division would have its
own wage index and its own urban
composite payment rate. This proposed
methodology is consistent with the new
CBSA-based labor market definitions
under the IPPS. (See the August 11,
2004 Federal Register, 69 FR 49029.)
(3) Micropolitan Statistical Areas
In its June 6, 2003 bulletin, OMB also
designated another classification of
metropolitan area, Micropolitan
Statistical Areas, which we will refer to
as Micropolitan Areas. That bulletin
listed 565 Micropolitan Areas. Of the
3142 counties in the United States, 1090
are in MSAs and 674 are in
E:\FR\FM\08AUP2.SGM
08AUP2
45796
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Micropolitan Areas, with the remaining
1378 outside of either classification. As
discussed in greater detail in the August
11, 2004 IPPS final rule (69 FR 49029–
49032), the way that Micropolitan Area
counties are classified in connection
with developing revised wage indexes
has a substantial impact on the wage
index adjustment. Specifically, whether
or not Micropolitan Areas are included
in computing the statewide rural wage
indexes has a significant effect on the
rural wage index in any State that
contains these locales. Consistent with
the IPPS final rule, we are proposing
that each Micropolitan Area county
continue to be considered part of each
State’s rural labor market area. That is,
we would continue to classify all
Micropolitan counties as rural.
To facilitate an understanding of our
proposed policies relating to the
revisions to the ESRD facility labor
market areas discussed in this proposed
rule, we have provided addendum F in
the Addendum section to this proposed
rule. Addendum F is a crosswalk table
that contains a listing of each SSA State
and county location code; state and
county name; existing 1980 MSA based
labor market area designation; and
CBSA-based labor market area.
Addendum F also contains the new
wage indexes for each urban and rural
area.
f. Proposed Revisions to the Labor
Component of the Composite Rate
The current labor-related portions of
the hospital-based and independent
composite payment rates (in other
words, the portion adjusted by each
facility’s area wage index) are 36.78
percent and 40.65 percent, respectively.
These labor-related shares have not been
revised since the inception of the ESRD
composite payment system in 1983.
When the composite rates were
established in 1983, we developed the
labor-related share of the rate based on
1978 and 1979 cost data collected from
110 ESRD facilities; 40 independent and
70 hospital-based. For other PPSs
administered by us, the labor-related
shares are determined based on the
labor components established in the
relevant market baskets for each
provider type.
The basis for determining the current
labor shares is based on outdated data
from very few facilities relative to the
current number of ESRD facilities (110
versus approximately 4300 facilities).
We are proposing to establish a single
labor-related share applicable to all
ESRD facilities based on the laborrelated categories included in the ESRD
composite rate market basket. This
change will bring the methodology for
the ESRD composite rate labor-related
share more in line with that for
determining the labor-related shares for
other Medicare PPSs.
(1) ESRD Composite Rate Market Basket
In the following sections, we present
a brief background on market baskets,
provide a reference to the detailed
methodology used to develop the ESRD
composite rate market basket, and
outline the methodology used to
determine the proposed ESRD labor
share.
As required by section 422(b) of the
Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection
Act of 2000 (BIPA), Pub. L. 106–554, we
developed an ESRD composite rate
market basket. Each of the PPSs that we
administer utilizes a market basket that
reflects each type of provider’s
production patterns used to furnish
patient care. The market baskets capture
the rate of price inflation for a fixed
quantity of inputs (both goods and
services used to provide medical
services) relative to a base year. Each of
the PPS market baskets distinguishes
between labor-related and non-labor
costs. Similar to other PPSs, we believe
the ESRD composite rate market basket
index is an appropriate measure for
revising the labor-related portion of the
composite payment rate. The detailed
methodology used to develop the ESRD
composite rate market basket, including
data sources, cost categories, and price
proxies, is set forth in the Secretary’s
May 2003 report to the Congress,
Toward a Bundled Outpatient Medicare
ESRD Prospective Payment System.
That report is available on the Internet
at https://qa.cms.hhs.gov/providers/esrd
and we recommend it to interested
readers. We used CY 1997 as the base
year for the development of the ESRD
composite rate market basket cost
categories. Source data included CY
1997 Medicare cost reports (Form CMS–
265–94), supplemented with 1997 data
from the U.S. Department of Commerce,
Bureau of the Census’ Business
Expenditure Survey (BES). Analysis of
Medicare cost reports for CYs 1996,
1997, 1998, and 1999 showed little
difference in cost weights compared to
CY 1997. Medicare cost reports from
independent ESRD facilities were used
to construct the market basket because
data from independent ESRD facilities
tend to reflect the actual cost structure
faced by the ESRD facility itself, and are
not influenced by the allocation of
overhead over the entire institution as
in hospital-based facilities. This
approach is consistent with our
standard methodology used in the
development of other market baskets,
particularly those used for updating the
SNF and home health PPSs. We expect
that the cost structure in both hospitalbased and independent ESRD facilities
and units would be similar. Therefore,
we are proposing to base the laborrelated share of the composite payment
rates on data from freestanding facilities
only.
In Table 24, we have reproduced
Table 2 from the May 2003 report to the
Congress containing the ESRD
composite rate market basket cost
categories, weights, and price proxies in
this proposed rule. This table lists all of
the expenditure categories in the ESRD
composite rate market basket.
TABLE 24.—ESRD COMPOSITE RATE MARKET BASKET COST CATEGORIES, WEIGHTS, AND PRICE PROXIES
Cost category
Price/wage variable
Total .............................................................................................
Compensation ..............................................................................
Wages and Salaries ..............................................................
Employee Benefits ................................................................
Professional Fees ........................................................................
Utilities ..........................................................................................
Electricity ...............................................................................
Natural Gas ...........................................................................
Water and Sewerage ............................................................
All Other .......................................................................................
.....................................................................................................
.....................................................................................................
ECI—Health Care Workers .........................................................
ECI—Benefits Health Care Workers ..........................................
ECI—Compensation Prof. & Tech. (Priv.) ..................................
.....................................................................................................
WPI—Commercial Electric Power ..............................................
WPI—Commercial Natural Gas ..................................................
CPI—Water & Sewage ...............................................................
.....................................................................................................
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00034
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
Base-year:
CY 1997
weights (percent)
100.000
47.388
38.808
8.580
0.903
1.524
0.818
0.113
0.593
36.156
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
45797
TABLE 24.—ESRD COMPOSITE RATE MARKET BASKET COST CATEGORIES, WEIGHTS, AND PRICE PROXIES
Cost category
Price/wage variable
Pharmaceuticals ....................................................................
Supplies ................................................................................
Labs ......................................................................................
Telephone .............................................................................
Housekeeping and Operations .............................................
Administrative and Other Costs ............................................
Capital Costs ................................................................................
Capital Related—Building and Equipment ...........................
Capital Related—Machinery .................................................
WPI—Prescription Drugs ............................................................
PPI—Surgical, Medical and Dental* ...........................................
PPI—Medical Labs .....................................................................
CPI—Telephone Services ...........................................................
PPI—Building, cleaning, and maintenance ................................
CPI—All items less food and energy ..........................................
.....................................................................................................
CPI—Residential Rent ................................................................
PPI—Electrical Machinery and Equipment .................................
The labor-related share of a market
basket is determined by identifying the
national average proportion of operating
costs that are related to, influenced by,
or vary with the local labor market. The
labor-related share is typically the sum
of wages and salaries, fringe benefits,
professional fees, labor-intensive
services, and a portion of the capital
share from the appropriate market
basket.
We used the 1997-based ESRD
composite rate market basket costs to
determine the proposed labor-related
share for ESRD facilities. The proposed
labor-related share for ESRD facilities is
53.711, as shown in Table 25. It is the
sum of wages and salaries, employee
benefits, professional fees,
housekeeping and operations, and 46
percent of the weight for capital-related
building and equipment (the portion of
capital that we have determined to be
influenced by local labor markets). The
following section describes each of the
categories that make up the proposed
labor-related share for the ESRD
composite rate payment system and
how they were derived.
(2) Wage and Salaries
The wages and salaries weight for the
ESRD composite rate labor-related share
includes salaries for both direct and
indirect patient care. We computed a
weight for wages and salaries for direct
patient care from Worksheet B of the
Medicare cost report. However,
Worksheet B only includes direct
patient care salaries. We had to derive
an estimate for non-direct patient care
salaries in order to calculate the market
basket weight. We first computed the
ratio of salaries to total cost in each cost
center from the trial balance of the cost
report (Worksheet A). We applied these
ratios to the costs reported on
Worksheet B for the corresponding cost
centers to obtain the total wages and
salaries for each composite rate cost
center. These salaries were then
summed and added to the direct patient
care salary amount that is reported
separately. When divided by total
composite rate costs, the result is a cost
weight for total salaries. This increased
the expenditure weight from 34.154
percent for direct patient care salaries to
38.808 percent for total salaries.
(3) Employee Benefits
TABLE 25.—PROPOSED ESRD COMThe benefits weight was derived from
POSITE
RATE
LABOR-RELATED
the BES since a benefit share for all
SHARE
Cost category
Proposed CY
1997-based
ESRD composite rate
labor share
(percent)
Wages and salaries ................
Employee benefits ..................
Professional fees ....................
Housekeeping and operations
38.808
8.580
0.903
1.247
SUBTOTAL ......................
49.538
Labor-related share of capital
costs ....................................
4.173
Total .................................
53.711
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
employees is not available for the ESRD
Medicare cost reports. The cost reports
only reflect benefits for direct patient
care. We applied the benefits proportion
of wages and salaries for kidney dialysis
centers from the BES to the salary
amount calculated from the cost reports
as described above. This resulted in a
benefit weight that was 1.758 percentage
points larger (8.850 versus 6.822) than
the benefits for direct patient care
calculated from the cost reports. To
avoid double counting and to ensure all
of the market basket weights still totaled
100 percent, we removed this additional
1.758 percentage points for benefits
from pharmaceuticals, administrative
and general, supplies, laboratory
PO 00000
Frm 00035
Fmt 4701
Sfmt 4702
Base-year:
CY 1997
weights (percent)
0.967
17.748
0.433
0.875
1.247
14.886
14.029
9.071
4.957
services, housekeeping and operations,
and the capital components. This
calculation reapportions the benefits
expense for each of these categories
using a method similar to the method
used for distributing non-direct patient
care salaries as described above. This
method approximates the proportion of
each cost center’s costs that are benefits
using available salary expenditure data.
(4) Professional Fees
Professional fees include accounting,
bookkeeping, and legal expenses. We
derived the weight for professional fees
from the BES since the Medicare cost
reports do not include this level of
detail. We first calculated the ratio of
BES professional fees for kidney dialysis
centers to total BES wages and salaries
for kidney dialysis centers. We applied
this ratio to the total wages and salaries
share calculated from the cost reports to
estimate the proportion of ESRD facility
professional fees. The resulting weight
was 0.903 percent. To avoid double
counting, this proportion was deducted
from the calculated weight for the
administrative and other expenditure
category, where the fees would have
been reported on the Medicare cost
reports.
(5) Housekeeping and Operations
The housekeeping and operations cost
category includes expenses such as
janitorial and building services costs.
We developed a market basket weight
for this category using data from both
Worksheets A and B of the cost reports.
Worksheet B combines the capitalrelated costs for buildings and fixtures
with the operation and maintenance of
plant (operations) and housekeeping
cost centers, so we were unable to
calculate a weight directly from
Worksheet B. Accordingly, we
computed the proportion of
housekeeping and operations costs, to
the combination of total capital-related
costs for buildings and fixtures and
housekeeping and operations costs
E:\FR\FM\08AUP2.SGM
08AUP2
45798
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
using Worksheet A because these
categories are individually reported on
this worksheet. We then subtracted this
share from the proportion of Worksheet
B total capital-related costs to yield a
weight for housekeeping and operations.
To avoid double counting, we
subtracted utilities expenditures (which
are included in the utilities weight
shown in Table 24) from the
housekeeping and operations weight, as
well as the non-direct patient care
salaries and benefits share associated
with the operations and housekeeping
cost centers from Worksheet A. The
resulting market basket weight for
housekeeping and operations was 1.247
percent.
(6) Labor-Related Share for CapitalRelated Expenses
The labor-related share for capitalrelated expenses (46 percent of ESRD
facilities’ adjusted capital-related
building and equipment expenses)
reflects the proportion of ESRD
facilities’ capital-related building and
equipment expenses that we believe
varies with local area wages.
Capital-related expenses are affected
in some proportion by local area labor
costs (such as construction worker
wages) that are reflected in the price of
the capital asset. However, many other
inputs that determine capital costs are
not related to local area wage costs, such
as interest rates. Thus, it is appropriate
that capital-related expenses would vary
less with local wages than would the
operating expenses for ESRD facilities.
The 46 percent figure is based on
regressions run for the Prospective
Payment System for Inpatient Hospital
Capital-Related Costs in 1991 (56 FR
43375).
We use a similar methodology to
calculate capital-related expenses for
the labor-related shares for
rehabilitation facilities, psychiatric
facilities, long-term care facilities, and
SNFs. (See Rehabilitation Facility
Prospective Payment System for FY
2006, Part II (70 FR 30233) and
Prospective Payment System and
Consolidated Billing for Skilled Nursing
Facilities-Update (66 FR 39585)).
Table 26 provides a comparison of the
current and proposed labor/nonlabor
portions of the ESRD base composite
rate.
TABLE 26.—COMPARISON OF THE CURRENT AND PROPOSED LABOR/NONLABOR PORTIONS OF THE ESRD BASE
COMPOSITE RATE
Hospitalbased
Independent
Base Composite Rate ..................................................................................................................................................
Current Labor Share ....................................................................................................................................................
Current NonLabor Share .............................................................................................................................................
$132.41
48.70
83.71
$128.35
52.17
76.18
Proposed Labor Share (53.711 percent) .....................................................................................................................
Proposed NonLabor Share ..........................................................................................................................................
71.12
61.29
68.94
59.41
As indicated earlier in this
discussion, the ESRD market basket was
derived from CY 1997 data. As with
other payment systems, we would
propose updating the labor share of the
composite payment when the
components of the ESRD market basket
are rebased to reflect more recent data.
g. Implementation of Revised Composite
Wage Indexes
In the section below, we explain how
each ESRD facility’s new composite
payment rate would be determined to
reflect the proposed 2 year transition,
based on section 623(d)(1) of the MMA’s
requirement that the application of any
revised geographic index be phased in
over a multi-year period.
(1) Hospital Data Used
In this proposed rule, for purposes of
adjusting the labor-related portion of the
ESRD composite rate beginning January
1, 2006, we propose to use acute care
hospital inpatient wage index data. This
data was generated from cost reporting
periods beginning FY 2002, and is the
most recent complete data available.
To determine the applicable ESRD
wage index values, we are proposing to
use the acute care hospital inpatient
wage data without regard to any
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
approved geographic reclassification
under section 1886(d)(8) or (d)(10) of
the Act, which only applies to hospitals
that are paid under the IPPS. We note
this policy is consistent with the area
wage adjustments used in all other nonacute care facility PPSs (such as, SNFs,
IPPSs, HHAs, and IRFs).
The proposed wage index values that
would be applicable to the ESRD
composite rate for services furnished on
or after January 1, 2006, are shown in
Tables 27 and 28 in this proposed rule.
(2) Labor Market Areas With No
Hospital Wage Data
In adopting OMB’s CBSA
designations, we identified a small
number of ESRD facilities in both urban
and rural geographic areas where there
were no hospitals, and, thus, no hospital
wage index data on which to base the
calculations of the FY 2006 ESRD wage
index. The first situation is rural
Massachusetts. Because there is no
reasonable proxy for rural data within
Massachusetts, we are proposing to use
last year’s acute care hospital wage
index value for rural Massachusetts.
The second situation involves ESRD
facilities in urban areas in Hinesville,
GA (CBSA 25980) and Mansfield, OH
(CBSA 31900). We propose to use a
PO 00000
Frm 00036
Fmt 4701
Sfmt 4702
wage index based on the wage indexes
in all of the other urban areas within the
state to serve as a reasonable proxy for
the urban areas without hospital wage
index data. Specifically, we are
proposing to use the average wage index
for all urban areas within the State as
the urban wage index value for purposes
of the ESRD wage index for these areas.
We solicit comments on these
approaches to calculating the wage
index values for areas without hospitals
(and, thus, without hospital wage data)
for FY 2006 and subsequent years.
(3) Use of Floor/Ceiling Values
As discussed in this preamble, the
current wage index values applied to
the labor share of the ESRD composite
payment rate are restricted at the high
and low ends with a floor of 0.9000 and
a cap of 1.3000. The effects of these
restrictions have been to overpay
facilities in low wage areas and
underpay facilities in high wage areas.
The floor and cap were originally
intended to remain in effect only until
the transition from use of BLS wage date
to hospital wage data ended. However,
since the transition was never
completed because of the statutory
restrictions discussed above in this
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
preamble, the floor and cap have
remained in effect since 1983.
The basis for the 1.3000 wage index
cap was to ensure that we did not pay
any more than the allowable reasonable
charge per treatment that was in effect
before the composite payment rate
system was implemented. Since the
allowable reasonable charge screen no
longer has any relevance to the current
composite rate, and because of the effect
it has had on restricting payment in
high cost wage areas, we are proposing
to eliminate the wage index cap.
However, because of the potential
adverse impact that removing the wage
index floor could have on access to
dialysis for ESRD beneficiaries, we are
proposing to maintain a wage index
floor at this time. We note that when we
established the 0.9000 floor beginning
in 1983, it was intended that the floor
would be phased out by the end of the
transition. Because the floor has been in
place for so long, we are concerned that
eliminating the floor entirely could
decrease payments to facilities in some
areas significantly. However, we believe
that a floor of 0.9000 may be too high
under the proposed revision to the labor
market areas, since a substantial number
of wage areas (172 out of 481 wage
areas) have wage index values less than
0.9000. The current wage areas used for
adjusting composite rate payments have
only 83 areas with wage index values
below 0.9000.
Given that the distribution of wage
index values has changed so
significantly, we are proposing to
reduce the floor to 0.8500 for CY 2006
and to 0.8000 for CY 2007 as we
transition to the new geographic areas
and wage indexes. This would result in
application of the wage index floor to
17.7 percent of facilities that would
otherwise have been subject to the
current 0.9000 floor in CY 2006 and to
10.0 percent of facilities in CY 2007. It
would also protect 86 geographic areas
at a floor of 0.8500 in CY 2006 and 36
geographic areas at a floor of 0.8000 in
CY 2007.
Although we are proposing to
maintain a wage index floor through CY
2007, our goal is to eliminate the wage
index floor in the future. Therefore, for
CY 2008 we would re-evaluate the need
for continuing the floor. We are
soliciting comment on this issue,
especially in light of the fact the any
wage index changes must be budget
neutral for aggregate payments to
facilities.
(4) Transition Period
Section 623(d) of MMA added section
1881(b)(12)(D) of the Act which requires
that any revisions to the geographic
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
adjustments applied to the composite
payment rate must be phased-in over a
multiyear period. In determining the
best approach to phasing-in the
proposed new wage index adjustments,
we considered not only the immediate
impact on payments from revising the
wage index values, but also the impact
on payments over time because of our
inability to update the wage index.
Facilities in areas where wages have
increased at a higher rate than the
national average may have been
disadvantaged by the continued use of
outdated wage data and geographic
designations to adjust the composite
payment rate.
With both of these considerations in
mind, we are proposing a two-year
transition under which facilities would
be paid the higher of the new wageadjusted composite rate, or a 50–50
blend of the current wage adjusted
composite rate and the new wageadjusted composite rate. This proposed
transition would allow facilities that
may have been disadvantaged under the
current wage index adjustment to move
immediately to the new wage
adjustment. It also provides for a
reasonable transition period for other
facilities. Given the age of the current
wage index adjustments, we believe it is
appropriate to move as quickly as
possible to the revised updated wage
adjustments. Since we are proposing to
maintain the wage index floor during
the transition period, we believe the
overall impact to facilities will be
mitigated. Also, as discussed in the
following section, the proposed budget
neutrality adjustment will ensure that
the level of aggregate payments to ESRD
facilities is maintained. We note that
our proposal to allow some facilities to
move directly to the new wage-adjusted
composite rate will have some impact
on the level of the budget neutrality
adjustment. However, we estimate that
the overall effect on total payments to
facilities would not be significant. For
example, the impact on aggregate
payments to rural facilities would be a
decrease of about 0.2 percent and an
increase of about 0.1 percent for urban
facilities. This occurs because all of the
facilities that are currently subject to the
1.300 wage index cap are located in
urban areas.
We also considered alternative
approaches for transitioning facilities to
the proposed updated wage
adjustments. Another approach would
be to apply the proposed 50–50
transition to all facilities, whether or not
they do better using the updated wage
index adjustment. This approach would
treat all facilities equally for transition
purposes, but would mean that those
PO 00000
Frm 00037
Fmt 4701
Sfmt 4702
45799
facilities that are currently underpaid
because of the current outdated wage
index adjustment would have to wait
until the transition was completed to
receive the higher payment to which
they are entitled.
An alternative to the proposed twoyear transition would be to adopt a
three-year transition. This would allow
facilities that would receive lower
payments using the revised wage
adjustment to have an additional year to
adapt to the lower payment amount.
This approach, if coupled with allowing
facilities that do better to move
immediately to the new wage index,
would have a more significant impact
on the budget neutrality adjustment
required by MMA. (See budget
neutrality discussion below.).
We are specifically seeking comments
on the proposed transition or any of the
alternative approaches mentioned
above.
(5) ESRD Wage Index Budget Neutrality
Section 623(d) of MMA amended
section 1881(b)(12)(E)(i) of the Act
which requires that any revisions to the
ESRD composite rate payment system as
a result of the MMA provision
(including the geographic adjustment)
be made in a budget neutral manner.
This means that aggregate payments to
ESRD facilities in CY 2006 should be
the same as aggregate payments would
have been if we had not made any
changes to the geographic adjusters. In
order to achieve budget neutrality, we
are proposing to apply a budget
neutrality adjustment factor directly to
the revised ESRD wage index values,
rather than applying the adjustment to
the base composite payment rates. For
payment purposes, we believe this is the
simplest approach since it allows us to
maintain a base composite rate for
hospital-based facilities and one for
independent facilities during the
transition from the current wage
adjustments to the revised wage
adjustments.
In order to compute the proposed
wage index budget neutrality
adjustment factor, we used treatment
counts from the CY 2004 billing data
and facility-specific 2005 composite
payment rates. We note that this file is
currently only about 85 percent
complete. For the final rule, we expect
to use the most complete CY 2004 file
available. Using the CY 2004 billing
data, we first computed the estimated
total dollar amount that ESRD facilities
would have received in CY 2006 had
there been no changes to the ESRD wage
index. This amount becomes the
estimated target amount of expenditures
for all ESRD facilities. Then we
E:\FR\FM\08AUP2.SGM
08AUP2
45800
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
computed the estimated dollar amount
that would be paid to the same ESRD
facilities using the revised ESRD wage
index. After comparing these two dollar
amounts, we calculate an adjustment
factor to the ESRD wage index as the
factor that when multiplied by the
revised ESRD wage index will result in
the target amount of expenditures for all
ESRD facilities. Since the revised wage
index values are only applied to the
labor-related portion of the composite
payment rate, we computed the
adjustment based on that proportion
(that is, 53.711 percent). We applied the
estimated budget neutrality adjustment
factor to the revised wage index values
and then simulated payments for CY
2006 to ensure that estimated aggregate
payments to ESRD facilities would
remain budget neutral. This proposed
adjustment factor would be 1.023024.
Each ESRD wage index value has been
adjusted by this factor to establish the
budget neutral wage index values that
we propose to use to adjust the labor
portion of the composite payment rate
beginning January 1, 2006. (See Tables
27 and 28.) By using these adjusted
ESRD wage index values, the estimated
aggregate payments to ESRD facilities
will meet the estimated target
expenditure amount.
This calculation becomes more
complex because of our proposed
transition policy. Under that policy an
ESRD facility that would receive a
higher composite rate payment using
the new geographic adjustment would
receive 100 percent of that rate in the
first year of transition. However, if an
ESRD facility’s composite rate using the
new geographic adjustment is less than
its current rate, then that facility will
receive 50 percent of the composite rate
payment it would have received using
the current wage index and 50 percent
of the composite rate using the revised
wage index. To account for the
differential payments, we compare the
target amount of expenditures for all
ESRD facilities in an iterative fashion
until the time that the ESRD wage index
adjustment factor would result in the
target amount of expenditures for all
ESRD facilities. This is shown in
column 4 of Table 37 in section V.
(Regulatory Impact Analysis) of this
proposed rule. In aggregate the change
to all ESRD facilities would be 0.0
percent. The distributive effect of the
revised ESRD wage index can be seen in
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
the various impact table groupings in
column 4 of Table 37 in section V. of
this proposed rule.
Another element of the proposed
transition policy would be a proposed
wage index floor of 0.8500. Using the
method described above to compute the
budget neutrality factor, makes it
necessary to apply the budget neutrality
factor to this floor which would result
in a proposed adjusted floor of 0.8696.
(6) Transition Examples
In the following examples, we show
the application of revised wage adjusted
composite payment rates during the
proposed two year transition period:
• Example 1—Neighborhood Dialysis
Center is an independent dialysis
facility located in Baltimore County,
Maryland. As the Crosswalk Table (see
addendum F) reveals, Baltimore County
was previously classified as part of the
Baltimore MSA, and is still classified as
an urban county under the new CBSA
classification system. The current wageadjusted composite payment rate for
Neighborhood Dialysis Center is
$134.93.
Because Neighborhood Dialysis
Center is located within the BaltimoreTowson MD CBSA (code 12580), its new
wage index, which has been adjusted for
budget neutrality, is 1.0135. Applying
the wage index of 1.0135 to the revised
labor-related component of the base
composite rate for independent facilities
shown in Table 26, yields a labor
adjusted payment rate of $129.28.
($68.94 × 1.0135) + $59.41 = $129.28
This labor adjusted payment rate of
$129.28 is less than the wage-adjusted
composite rate of $134.93 currently
applicable to Neighborhood Dialysis
Center. In accordance with our
proposed two year transition, this
facility would receive a wage-adjusted
composite payment rate beginning
January 1, 2006 equal to 50 percent of
its current wage-adjusted rate plus 50
percent of its new wage-adjusted rate.
The CY 2006 blended wage-adjusted
rate for this facility would be $132.11.
($0.50 × $134.93) + (0.50 × $129.28) =
$132.11
The 8.9 percent drug add-on
adjustment and relevant case-mix
adjustments (related to the budget
neutrality adjustment) would be applied
to this blended rate.
• Example 2—Serve U Well is a
hospital-based dialysis facility located
PO 00000
Frm 00038
Fmt 4701
Sfmt 4702
in Morrow County, Ohio. The Crosswalk
table (see Addendum F) reveals that
Morrow County was previously
classified as rural, but is now classified
urban as part of the Columbus, OH
CBSA, code 18140. The new CBSA wage
index applicable to Serve U Well,
adjusted for budget neutrality, is 1.0077.
Applying the wage index of 1.0077 to
the revised labor related component of
the base composite rate for hospitalbased facilities shown in Table 26 yields
a wage-adjusted composite rate of
$132.96.
($71.12 × 1.0077) + $61.29 = $132.96
Serve U Well’s current rural Ohio
wage-adjusted composite payment rate
is $128.66. Because the revised wageadjusted composite payment rate of
$132.96 is greater than $128.66, Serve U
Well would receive 100 percent of its
new wage-adjusted composite payment
rate of $132.96 beginning January 1,
2006.
As in the previous example, the 8.9
percent drug add-on adjustment and
relevant case-mix adjustments (related
to the budget neutrality adjustment)
would be applied to this new wageadjusted composite rate.
(7) Frequency of Update
Section 623(d)(1) of the MMA
provides that any revised wage index
used in connection with the composite
payment rates must be phased-in over a
multiyear period. We are proposing a
two-year transition period to the new
wage indexes based on CBSAs. An issue
remains as to how frequently the new
wage index values should be updated to
reflect changes in area wage levels.
These changes would be detected
through our receipt of hospital wage and
employment data obtained from the
Medicare hospital cost reports
subsequent to FY 2005. In order to keep
payments to ESRD facilities as up-todate as possible, we propose to update
the wage index on an annual basis, as
part of the overall ESRD payment
update.
(8) Wage Index Table
The following two tables show the
proposed ESRD wage index for urban
areas (Table 27) and rural areas (Table
28).
BILLING CODE 4120–01–P
E:\FR\FM\08AUP2.SGM
08AUP2
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00039
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45801
EP08AU05.003</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00040
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.004</GPH>
45802
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00041
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45803
EP08AU05.005</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00042
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.006</GPH>
45804
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00043
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45805
EP08AU05.007</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00044
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.008</GPH>
45806
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00045
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45807
EP08AU05.009</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00046
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.010</GPH>
45808
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00047
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45809
EP08AU05.011</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00048
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.012</GPH>
45810
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00049
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45811
EP08AU05.013</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00050
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.014</GPH>
45812
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00051
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45813
EP08AU05.015</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00052
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.016</GPH>
45814
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00053
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45815
EP08AU05.017</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00054
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.018</GPH>
45816
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00055
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45817
EP08AU05.019</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00056
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.020</GPH>
45818
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00057
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45819
EP08AU05.021</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00058
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.022</GPH>
45820
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00059
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45821
EP08AU05.023</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00060
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.024</GPH>
45822
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00061
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45823
EP08AU05.025</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00062
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.026</GPH>
45824
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00063
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45825
EP08AU05.027</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00064
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.028</GPH>
45826
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00065
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45827
EP08AU05.029</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00066
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.030</GPH>
45828
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00067
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45829
EP08AU05.031</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00068
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.032</GPH>
45830
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00069
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45831
EP08AU05.033</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00070
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.034</GPH>
45832
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00071
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45833
EP08AU05.035</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00072
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.036</GPH>
45834
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00073
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45835
EP08AU05.037</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00074
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.038</GPH>
45836
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00075
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
45837
EP08AU05.039</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
VerDate jul<14>2003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00076
Fmt 4701
Sfmt 4725
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.040</GPH>
45838
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
45839
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00077
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.041</GPH>
BILLING CODE 4120–01–C
45840
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 28.—PROPOSED ESRD WAGE the changes in the additional payment
INDEX FOR RURAL AREAS BASED ON for separately billable drugs.
CBSA LABOR MARKET AREAS
5. Proposed Revisions to the Composite
CBSA
code
Nonurban
area
Wage
index
1 ........
2 ........
3 ........
4 ........
5 ........
6 ........
7 ........
8 ........
10 ......
11 ......
12 ......
13 ......
14 ......
15 ......
16 ......
17 ......
18 ......
19 ......
20 ......
21 ......
22 ......
23 ......
24 ......
25 ......
26 ......
27 ......
28 ......
29 ......
30 ......
32 ......
33 ......
34 ......
35 ......
36 ......
37 ......
38 ......
39 ......
42 ......
43 ......
44 ......
45 ......
46 ......
47 ......
48 ......
49 ......
50 ......
51 ......
52 ......
Alabama ............................
Alaska ...............................
Arizona ..............................
Arkansas ...........................
California ...........................
Colorado ............................
Connecticut .......................
Delaware ...........................
Florida ...............................
Georgia .............................
Hawaii ...............................
Idaho .................................
Illinois ................................
Indiana ..............................
Iowa ...................................
Kansas ..............................
Kentucky ...........................
Louisiana ...........................
Maine ................................
Maryland ...........................
Massachusetts ..................
Michigan ............................
Minnesota ..........................
Mississippi .........................
Missouri .............................
Montana ............................
Nebraska ...........................
Nevada ..............................
New Hampshire ................
New Mexico ......................
New York ..........................
North Carolina ...................
North Dakota .....................
Ohio ...................................
Oklahoma ..........................
Oregon ..............................
Pennsylvania .....................
South Carolina ..................
South Dakota ....................
Tennessee ........................
Texas ................................
Utah ...................................
Vermont .............................
Virginia ..............................
Washington .......................
West Virginia .....................
Wisconsin ..........................
Wyoming ...........................
0.8696
1.2266
0.8979
0.8696
1.1107
0.9605
1.2066
0.9827
0.8796
0.8696
1.0805
0.8696
0.8696
0.8829
0.8698
0.8696
0.8696
0.8696
0.9056
0.9304
1.0451
0.9074
0.9394
0.8696
0.8696
0.9036
0.8865
0.9283
1.0923
0.8843
0.8696
0.8764
0.8696
0.8988
0.8696
1.0056
0.8696
0.8840
0.8696
0.8696
0.8696
0.8696
1.0067
0.8696
1.0699
0.8696
0.9698
0.9426
(9) Crosswalk Table
The crosswalk table for the MSA and
CBSA can be found in Addendum F to
this proposed rule.
4. Proposed Revisions to § 413.170
(Scope) and § 413.174 (Prospective
Rates for Hospital-Based and
Independent ESRD Facilities)
Under section 623 of the MMA, we
propose to revise § 413.170(b) to specify
that this subpart provides procedures
and criteria under which only a
pediatric facility may receive an
exception.
Also under section 623 of the MMA,
we propose to revise § 413.174 to reflect
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Payment Rate Exceptions Process
[If you choose to comment on issues in
this section, please include the caption
‘‘ESRD-Exceptions Process’’ at the
beginning of your comments.]
The current regulations at § 413.180
through § 413.192 contain the
procedures for requesting exceptions to
ESRD facility composite payment rates,
and establish five criteria for approval of
exception requests. The five criteria are
as follows:
• Atypical service intensity
(§ 413.184).
• Isolated essential facility
(§ 413.186).
• Extraordinary circumstances
(§ 413.188).
• Self-dialysis training costs
(§ 413.190).
• Frequency of dialysis (§ 413.192).
Under section 1881(b)(7) of the Act,
when a facility’s costs were higher than
the prospectively determined composite
rate, we could, under certain conditions,
grant the facility an exception to its
composite payment rate and set a higher
prospective rate. The facility had to
show, on the basis of projected cost and
utilization trends, that it would have an
allowable cost per treatment higher than
its prospective composite payment rate
and that any excess costs were
attributable to one or more of the
specific exception criteria.
As explained further below, ESRD
facility exception rates in effect on
December 31, 2000, or those that were
subsequently approved based on an
application under section 422(a)(2)(B) of
BIPA, (collectively hereinafter termed
‘‘existing exception rates’’), will remain
in effect under section 422(a)(2)(C) of
BIPA as long as the exception rate
exceeds the facility’s updated composite
payment rate.
Section 623 of the MMA amended
BIPA to provide that the prohibition on
exceptions to the ESRD composite rate
does not apply to pediatric facilities that
do not have an exception rate in effect
on October 1, 2002. As a result, only
pediatric facilities can now qualify for
exception rates. We do not intend for
the proposed regulation changes
detailed below to limit the exception
criteria under which a pediatric facility
may qualify. However, we believe that
pediatric facilities would not qualify for
an exception under most of the existing
exception criteria because of the
uniqueness of their pediatric patient
population (at least 50 percent) and, in
the past, ESRD facilities with high
percentages of pediatric patients only
PO 00000
Frm 00078
Fmt 4701
Sfmt 4702
qualified for exceptions under the
‘‘atypical patient mix’’ criterion.
Therefore, we are proposing to revise
the regulations by eliminating the other
exception criteria (Isolated essential
facilities, Extraordinary circumstances,
and Frequency of dialysis) specified in
§ 413.182(b), (c), and (e). However, we
are proposing to retain the exception
criterion for self-dialysis training costs
under § 413.182(d) because some
pediatric facilities may qualify for an
exception on that basis.
a. Statutory Changes
Section 422 of BIPA 2000, prohibited
us from providing for any further
composite rate exceptions on or after
December 31, 2000; allowed one final
opportunity for ESRD facilities that did
not apply for an exception during 2000
to apply for one by July 1, 2001; and
provided for approved exceptions
(either those in effect or those that were
approved based on subsequent
applications) to continue in effect as
long as the rate exceeds the updated
composite rate.
By prohibiting future exceptions to
the composite rate for ESRD facilities,
we believe the Congress intended to
make the ESRD composite rate payment
system more compatible with other
Medicare PPSs that do not allow
exceptions to their payment rates. By
providing for the continuation of
existing exception rates as long as those
rates exceed the updated case-mix
adjusted composite rate, we believe the
Congress intended, in effect, to provide
for the transition of most ESRD facilities
to payment under the composite rate
payment system.
In response to ESRD facility concerns
about the current composite rate
payment methodology, the Congress
enacted section 623 of the MMA, which
revised ESRD facility prospective
composite payment rates. As a result,
effective January 1, 2005, ESRD facility
prospective composite payment rates
were increased 1.6 percent and include
a drug add-on of 8.7 percent. These
increases were implemented in the PFS
final rule published on November 15,
2004 (69 FR 66319–66320). Section 623
also amended section 422(a)(2) of BIPA
to provide that the prohibition on
exceptions to the ESRD composite rates
does not apply as of October 1, 2002, to
pediatric facilities that do not have an
exception rate in effect on October 1,
2002—in effect restoring the exception
process for pediatric facilities. Pediatric
facilities are defined as ‘‘renal facilities
at least 50 percent of whose patients are
individuals under 18 years of age.’’
Existing exception rates are protected
under section 422(a)(2)(C) of BIPA 2000.
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
The ‘‘protection’’ clause for existing
exception rates provides that exception
rates in effect on December 1, 2000 (or
approved based on an application by
July 1, 2001) shall remain in effect as
long as the facility’s exception rate is
higher than the updated composite rate.
Pediatric ESRD facility exception rates
granted under the provisions of section
623 of the MMA are not subject to the
‘‘protection’’ clause for existing
exception rates.
b. Summary of Proposed Changes to Part
413, Subpart H
As a result of the statutory changes
discussed above, we are proposing to
revise both the content and the
organization of the existing regulations
at 42 CFR part 413, subpart H (Payment
for ESRD Services and Organ
Procurement Costs) by limiting certain
qualifications and clarifying the
regulations. Currently, all of the
Medicare rules for requesting exceptions
to composite rate payments for covered
outpatient maintenance dialysis
treatments can be found at § 413.180
through § 413.192. We propose to revise
the current regulations at part 413,
subpart H by—
• Adding a definition of a ‘‘pediatric
facility’’ (in accordance with section
422(a)(2)of BIPA 2000, as amended by
section 623(b) of the MMA) to mean a
renal facility at least 50 percent of
whose patients are individuals under 18
years of age;
• Removing existing exception
criteria that are no longer applicable;
and
• Adjudicating future exception
requests in accordance with the
proposed revised exception criteria.
(1) Proposed Revisions to § 413.180
(Procedures for Requesting Exceptions
to Payment Rates)
In response to the changes made by
section 422 of BIPA 2000 and section
623 of MMA, we are proposing
significant changes to the existing
regulations at § 413.180 through
§ 413.192 regarding ESRD exception
criteria and application procedures.
Under our current regulations, existing
exception rates that were approved prior
to December 31, 2000 (or those
approved during the window that
closed on July 1, 2001) would remain in
effect as long as the conditions under
which the exception was granted have
not changed and as long as the facility
files a request to retain the exception
rate with its fiscal intermediary during
the 30-day period before the opening of
an exception cycle (and the request is
approved by the fiscal intermediary.)
Even though pediatric exceptions are
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
not subject to the ‘‘protection’’ clause
under section 422(a)(2)(C) of BIPA, we
propose to continue all exception rates
in effect on the same basis. Since
section 422(a)(2)(B) of BIPA allows
existing exception rates to continue in
effect as long as the exception rate
exceeds the facility’s updated composite
payment rate, we expect that the
facilities will compare their existing
exception rates to their basic case-mix
adjusted composite rates to determine
which is the best payment rate for their
facility. We expect that each ESRD
facility would choose to be paid at the
higher of its existing exception rate or
its basic case-mix composite rate (which
includes all the payment adjustments
required under section 623 of the
MMA). If the facility retains its
exception rate, the rate is not subject to
any of the adjustments specified in
section 623 of the MMA. We believe the
determination as to whether an ESRD
facility’s exception rate per treatment
will exceed its average case-mix
adjusted composite rate per treatment is
best left to the affected entity. An ESRD
facility that has an existing exception
rate may give up that rate if it
determines that it should be paid
instead under the case-mix adjusted
composite rate methodology.
In § 413.180, we propose to revise our
regulations to provide that each ESRD
facility must notify its fiscal
intermediary (in writing) if it wishes to
give up its exception rate. The facility
would be paid based on its case-mix
adjusted composite payment rate
beginning thirty days after the
intermediary’s receipt of written
notification that the facility wishes to
give up its exception rate. Once a
facility notifies its fiscal intermediary
that it wishes to give up its exception
rate, that decision could not be
subsequently rescinded or reversed. We
also propose to revise paragraph (b) of
this section to provide that ESRD
facilities that retain their existing
exception rates do not need to notify
their intermediaries. Therefore, we
propose to remove the last sentence
from paragraph (b) that states,
‘‘However, a facility may only request
an exception or seek to retain its
previously approved exception rate
when authorized under the conditions
specified in paragraphs (d) and (e) of
this section.’’
In the past, an ESRD facility could
request an exception to its prospective
composite payment rate within 180 days
of the effective date of its new
composite rate(s) or the date on which
we opened a specific exception
window. Because only pediatric
facilities can now file for exceptions, we
PO 00000
Frm 00079
Fmt 4701
Sfmt 4702
45841
expect to receive a minimal number of
exception applications. In this section,
we propose to revise paragraph (d) to
remove the requirement that an
application for an exception be filed
within the 180-day window because we
believe the small volume of applications
will make it administratively feasible for
us to accept applications on a rolling
basis. Further, we are proposing to
revise paragraph (d) to state that a
pediatric ESRD facility may request an
exception to its composite payment rate
at any time after it is in operation for at
least 12 consecutive months.
We are proposing to permit pediatric
ESRD facilities to file exception requests
at any time. We also propose to change
our regulations to continue pediatric
facility exception rates granted under
section 623 of the MMA (hereinafter
referred to as ‘‘pediatric facility
exception rates’’) in the same way as
existing exception rates. Specifically,
we are proposing that pediatric facility
exception rates would remain in effect
until the facility notifies its fiscal
intermediary that it wishes to give up its
rate because its case-mix adjusted
composite rate is higher. Therefore, we
propose to eliminate paragraph (e) of
this section, entitled ‘‘Criteria for
retaining a previously approved
exception request’’ and replace it with
paragraph (f) (Completion of
requirements and criteria) of this
section. We are proposing to eliminate
paragraph (e) because ESRD facilities
that have an approved exception rate
(either an existing exception rate or a
pediatric facility exception rate) and
elect to retain it do not need to notify
their intermediaries. Current paragraph
(f), entitled, ‘‘Documentation for a
payment rate exception request’’, would
be redesignated as proposed paragraph
(e). We are proposing to clarify existing
regulations by indicating that the
applicant must include in its
documentation a copy of the most
recent cost report filed in accordance
with § 413.198. As a result of these
proposed changes to this section, we
propose to revise the remaining
paragraphs as follows:
• Current paragraph (g) would be
redesignated as proposed paragraph (f).
• Current paragraph (h) would be
redesignated as proposed paragraph (g).
• Current paragraph (i) would be
redesignated as proposed paragraph (h).
• Current paragraph (j) provides the
period of an exception approval. We
would redesignate paragraph (j) as
proposed paragraph (i). We propose to
revise the redesignated paragraph to
state that an approved exception
payment rate applies for the period from
the date the complete exception request
E:\FR\FM\08AUP2.SGM
08AUP2
45842
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
was filed with the facility’s fiscal
intermediary until thirty days after the
intermediary’s receipt of the facility’s
letter notifying the intermediary of the
facility’s request to give up its exception
rate and become subject to the current
composite payment rate methodology.
Once a facility decides not to retain its
current exception rate (and puts that
decision in writing), that decision
cannot be subsequently rescinded or
reversed.
• Current paragraph (k) would be
removed.
• Current paragraph (l) would be
redesignated as proposed paragraph (j).
• Current paragraph (m) would be
redesignated as proposed paragraph (k).
In the past, a pediatric facility denied an
exception rate would have to wait until
a subsequent exception window opened
to file a new request. We are proposing
to revise redesignated paragraph (m) to
state that a pediatric ESRD facility that
has been denied an exception rate may
immediately file another exception
request. Any subsequent exception
request would be required to address
and document the issues cited in our
denial letter.
(2) Proposed Revisions to § 413.182
(Criteria for Approval of Exception
Requests)
We propose to revise this section to
state that CMS may approve exceptions
to a pediatric ESRD facility’s
prospective payment rate if the pediatric
facility did not have an approved
exception rate as of October 1, 2002.
The proposed revised section would
also state that the pediatric facility
would be required to demonstrate, by
convincing objective evidence, that its
total per treatment costs are reasonable
and allowable under the relevant cost
reimbursement principles of part 413
and that its per treatment costs in excess
of its payment rate would be directly
attributable to any of the following
criteria:
• Pediatric patient mix, as specified
in § 413.184.
• Self-dialysis training costs in
pediatric facilities, as specified in
§ 413.186.
In the future, pediatric facilities
would file for an exception under the
proposed revised exception criteria in
revised § 413.184 (Payment exception:
Pediatric patient mix) and redesignated
§ 413.190 (Payment exception: Selfdialysis training costs in pediatric
facilities). (We are proposing to revise
§ 413.190 and redesignate it as
§ 413.186, see discussion below.).
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
(3) Proposed Revisions to § 413.184
(Payment Exception: Atypical Service
Intensity (Patient Mix))
(4) Proposed Removal of § 413.186
(Payment Exception: Isolated Essential
Facility)
Because only pediatric ESRD facilities
(those with at least a 50 percent patient
mix) may qualify for an exception rate,
we are proposing to rename § 413.184 to
read, ‘‘Payment exception: Pediatric
patient mix’’. We also propose to revise
paragraph (a) of this section to specify
that to qualify for an exception to its
prospective payment rate based on its
pediatric patient mix, a facility would
be required to demonstrate that—
• At least 50 percent of its patients
are individuals under 18 years of age;
• Its nursing personnel costs are
allocated properly between each mode
of care;
• The additional nursing hours per
treatment are not the result of an excess
number of employees;
• Its pediatric patients require a
significantly higher staff-to-patient ratio
than typical adult patients; and
• These services, procedures, or
supplies and its per treatment costs are
clearly prudent and reasonable when
compared to those of pediatric facilities
with a similar patient mix.
The ‘‘Atypical service intensity’’
criterion is the one under which
exceptions for facilities that treated a
high proportion of pediatric patients
were granted in the past. In order to
receive approval for an exception rate,
pediatric facilities would still need to
meet many of the same criteria
previously required under § 413.184 for
‘‘Atypical service intensity.’’
To better match the patient listing
documentation requirements to the
characteristics of pediatric ESRD
facilities, we are proposing to eliminate
five categories currently required in
§ 413.184(b) (Documentation) and
replace those items with a revised list.
Under the proposed revised paragraph,
a facility would be required to submit a
listing of all outpatient dialysis patients
(including all home patients) treated
during its most recently completed and
filed cost report (cost reporting
requirements under § 413.198)
showing—
• Age of patients, and the percentage
of patients under the age of 18;
• Individual patient diagnosis;
• Home patients and ages;
• In-facility patients, staff assisted, or
self-dialysis;
• Diabetic patients; and
• Patients isolated because of
contagious disease.
Since pediatric facilities are the only
ESRD facilities that can now apply for
exceptions, we are proposing to remove
§ 413.186 to conform with the
elimination of § 413.182(b), (c) and (e)
as discussed above and redesignate
§ 413.190 as the new § 413.186. We
would also rename the section to read,
‘‘Payment exception: Self-dialysis
training costs in pediatric facilities’’. No
further changes are proposed to
§ 413.186.
PO 00000
Frm 00080
Fmt 4701
Sfmt 4702
(5) Proposed Removal of § 413.188
(Payment Exception: Extraordinary
Circumstances)
We are proposing to remove this
§ 413.188 to conform with the
elimination of elimination of
§ 413.182(b), (c) and (e) as discussed
above.
(6) Proposed Redesignation of § 413.190
(Payment Exception: Self-Dialysis
Training Costs)
We propose to continue to recognize
exceptions for self-dialysis training
costs under § 413.190 only for pediatric
facilities, and to rename this section,
‘‘Payment exception: Self-dialysis
training costs in pediatric facilities.’’ We
are proposing to change the name to
conform with the current statute that
prohibits exceptions for facilities other
than pediatric ESRD facilities. We are
also proposing to redesignate this
section as § 413.186. (As discussed
above, we are proposing to remove
existing § 413.186.) The current
regulatory language in § 413.190
(proposed to be redesignated as
§ 413.186) would remain unchanged.
(7) Proposed Removal of § 413.192
(Payment Exception: Frequency of
Dialysis)
We are proposing to remove this
section to conform with the elimination
of § 413.182(b), (c) and (e) as discussed
above.
H. Payment for Covered Outpatient
Drugs and Biologicals
[If you choose to comment on issues in
this section, please include the caption
‘‘Payment for Covered Outpatient Drugs
and Biologicals’’ at the beginning of
your comments.]
Medicare Part B covers a limited
number of prescription drugs and
biologicals. For the purposes of this
proposed rule, the term ‘‘drugs’’ will
hereafter refer to both drugs and
biologicals. Medicare Part B covered
drugs not paid on a cost or prospective
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
payment basis generally fall into three
categories:
• Drugs furnished incident to a
physician’s service.
• DME drugs.
• Drugs specifically covered by
statute (immunosuppressive drugs, for
example).
Beginning in CY 2005, the vast
majority of Medicare Part B drugs not
paid on a cost or prospective payment
basis are paid under the ASP
methodology. The ASP methodology is
based on data submitted to us quarterly
by manufacturers. In addition to the
payment for the drug, Medicare
currently pays a dispensing fee for
inhalation drugs, a furnishing fee for
blood clotting factors, and a supplying
fee for certain Part B drugs.
This section of the preamble discusses
proposed changes and issues related to
the determination of the payment
amounts for covered Part B drugs and
the separate payments allowable for
dispensing inhalation drugs, furnishing
blood clotting factor, and supplying
certain other Part B drugs. This section
of the preamble also discusses proposed
changes in how manufacturers calculate
and report ASP data to us.
1. ASP Issues
[If you choose to comment on issues in
this section, please include the caption
‘‘ASP Issues’’ at the beginning of your
comments.]
Section 303(c) of the MMA amended
Title XVIII of the Act by adding new
section 1847A. This new section
establishes the use of the ASP
methodology for payment for most
drugs and biologicals not paid on a cost
or prospective payment basis furnished
on or after January 1, 2005. The ASP
reporting requirements are set forth in
section 1927(b) of the Act.
Manufacturers must submit ASP data to
us quarterly. The manufacturers’
submissions are due to us not later than
30 days after the last day of each
calendar quarter. The methodology for
developing Medicare drug payment
allowances based on the manufacturers’
submitted ASP data is specified in the
regulations in part 414, subpart K. Based
on the data we receive, we update the
Part B drug payment amounts quarterly.
In this section of the preamble, we
discuss issues and propose changes
related to the methodology
manufacturers use to apply the estimate
of lagged price concessions in the ASP
calculation. We also discuss the
submission of ASP data, including
WAC, and our intent to propose, in a
separate notice, the collection of
additional information from
manufacturers, using a revised reporting
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
format, to ensure more accurate
calculation of the Medicare payment
amounts.
Also, included in this section is a
discussion of the weighting
methodology we follow to establish the
Medicare payment amounts using the
ASP data.
a. Estimation Methodology for Lagged
Price Concessions
Section 1847A(c)(5)(A) of the Act
states that the ASP is to be calculated by
the manufacturer on a quarterly basis.
As a part of that calculation,
manufacturers are to take into account
price concessions such as—
• Volume discounts.
• Prompt pay discounts.
• Cash discounts.
• Free goods that are contingent on
any purchase requirement.
• Chargebacks.
• Rebates (other than rebates under
the Medicaid drug rebate programs).
If the data on these price concessions
are lagged, then the manufacturer is
required to estimate costs attributable to
these price concessions. Specifically,
the manufacturer sums the price
concessions for the most recent 12month period available associated with
all sales subject to the ASP reporting
requirements. The manufacturer then
calculates a percentage using this
summed amount as the numerator and
the corresponding total sales data as the
denominator. This results in a 12-month
rolling average price concession
percentage that is applied to the total in
dollars for the sales subject to the ASP
reporting requirement for the quarter
being submitted to determine the price
concession estimate for the quarter. The
methodology is specified in
§ 414.804(a)(3) and was published in the
Manufacturer Submission of
Manufacturer’s ASP Data for Medicare
Part B Drugs and Biologicals final rule
published on September 16, 2004 (69 FR
55763).
Our goal is to ensure that the ASP
data submitted by manufacturers
reflects an appropriate estimate of
lagged price concessions. Since
publication of the September 16, 2004
final rule, we have identified a
refinement of the ASP calculation and
lagged price concession estimation
methodology related to chargebacks that
we believe will improve the accuracy of
the estimate. As a result, we are
proposing to clarify the ASP calculation
in this proposed rule.
b. Price Concessions: Wholesaler
Chargebacks
Wholesaler chargebacks are a type of
price concession, generally paid on a
PO 00000
Frm 00081
Fmt 4701
Sfmt 4702
45843
lagged basis, that apply to sales to
customers (for example, physicians) via
a wholesaler (or distributor). Wholesaler
chargeback arrangements may vary in
scope and complexity. However, simply
put, the wholesaler administers contract
prices negotiated between the
manufacturer and end purchasers (for
example, physician or other health care
providers), or otherwise implements
pricing terms established by the
manufacturer (for example, pricing that
varies by type of purchaser or class of
trade). The wholesaler charges the
customer a certain price and charges
back the manufacturer an agreed upon
amount for the purposes of making up
the difference between the wholesaler’s
price (for example, WAC) and the
customer’s price.
Under the current estimation
methodology for lagged price
concessions, total lagged price
concessions, including lagged
wholesaler chargebacks, for the 12month period are divided by total sales
for that same period to determine a ratio
that is applied to the total sales for the
reporting period. The ratio of lagged
price concessions to sales is calculated
over all sales, both indirect sales (sales
to wholesalers and distributors and
other similar entities that sells to others
in the distribution chain) and direct
sales (sales directly from manufacturer
to providers, such as hospitals or
HMOs). To the extent that the
relationship between total dollars for
indirect sales and total dollars for all
sales is different for the reporting
quarter and the 12-month period used,
the current ratio methodology for
estimating lagged price concessions may
overstate or understate wholesaler
chargebacks expected for the reporting
period. A more accurate estimation of
lagged price concessions would
minimize the effect of quarter to quarter
variations in the relationship between
indirect sales and all sales.
As a result, we propose to revise
§ 414.804 to require manufacturers to
calculate the ASP for direct sales
independently from the ASP for all
other sales subject to the ASP reporting
requirement (indirect sales). Then, the
manufacturer would calculate a
weighted average of the direct sales ASP
and the indirect sales ASP to submit to
us. For example, for a National Drug
Code (NDC), the manufacturer has 100
direct sales and 200 indirect sales.
Taking into account applicable price
concessions for direct sales and those
for indirect sales, including use of the
ratio methodology for estimating lagged
price concessions, the direct sales ASP
is $25, and the indirect sales ASP is $27.
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
The weighted average of the ASPs
would be as shown in this example.
(100 × 25) + (200 × 27)
100 + 200
= $26.33
We believe the weighted average of
direct sales ASP and indirect sales ASP
improves the overall accuracy of the
ASP calculation, particularly for NDCs
with significant fluctuations in the
percentage of sales that are direct sales.
We are proposing conforming changes
to § 414.804 for the methodology for
calculating the lagged price concessions
percentage. We are also proposing to
revise the regulation text to clarify that
the estimation ratio methodology relates
to lagged price concessions. We also are
proposing to define direct sales and
indirect sales in § 414.802, and seek to
develop definitions for these terms so
that all sales subject to the ASP
reporting requirement are included
under these two definitions.
We seek comments about the
advisability of requiring manufacturers
to calculate the ASP for direct sales,
including price concessions,
independently from the ASP for indirect
sales and then calculating a weighted
average of these ASPs to submit to CMS.
We also seek comments about the
potential affects of this approach on the
ASP as well as our proposed definitions
of direct sales and indirect sales (that is,
that direct sales are from manufacturer
to provider or supplier, and indirect
sales are the remaining sales subject to
the ASP reporting requirement).
c. Determining the Payment Amount
Based on ASP Data
We have received inquiries related to
the formula we use to calculate the
payment amount for each billing code.
We posted a Frequently Asked Question
on this subject on our Web site
(https://www.questions.cms.hhs.gov)
earlier this year. We are including this
section in this preamble to ensure
greater public access to this information.
Our approach to calculating the
payment amounts is as follows:
• For each billing code, we calculate
a weighted ASP using the ASP data
submitted by manufacturers.
• Manufacturers submit ASP data at
the 11-digit NDC level.
• Manufacturers submit the number
of units of the 11-digit NDC sold and the
ASP for those units.
• We convert the manufacturers’ ASP
for each NDC into the ASP per billing
unit by dividing the manufacturer’s ASP
for that NDC by the number of billing
units in that NDC. For example, a
manufacturer sells a box of 4 vials of a
drug. Each vial contains 20 milligrams
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
(mg). The billing code is per 10 mg. The
conversion formula is: Manufacturer’s
ASP/[(4 vials × 20 mg)/10 mg = 8
billable units per NDC].
• Then, the ASP per billing unit and
the number of units (11-digit NDCs) sold
for each NDC assigned to the billing
code are used to calculate a weighted
ASP for the billing code. We sum the
ASP per billing unit times the number
of 11-digit NDCs sold for each NDC
assigned to the billing code, and then
divide by the total number of NDCs
sold. The ASP per billing unit for each
NDC is weighted equally regardless of
package size.
d. Reporting WAC
In response to manufacturer’s
questions about reporting WAC, we
posted a Frequently Asked Question on
this subject on our Web site (https://
www.questions.cms.hhs.gov) last year.
In the posting on the Web site, we state
that manufacturers must report the
WAC for a single source drug or
biological if it is less than the ASP for
a quarter and in cases where the ASP
during the first quarter of sales is
unavailable. Upon further review, we
have determined that the WAC must be
reported each quarter if required for
payment to be made under section
1847A of the Act, in addition to the
ASP, if available.
Section 1927(b)(3)(A)(iii) of the Act
specifies the ASP data manufacturers
must report. Section
1927(b)(3)(A)(iii)(II) of the Act specifies
that the manufacturer must report the
WAC, if it is required in order for
payment to be made under section
1847A of the Act. Under section 1847A
of the Act, the payment is based on
WAC (as opposed to ASP) in the
following cases:
• For a single source drug or
biological, when the WAC-based
calculated payment is less than the
ASP-based calculated payment for all
NDCs assigned to such drug or
biological product. (See section
1847A(b)(4) of the Act.)
• During an initial period in which
data on the prices for sales for the drug
or biological is not sufficiently available
from the manufacturer to compute an
ASP. (See section 1847A(c)(4) of the
Act.)
In these instances, we must make the
determination of whether the payment
amount is based on ASP or WAC.
Therefore, WAC is required for payment
in all of these instances.
On April 6, 2004, we published the
ASP reporting regulations in the
Manufacturer Submission of
Manufacturer’s ASP Data for Medicare
Part B Drugs and Biologicals interim
PO 00000
Frm 00082
Fmt 4701
Sfmt 4702
final rule with comment (66 FR 17935–
17941). In that interim final rule, we
specified that manufacturers must
report the ASP data to us using the
template provided in Addendum A of
that interim final rule. That template
included the manufacturer’s name,
NDC, manufacturer’s ASP, and number
of units. The WAC was not included in
the template. Therefore, in order to
report the WAC, manufacturers have
used several approaches. Some
manufacturers have appended the WAC
to the template; others have noted it in
their written cover letters to their
submissions. Still others have sent the
WAC to us using electronic mail.
Because a place for the WAC was not
included in the template, it is possible
that manufacturers may not have
submitted the WAC even though it was
required. On a few occasions, we have
contacted the manufacturer to obtain the
WAC when it was needed to determine
the payment amount. Therefore, because
of the requirement to submit the WAC
and the confusion manufacturers have
experienced in submitting the WAC
data we will propose, in a separate
information collection notice, to revise
the reporting template to include a place
to report WAC. See the discussion in
section e. below for further details about
potential changes to the reporting
format.
To clarify the instances when
manufacturers are required to report the
WAC, in this proposed rule we are
clarifying that manufacturers are
required to report quarterly both the
ASP and the WAC for NDCs assigned to
a single source drug or biological billing
code. Manufacturers are also required to
report the WAC for use in determining
the payment during the initial period
under section 1847A(c)(4) of the Act.
That is, the WAC is reported for the
reporting period prior to reporting the
ASP based on a full quarter of sales.
Because the WAC could change
during a reporting period, we are
proposing that in reporting the WAC,
manufacturers would be required to
report the WAC in effect on the last day
of the reporting period.
e. Revised Format for Submitting ASP
Data
As specified in the April 6, 2004
interim final rule, manufacturers are
required to report the ASP data to us in
Microsoft Excel using the specified
template. As discussed above, the
current template does not provide
adequate instructions for manufacturers
to report both the ASP and the WAC.
Therefore, in a separate information
collection notice that will be published
at or about the same time as this
E:\FR\FM\08AUP2.SGM
08AUP2
EP08AU05.042</MATH>
45844
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
proposed rule, we will propose to revise
the ASP reporting format to
accommodate submission of both the
ASP and the WAC. We will also propose
to collect the following additional
information:
• Drug name.
• Package size (strength of product,
volume per item, and number of items
per NDC).
• Expiration date for last lot
manufactured.
• Date the NDC was first marketed
(for products first marketed on or after
October 1, 2005).
• Date of first sale for products first
sold on or after October 1, 2005.
We are mentioning the separate
information collection notice in this
proposed rule in order to broaden
public awareness of the separate notice.
The separate notice will be posted at
https://www.cms.hhs.gov/regulations/
pra/. The current reporting format is an
approved information collection. The
OMB control number is 0938–0921.
f. Limitations on ASP
Section 1847A(d)(1) of the Act states
that ‘‘the Inspector General of the
Department of Health and Human
Services shall conduct studies, which
may include surveys to determine the
widely available market prices of drugs
and biologicals to which this section
applies, as the Inspector General, in
consultation with the Secretary
determines to be appropriate.’’ Section
1847A(d)(2) of the Act states that
‘‘Based upon such studies and other
data for drugs and biologicals, the
Inspector General shall compare the
ASP under this section for drugs and
biologicals with—
• The widely available market price
for such drugs and biologicals (if any);
and
• The average manufacturer price (as
determined under section 1927(k)(1) for
such drugs and biologicals.’’
Section 1847A(d)(3)(A) of the Act
states that ‘‘The Secretary may disregard
the ASP for a drug or biological that
exceeds the widely available market
price or the average manufacturer price
for such drug or biological by the
applicable threshold percentage (as
defined in subparagraph (B)).’’ The
applicable threshold is specified as 5
percent for CY 2005. For CY 2006 and
subsequent years, section
1847A(d)(3)(B)of the Act establishes that
the applicable threshold is ‘‘the
percentage applied under this
subparagraph subject to such
adjustment as the Secretary may specify
for the widely available market price or
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
the average manufacturer price, or
both.’’
For CY 2006, we propose to specify an
applicable threshold percentage of 5
percent for both the widely available
market price (WAMP) and average
manufacturer price (AMP). The OIG is
conducting its first review. However, we
did not receive the OIG’s final report in
time for consideration before developing
this proposed rule. Thus, we believe
that continuing the CY 2005 threshold
percentage applicable to both the
WAMP and AMP is most appropriate.
2. Payment for Drugs Furnished During
CY 2006 in Connection With the
Furnishing of Renal Dialysis Services if
Separately Billed by Renal Dialysis
Facilities
[If you choose to comment on issues in
this section, please include the caption
‘‘Payment for ESRD Drugs’’ at the
beginning of your comments.]
Section 1881(b)(13)(A)(iii) of the Act
indicates that payment for a drug
furnished during CY 2006 and
subsequent years in connection with the
furnishing of renal dialysis services, if
separately billed by renal dialysis
facilities, will be based on the
acquisition cost of the drug as
determined by the OIG report to the
Secretary as required by section 623(c)
of the MMA or, the amount determined
under section 1847A of the Act for the
drug, as the Secretary may specify. In
the report entitled, ‘‘Medicare
Reimbursement for Existing End Stage
Renal Disease Drugs,’’ the OIG obtained
the drug acquisition costs for the top 10
ESRD drugs for the 4 largest ESRD
chains as well as a sampling of the
remaining independent facilities. Based
on the information obtained from this
report, for CY 2005, payment for the top
10 ESRD drugs billed by freestanding
facilities and payment for EPO billed by
hospital-based facilities was based on
acquisition costs as determined by the
OIG. Due to the lag in the data obtained
by the OIG, we updated the acquisition
costs for the top 10 ESRD drugs to 2005
by the PPI. The separately billable ESRD
drugs not contained in the OIG report
were paid at the ASP +6 percent for
freestanding facilities. The payment
allowances for these remaining drugs
were updated on a quarterly basis
during 2005.
Section 1881(b)(13)(A)(iii) of the Act
gives the Secretary the authority to
establish the payment amounts for
separately billable ESRD drugs
beginning in 2006 based on acquisition
costs or the amount determined under
section 1847A of the Act. For reasons
PO 00000
Frm 00083
Fmt 4701
Sfmt 4702
45845
discussed below, we do not believe that
it is appropriate to continue to use 2002
acquisition costs updated by the PPI for
another year as the basis for payment.
The acquisition costs are based on 2002
data which, despite updates by the PPI,
do not necessarily reflect current market
conditions. As discussed below, the
chances increase that Medicare
payments will either overpay or
underpay for drugs, thus, resulting in
payments that are inconsistent with the
goal of making accurate payments for
drugs. We also considered whether
actual acquisition cost data could be
periodically updated. However, we do
not believe that it would be feasible to
base Medicare payments over the long
term on continually acquiring data on
actual acquisition costs from ESRD
facilities. This approach would provide
incentives for manufacturers and
facilities to increase acquisition costs
without constraint. It also would not
necessarily provide data regarding
current market rates. Therefore, we
believe it is appropriate for the payment
methodology for all ESRD drugs when
separately billed by freestanding ESRD
facilities during CY 2006 to be paid the
amount determined under section
1847A of the Act. This payment amount
is the ASP +6 percent rate.
In reaching the conclusion about
establishing payment using the amount
determined under section 1847A of the
Act rather than actual acquisition costs,
we analyzed the ASP +6 percent
payment rates for all separately billable
ESRD drugs, including the top 10, for
both the first and second quarters of CY
2005. (We note that the ASP payment
rates are updated quarterly. The new
rates are made available each quarter at
the following Web site: https://
www.cms.hhs.gov/providers/drugs/
asp.asp.). Additionally, we analyzed the
CY 2005 payment rates, based on OIG
data, updated by the PPI to reflect
inflation as well as the potential CY
2006 payment rates, based on the OIG
data, also updated by the PPI to reflect
inflation for the top 10 separately
billable ESRD drugs. As indicated in the
‘‘Top 10 Separately Billable ESRD
Drugs’’ chart, the payment rates for the
top 10 separately billable ESRD drugs
based on the acquisition costs (as
determined by the OIG), updated by the
PPI would increase by 7 percent for CY
2006. In contrast, the percentage change
in the ASP +6 percent payment rates for
the top 10 separately billable ESRD
drugs based on the first and second
quarters of CY 2005 varied on a drugby-drug basis.
E:\FR\FM\08AUP2.SGM
08AUP2
45846
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TOP 10 SEPARATELY BILLABLE ESRD DRUGS
2005 Payment
rate
Drug name
Estimated
2006 payment
rate based on
OIG data
(2003 data inflated 16.2%
to 2006 by the
estimated PPI)
Estimated
2006 payment
rate based on
ASP+6 (2nd
quarter 2005
rates)
Percent
change in ASP
+6 rates between 1st
quarter and
2nd quarter
2005
(percent)
$9.760
$4.000
$4.950
$0.370
$13.630
$2.600
$0.960
$10.940
$2.980
$31.740
$10.440
$4.270
$5.290
$0.390
$14.560
$2.780
$1.030
$11.700
$3.190
$33.920
$9.250
$3.971
$4.726
$0.365
$11.122
$2.784
$0.859
$11.218
$3.188
$30.089
¥1%
¥1
¥2
1
¥24
¥0.5
21
1
32
0
Epoetin alpha ...................................................................................................
Paricalcitol ........................................................................................................
Sodium Ferric Gluconate .................................................................................
Iron Sucrose ....................................................................................................
Levocarnitine ....................................................................................................
Doxercalciferol .................................................................................................
Calcitriol ...........................................................................................................
Iron Dextran .....................................................................................................
Vancomycin .....................................................................................................
Alteplase, Recombinant ...................................................................................
However, the percentage increases or
decreases in the ASP +6 percent
payment rates are relatively minimal.
For example, the payment allowance for
Alteplase, recombinant, J2997,
decreased from first quarter 2005 to
second quarter 2005 by less than 1
percent. Based on an analysis of the
2002 acquisition costs for the top 10
separately billable ESRD drugs, when
updated by the PPI for CY 2006, it is our
contention that relying on 2002
acquisition cost data updated for a
number of years as would be necessary
to establish a payment amount for 2006
is not the most appropriate option for
determining Medicare payment rates
when other drug-specific pricing is
available. Further, we contend that
relying on the ASP +6 percent as the
payment rate for all separately billable
ESRD drugs when billed by freestanding
ESRD facilities for CY 2006 is a more
reliable indicator of the market
transaction prices for these drugs. The
ASP is reflective of manufacturer sales
for specific drug products and is more
indicative of market and sales trends for
those specific products than the 2002
OIG acquisition cost data.
We also note MedPAC’s
recommendation in its June 2005 report
that the ASP be the basis of payment for
all separately billable ESRD drugs
provided by both freestanding and
hospital-based facilities in CY 2006
(MedPAC, ‘‘Report to the Congress:
Issues in a Modernized Medicare
Program,’’ June 2005). In making this
recommendation, MedPAC states that
the ASP data are more current (updated
quarterly), and, thus, more likely to
reflect actual transaction prices,
compared with acquisition cost data
which are not regularly collected by the
OIG or CMS. Furthermore, the report
indicated that utilizing the same
payment policy for both freestanding
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
and hospital-based facilities would
ensure uniformity across the various
settings irrespective of the site of care.
In addition, MedPAC recommends in its
report that we obtain, ‘‘* * * data to
estimate hospitals’ costs and Medicare’s
payment per unit for these drugs. No
published source identifies the unit
payment for these drugs because
Medicare pays hospitals their
reasonable costs.’’ MedPAC further
states: ‘‘We attempted to calculate the
unit payment from 2003 claims data, but
the accuracy of the data fields we
needed to make this calculation was
unclear, particularly the number of
units furnished and Medicare’s payment
to the hospital.’’ MedPAC also
recommends that CMS and/or OIG
collect acquisition cost data periodically
in the future to gauge the appropriate
percentage of ASP for the payment
amount.
While we acknowledge MedPAC’s
recommendations, we are proposing to
make payment using the ASP +6 percent
methodology for all separately billed
ESRD drugs furnished in freestanding
facilities and for EPO furnished in
hospital-based facilities. Paying for EPO
furnished in hospital-based facilities
using the ASP +6 percent methodology
is consistent with past practices where
we have paid for EPO in hospital-based
facilities consistent with freestanding
facilities. That is, in 2005, we paid for
EPO in hospital-based facilities based
on acquisition costs consistent with
freestanding facilities. While we are not
proposing to pay for drugs other than
EPO furnished in hospital-based
facilities under the ASP +6 percent
methodology at this time, we are
interested in moving to this approach.
We believe that it is more appropriate to
pay for separately billed drugs furnished
in hospital-based facilities under the
ASP +6 percent methodology rather
PO 00000
Frm 00084
Fmt 4701
Sfmt 4702
than on a reasonable cost basis, as we
believe that there should be consistency
across sites in payment for the same
item or service. However, we have not
made this proposal due to the lack of
data regarding drug costs and
expenditures associated with hospitalbased ESRD payments. We have
discussed a potential approach to
making estimates of these costs and
units. We seek comments about the
estimation method discussed in section
II.G. of this proposed rule or other
methods or data that could be used.
Therefore, for CY 2006, we propose
that payment for a drug furnished in
connection with renal dialysis services
and separately billed by freestanding
renal dialysis facilities and EPO billed
by hospital-based facilities be based on
section 1847A of the Act. We propose to
update the payment allowances
quarterly based on the ASP reported to
us by drug manufacturers. We seek
comment on our proposed decision to
revise the payment methodology for
separately billable ESRD drugs. While
we have not proposed to pay hospitalbased facilities under the ASP +6
percent methodology for 2006, we seek
comments about the potential method
we have discussed to accomplish this
policy. We also seek comment on how
this proposed decision could affect
beneficiaries or providers access to
these drugs.
3. Clotting Factor Furnishing Fee
[If you choose to comment on issues in
this section, please include the caption
‘‘Clotting Factor’’ at the beginning of
your comments.]
Section 303(e)(1) of the MMA added
section 1842(o)(5) of the Act which
requires the Secretary, beginning in CY
2005 to pay a furnishing fee, in an
amount the Secretary determines to be
appropriate, to hemophilia treatment
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
centers and homecare companies for the
items and services associated with the
furnishing of blood clotting factor. In
the Revisions to Payment Policies Under
the Physician Fee Schedule for Calendar
Year 2005 final rule, published
November 15, 2004 (69 FR 66236) we
established a furnishing fee of $0.14 per
unit of clotting factor for CY 2005.
Section 1842(o)(5) of the Act specifies
that the furnishing fee for clotting factor
for years after CY 2005 will be equal to
the fee for the previous year increased
by the percentage increase in the
consumer price index (CPI) for medical
care for the 12-month period ending
with June of the previous year. The CPI
data for the 12-month period ending in
June 2005 is not yet available. As a
point of reference, we note that the
percent change in the CPI for medical
care for the 12-month period ending
June 2004 was 5.1 percent. In the final
rule, we will include the actual figure
for the percent change in the CPI
medical care for the 12-month period
ending June 2005, and the updated
furnishing fee for CY 2006 calculated
based on that figure.
4. Payment for Inhalation Drugs and
Dispensing Fee
[If you choose to comment on issues in
this section, please include the caption
‘‘Inhalation Drugs and Dispensing Fee’’
at the beginning of your comments.]
Medicare Part B pays for inhalation
drugs administered via a nebulizer, a
covered item of DME. Medicare Part B
pays for DME and associated supplies,
including inhalations drugs that are
necessary for the operation of the
nebulizer. Metered-dose inhalers (MDIs)
are another mode of delivery for
inhalation drugs. MDIs are considered
disposable medical equipment (for
which there is no current Medicare Part
B benefit category), and consequently
are not currently covered under Part B.
Beginning in CY 2006, coverage for
MDIs will generally be available through
the Medicare Part D benefit. This
represents an important expansion in
the options available to beneficiaries for
inhalation drug coverage under
Medicare. With Medicare coverage of
both delivery methods available, we
anticipate that physicians will choose
the option that best suits a patient’s
particular needs consistent with the
applicable standards of medical
practice. We expect that both modes of
inhalation drug delivery will play an
important role in the Medicare program
in the years to come.
Prior to CY 2004, most Medicare Part
B covered drugs, including inhalation
drugs, were paid at 95 percent of the
AWP. Numerous studies by the OIG and
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
General Accounting Office (GAO)
indicated that 95 percent of AWP
substantially exceeded suppliers’
acquisition costs for Medicare Part B
drugs, particularly for the high volume
nebulizer drugs, albuterol and
ipratropium bromide.1 For example,
supplier’s acquisition costs were
estimated to be 34 percent of AWP for
ipratropium bromide and 17 percent of
AWP for albuterol based on averaging
results from a GAO and an OIG study.2
The MMA changed the Medicare
payment methodology for many Part B
covered drugs. As an interim step, in CY
2004, Medicare paid a reduced
percentage of AWP, 80 percent of AWP
in the case of albuterol and ipratropium
bromide. Beginning with CY 2005,
Medicare paid for nebulizer drugs at 106
percent of the ASP. The move to the
ASP system represented a substantial
reduction in reimbursement for the high
volume nebulizer drugs.
In addition to paying for the cost of
the drug itself, Medicare has paid a
dispensing fee for inhalation drugs.
Prior to CY 2005, Medicare paid a
monthly $5 dispensing fee for each
covered nebulizer drug or combination
of drugs used. In the Revisions to
Payment Policies Under the Physician
Fee Schedule for Calendar Year 2005
proposed rule, published August 5,
2004, we proposed to continue to pay a
dispensing fee for these drugs. In that
proposed rule, we sought comment on
an appropriate dispensing fee level to
cover the shipping, handling,
compounding, and other pharmacy
activities required to get these
medications to beneficiaries.
In response to last year’s proposed
rule, we received a number of comments
that varied substantially in terms of the
dispensing fee amount that commenters
thought was adequate. We received
comments from a retail pharmacy that
indicated that a dispensing fee of five to
six times the prior $5 fee was necessary
to cover costs. Another retail pharmacy
indicated that a dispensing fee of $25
would be an adequate amount and
would be profitable.
We also received several comments
that asserted that a substantially higher
fee was needed and that the dispensing
fee should cover a variety of services. A
number of commenters referenced an
1 GAO, ‘‘Medicare Payment for Covered
Outpatient Drugs Exceed Providers’ Costs,’’
September 2001. OIG, ‘‘Excessive Medicare
Reimbursement for Albuterol,’’ March 2002. OIG,
‘‘Excessive Medicare Reimbursement for
Ipratropium Bromide,’’ March 2002.
2 For more details see the Interim Final Rule
regarding Changes to Medicare Payment for Drugs
and Physician Fee Schedule Payments for Calendar
Year 2004 published in the Federal Register on
January 7, 2004.
PO 00000
Frm 00085
Fmt 4701
Sfmt 4702
45847
August 2004 report prepared for the
American Association of Homecare
(AAH) by a consultant that surveyed
104 home care agencies, which
indicated that in order to maintain the
CY 2004 levels of service to Medicare
beneficiaries and provide an operating
margin of 7 percent, Medicare would
have to pay a dispensing fee of $68.10
per service encounter (service
encounters they estimate occur on
average every 42 days). The survey
included costs for a wide range of
activities including activities associated
with getting the drug to the beneficiary,
as well as other additional services.
More specifically, the AAH data
included the following cost categories:
• Clinical intake.
• Establishing and revising the plan
of care.
• Care coordination.
• Patient education.
• Caregiver training.
• Compliance monitoring/refill calls.
• In-home visits.
• Delivery of services.
• Billing/collections.
• Other costs (not specified by AAH).
As an example, the AAH data
indicated that inhalation drug suppliers
spent on average about 29 minutes per
new patient on patient education and
caregiver training and continued to
spend on average about 17 minutes per
month for each established patient on
patient education and caregiver training.
The data also indicated that suppliers
spent on average about 23 minutes per
patient each month on in-home visits,
with there being substantial variation in
the provision of this service. A number
of commenters asserted that these and
other services included in the AAH data
were important to the provision of
inhalation drugs, and should be paid for
by Medicare.
Between publication of the August 5,
2004 proposed rule and the November
15, 2004 final rule, the GAO released a
report based on a survey of 12
inhalation therapy companies,
representing 42 percent of the market,
which indicated wide variation across
companies in the patient monthly cost
of dispensing inhalation drugs from a
low of $7 to a high of $204.3 The GAO
report indicated that the wide variation
in supplier costs is due, in part, to
variation in the services suppliers offer
and that some of the costs incurred by
suppliers may not be necessary to
dispense inhalation drugs, for example,
3 GAO, ‘‘Appropirate Dispensing Fee Needed for
Suppliers of Inhalation Therapy Drugs,’’ GAO–05–
72, October 2004.
E:\FR\FM\08AUP2.SGM
08AUP2
45848
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
marketing, overnight shipping, and 24hour hotlines.
In light of the substantial changes
occurring in inhalation drug
reimbursement in 2005, we viewed 2005
as a transitional year. With the wide
variation in the reported costs and
services provided by inhalation drug
suppliers suggested by the comments
and the GAO study, we stated in last
year’s final rule that we would establish
an interim dispensing fee for inhalation
drugs applicable for CY 2005 and
reconsider the issue for CY 2006. The
2005 dispensing fee for a 30-day supply
of inhalation drugs was based on the
industry recommended $68 fee from
AAH study, excluding certain costs that
Medicare generally does not reimburse
regardless of the scope of the Medicare
benefit (that is, sales and marketing, bad
debt, and an explicit profit margin). The
resulting fee established for a 30-day
supply of inhalation drugs was $57 for
CY 2005. This CY 2005 fee substantially
exceeded some providers’ costs as
reflected in a few comments on last
year’s proposed rule and the GAO
study. For example, as noted previously,
we received comments from two retail
pharmacy companies indicating that a
fee of $25 or a fee of five to six times
the prior $5 fee was adequate to cover
costs. Because the AAH study did not
include cost data for a 90-day supply,
we applied the methodology used in the
GAO report to convert the 30-day fee to
a 90-day fee. The 2005 fee established
for a 90-day supply was $80. In using
the AAH data to establish an interim fee
for dispensing for CY 2005, we
indicated in last year’s final rule that we
were concerned that some of the
services included in the AAH study may
be outside the scope of a dispensing fee
and that we would consider this issue
further in order to establish an
appropriate dispensing fee for CY 2006.
Authority for a dispensing fee for
inhalation drugs is based on section
1842(o)(2) of the Act. This section of the
Act stipulates that if payment is made
to a licensed pharmacy for a drug or
biological under Medicare Part B, the
Secretary may pay a dispensing fee (less
the applicable deductible and
coinsurance) to the pharmacy. The
statute does not define ‘‘dispensing fee.’’
As noted above, the AAH data on which
the 2005 dispensing fee is based
includes a wide range of cost categories.
The cost categories include basic
pharmacy services such as delivery of
drugs, as well as other services such as
in-home visits. We are soliciting
comments on what services
appropriately fall within the scope of a
dispensing fee, the cost of providing
those services, and whether any of the
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
services being provided by inhalation
drug suppliers may be covered through
another part of the Medicare program,
such as the physician fee schedule or
the DME benefit. We intend to establish
a dispensing fee amount for 2006 that is
adequate to cover the costs of those
services that appropriately fall within
the scope of a dispensing fee, and we
think that it is likely that this fee
amount will be lower than the 2005
level. As discussed previously, we
believe that 2005 was a transition year.
Payment for inhalation drugs in 2005
was reduced from a percentage of AWP
to 106 percent of ASP and the 2005
dispensing fee was set at a much higher
level than previously paid based on the
limited information available and taking
into account the transition. Additional
changes will occur in 2006 because the
implementation of the Medicare
prescription drug benefit will expand
coverage options for inhalation drugs to
include metered dose inhalers under
Medicare Part D. As noted above, we
expect that physicians will choose the
treatment option that best suits a
particular beneficiary’s needs and that
both nebulizers and metered-dose
inhalers will play an important role in
the Medicare program. We do not know
what the effect will be of this upcoming
expansion of inhalation drug coverage
options, but we believe it is important
that this second transitional year be as
smooth as possible. We are seeking
comments on an appropriate dispensing
fee level for 2006. We also seek data and
information on the various services
inhalation drug suppliers are currently
providing to Medicare beneficiaries and
the associated costs. Furthermore, we
are also soliciting comments on how
inhalation drug suppliers have utilized
the newly available 90-day scripts in
order to reduce unit shipping costs and
any reasons as to why 90-day supplies
may not have been utilized. We also
seek information on how revised
guidelines regarding the time frame for
delivery of refills has affected the need
for overnight delivery services. We are
interested in comments that detail the
extent to which suppliers have shifted
their shipping to ground services.
CMS takes quality of care seriously
and we have been implementing a
number of quality initiatives such as the
chronic care improvement program. We
expect that Medicare beneficiaries
receive high quality care, and we seek
data and information on any efforts by
inhalation drug suppliers to measure
patient outcomes. Furthermore, we seek
comments and additional information
about what are typical dispensing costs
for an efficient, high-quality supplier.
PO 00000
Frm 00086
Fmt 4701
Sfmt 4702
Finally, we seek comment on the
potential impact on beneficiaries and
providers of possible changes to the
inhalation drug dispensing fee in 2006,
as well as the impact of the new drug
benefit on inhalation drug access.
5. Supplying Fee
[If you choose to comment on issues
in this section, please include the
caption ‘‘Supplying Fee’’ at the
beginning of your comments.]
Section 303(e)(2) of the MMA added
section 1842(o)(6) of the Act that
requires the Secretary to pay a
supplying fee (less applicable
deductible and coinsurance) to
pharmacies for certain Medicare Part B
drugs and biologicals, as determined
appropriate by the Secretary. The types
of Medicare Part B drugs and biologicals
eligible for a supplying fee are
immunosuppressive drugs described in
section 1861(s)(2)(J) of the Act, oral
anticancer chemotherapeutic drugs
described in section 1861(s)(2)(Q) of the
Act, and oral anti-emetic drugs used as
part of an anticancer chemotherapeutic
regimen described in section
1861(s)(2)(T) of the Act.
Beginning with CY 2005, we
established a supplying fee of $24 per
prescription for these categories of
drugs, with a higher fee of $50 for the
initial oral immunosuppressive
prescription supplied in the first month
after a transplant. When multiple drugs
are supplied to a beneficiary, a separate
supplying fee is paid for each
prescription, except when different
strengths of the same drug are supplied
on a single day. In the November 15,
2004 final rule, we indicated that we
were establishing a supplying fee that
was higher than that of other payers due
to the lack of on-line claims
adjudication for Medicare Part B oral
drugs. Other than the cost of billing
Medicare Part B, we indicated that we
did not believe there were any other
significant cost differences between
Medicare and other payers that justified
a higher Medicare supplying fee for
these drugs. We noted in last year’s final
rule that many other payers with online
adjudication have dispensing fees in the
range of $5 to $10 per prescription. We
also indicated that we had received
comments that the average cost to a
pharmacy to dispense a non-Medicaid
third party or cash prescription for those
drugs ranges anywhere from $7.50 to
$8.00.
When multiple drugs are supplied to
a beneficiary on the same day or in the
same month, current policy is to pay a
full supplying fee for each additional
drug. As mentioned previously, we
established a supplying fee higher than
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
that of other payers to compensate for
the added costs associated with our lack
of online claims adjudication. However,
in situations where multiple drugs are
supplied to a beneficiary during the
same month, many of which are likely
to be supplied on the same day, we are
concerned that we are overpaying for
the costs associated with our lack of
online claims adjudication. We believe
that there are likely to be substantial
economies of scale and that the burden
associated with our lack of online
claims adjudication would be relatively
similar whether one prescription or
multiple prescriptions were supplied
during the same month.
Consequently, in § 414.1001 (Basis of
payment), we are proposing changes to
the supplying fee for multiple
prescriptions supplied during the same
month. We would continue paying $24
for the first prescription supplied during
a month (or $50 for the first oral
immunosuppressive prescription
supplied in the first month after a
transplant). We believe that this $24
supplying fee for the first prescription
would adequately compensate a
supplier for the billing costs associated
with the lack of on-line claims
adjudication, and that the cost of
supplying additional prescriptions in
the same month should be comparable
to that of other payers. Therefore, in that
same section, we are proposing to pay
a supplier an $8 supplying fee per
prescription for any prescription, after
the first one, that that supplier provided
to a beneficiary during a month. If a
beneficiary obtained prescriptions at
two separate pharmacies during a onemonth period, each pharmacy would be
paid a $24 fee for the first drug it
supplied and an $8 fee per prescription
for any subsequent prescriptions during
the month.
We are also proposing to expand the
circumstances under which we pay
supplying fees for multiple
prescriptions filled on the same day.
Currently, we pay a supplying fee for
each prescription supplied on the same
day as long as the prescriptions are for
different drugs. We are now proposing
to pay a supplying fee for each
prescription, even if the prescriptions
are for different strengths of the same
drug. This change is intended to
recognize the costs involved in filling
separate prescriptions for different
strengths of a drug. For example, if two
prescriptions were supplied on a single
day and they were for different strengths
of the same drug, we are proposing to
pay a supplying fee of $24 for the first
prescription and a supplying fee of $8
for the second prescription.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Our goal is to ensure that each
beneficiary who needs covered oral
drugs has access to those medications
while maintaining our fiduciary
responsibility to pay appropriately for
Medicare covered services. We seek
comments about the appropriateness of
our proposed supplying fee for multiple
prescriptions supplied during a single
month. We also seek data and
information about the incremental costs
of supplying additional prescriptions to
a Medicare beneficiary during a single
month, as well as data and information
about how pharmacy costs and
reimbursement for supplying oral drugs
under Medicare compares to that of
other payers.
I. Private Contracts and Opt-Out
Provision
[If you choose to comment on issues in
this section, please include the caption
‘‘PRIVATE CONTRACTS AND OP–
OUT’’ at the beginning of your
comments.]
Section 4507 of the BBA of 1997
amended section 1802 of the Act to
permit certain physicians and
practitioners to opt-out of Medicare if
certain conditions were met, and to
provide through private contracts
services that would otherwise be
covered by Medicare. Under these
private contracts, the mandatory claims
submission and limiting charge rules of
section 1848(g) of the Act would not
apply. The amendments to section 1802
of the Act, which were effective on
January 1, 1998, made the provisions of
the Medicare statute that would
ordinarily preclude physicians and
practitioners from contracting privately
with Medicare beneficiaries to pay
without regard to Medicare limits
inapplicable if the conditions necessary
for an effective ‘‘opt-out’’ are met.
When a physician or practitioner fails
to maintain the conditions necessary for
opt-out and does not take good faith
efforts to correct his or her failure to
maintain opt-out, current regulations at
§ 405.435(b) specify the consequences to
that physician or practitioner for the
remainder of that physician’s or
practitioner’s 2-year opt-out period.
However, § 405.435(b) describes a
situation where the Medicare carrier
notifies the physician or practitioner
that he or she is violating the
regulations and the statute. The current
regulations do not address the
consequences to physicians and
practitioners in situations when a
condition resulting in failure to
maintain opt-out occurs during the 2year opt-out period, but a Medicare
carrier does not discover or give notice
of a physician’s or practitioner’s failure
PO 00000
Frm 00087
Fmt 4701
Sfmt 4702
45849
to maintain opt-out during the 2-year
opt-out period. Therefore, we are
proposing to amend § 405.435 in order
to clarify that the consequences
specified in § 405.435(b) for the failure
on the part of a physician or practitioner
to maintain opt-out will apply
regardless of whether or when a carrier
notifies a physician or practitioner of
the failure to maintain opt-out. We are
also proposing to add a new paragraph
(d) to clarify that in situations where a
violation of § 405.435(a) is not
discovered by the carrier during the 2year opt-out period when the violation
actually occurred, then the requirements
of § 405.435(b)(1) through (b)(8) would
be applicable from the date that the first
violation of § 405.435(a) occurred until
the end of the opt-out period during
which the violation occurred (unless the
physician or practitioner takes good
faith efforts to restore opt-out
conditions, for example, by refunding
the amounts in excess of the charge
limits to beneficiaries with whom he or
she did not sign a private contract).
These good faith efforts must be made
within 45 days of any notice by the
carrier that the physician or practitioner
has failed to maintain opt-out (where
the carrier discovers the failure after the
two-year opt-out period has expired), or
within 45 days after the physician or
practitioner has discovered the failure to
maintain opt-out, whichever is earlier.
J. Multiple Procedure Reduction for
Diagnostic Imaging
[If you choose to comment on issues in
this section, please include the caption
‘‘MULTIPLE PROCEDURE
REDUCTION’’ at the beginning of your
comments.]
Medicare has a longstanding policy of
reducing payment for multiple surgical
procedures performed on the same
patient, by the same physician, on the
same day. In those cases, full payment
is made for the highest priced procedure
and each subsequent procedure is paid
at 50 percent. Effective January 1, 1995,
the multiple procedure policy, with the
same reductions, was extended to
nuclear medicine diagnostic procedures
(CPT codes 78306, 78320, 78802, 78803,
78806 and 78807). In the Medicare
Program Physician Fee Schedule for
Calendar Year 1995 final rule, published
on December 8, 1994 (59 FR 63410), we
indicated that we would consider
applying the policy to other diagnostic
tests in the future.
Under the PFS, diagnostic imaging
procedures are priced in the following
three ways:
• The professional component (PC)
represents the physician work, that is,
the interpretation.
E:\FR\FM\08AUP2.SGM
08AUP2
45850
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
• The TC represents practice expense,
that is, clinical staff, supplies, and
equipment.
• The global service represents both
PC and TC. Generally, diagnostic
imaging procedures even those
performed on contiguous body parts are
paid at 100 percent for each procedure.
For example, the TC payment is
approximately $978 for a magnetic
resonance imaging (MRI) of the
abdomen (without and with dye), and
$529 for an MRI of the pelvis (with dye)
(CPT codes 74183 and 72196,
respectively), even when both
procedures are performed in a single
session.
Under the resource-based PE
methodology, specific PE inputs of
clinical labor, supplies and equipment
are used to calculate PE RVUs for each
individual service. We do not believe
these same inputs are needed to perform
subsequent procedures. When multiple
images are acquired in a single session,
most of the clinical labor activities and
most supplies are not performed or
furnished twice. Specifically, we
consider that the following clinical
labor activities are not duplicated for
subsequent procedures:
• Greeting the patient.
• Positioning and escorting the
patient.
• Providing education and obtaining
consent.
• Retrieving prior exams.
• Setting up the IV.
• Preparing and cleaning the room.
In addition, we consider that
supplies, with the exception of film, are
not duplicated for subsequent
procedures. Equipment time and
indirect costs are allocated based on
clinical labor time; therefore, these
inputs should be reduced accordingly.
Excluding the above practice expense
inputs, along with the corresponding
portion of equipment time and indirect
costs, supports a 50 percent reduction in
the payment for the TC of subsequent
procedures. Applying this reduction to
the two procedures indicated above
would result in a full payment of $978
for the highest priced procedure, and a
reduced payment of $264.50 (50 percent
× $529) for the second procedure. This
same calculation is currently used for
the multiple procedure payment
reduction for surgery. We are not
proposing to apply a multiple procedure
reduction to PC services at this time
because we believe physician work is
not significantly affected for multiple
procedures.
The global service payment equals the
combined PC and TC components.
When the global service code is billed
for these procedures, the TC would be
reduced the same as above, but the PC
would be paid in full at $117 and $90
for codes 74183 and 72196, respectively.
In our view, duplicate payment is
currently being made for the TC of
multiple diagnostic imaging services,
particularly when contiguous body parts
are viewed in a single session. The
Medicare Payment Advisory
Commission (MedPAC) supports this
reduction in its March 2005 Report to
the Congress on Medicare Payment
Policy.
We have identified 11 families of
imaging procedures by imaging
modality (ultrasound, CT and computed
tomographic angiography (CTA), MRI
and magnetic resonance angiography
(MRA) and contiguous body area (for
example, CT and CTA of Chest/Thorax/
Abdomen/Pelvis). MedPAC pointed out
that Medicare’s payment rates are based
on each service being provided
74183
PC .....................................................................
TC .....................................................................
Global ................................................................
$117.00
$978.00
$1,095.00
TABLE 29.—DIAGNOSTIC IMAGING
SERVICES
Family 1 Ultrasound (Chest/Abdomen/
Pelvis—Non-Obstetrical
76604 .............
76645 .............
76700 .............
76705 .............
76770 .............
VerDate jul<14>2003
Ultrasound exam, chest, bscan
Ultrasound exam, breast(s)
Ultrasound exam, abdom,
complete
Echo exam of abdomen
Ultrasound exam abdo back
wall, comp
20:18 Aug 05, 2005
Jkt 205001
72196
$90.00
$530.00
$620.00
Total current
payment
76778 .............
76830 .............
76831 .............
76856 .............
76857 .............
PO 00000
Frm 00088
Ultrasound exam abdo back
wall, lim
Ultrasound exam kidney
transplant
Transvaginal Ultrasound,
non-ob
Echo exam, uterus
Ultrasound exam, pelvic,
complete
Ultrasound exam, pelvic, limited
Fmt 4701
Sfmt 4702
Total proposed
payment
$207.00
$1,507.00
$1,714.00
TABLE 29.—DIAGNOSTIC IMAGING
SERVICES—Continued
76775 .............
independently and that the rates do not
account for efficiencies that may be
gained when multiple studies using the
same imaging modality are performed in
the same session. Those efficiencies are
more likely when contiguous body areas
are the focus of the imaging because the
patient and equipment have already
been prepared for the second and
subsequent procedures, potentially
yielding resource savings in areas such
as clerical time, technical preparation,
and supplies. Using billing data, we
identified a number of contiguous body
areas for which imaging is performed
during the same session. Next, because
our proposed discounting policies are
based on the expectation that facilities
will achieve savings by not having to
expend more than once, many of the
resources associated with performance
of a second, and any subsequent
procedures, we organized the families
by imaging modality.
We propose extending the multiple
procedure payment reduction to TC
only services and the TC portion of
global services for the procedures in
Table 29, below. At this time, we
propose applying the reduction only to
procedures involving contiguous body
parts within a family of codes, not
across families. For example, the
reduction would not apply to an MRI of
the brain (CPT 70552) in code family 5,
when performed in the same session as
an MRI of the neck and spine (CPT
72142) in code family 6. When multiple
procedures within the same family are
performed in the same session, we
propose making full payment for the TC
of the highest priced procedure and
payment at 50 percent of the TC for each
additional procedure. The following is
an example of the current and proposed
payments:
$207.00
$1,243
$1,450
Payment calculation
no reduction.
$978 + (.5 × $530)
$207 + $978 + (.5 × $530)
TABLE 29.—DIAGNOSTIC IMAGING
SERVICES—Continued
Family 2 CT and CTA (Chest/Thorax/Abd/
Pelvis)
71250
71260
71270
71275
72191
72192
72193
72194
74150
74160
E:\FR\FM\08AUP2.SGM
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
08AUP2
CT thorax w/o dye
CT thorax w/ dye
CT thorax w/o & w/ dye
CTA, chest
CTA, pelv w/o & w/ dye
CT pelvis w/o dye
CT pelvis w/ dye
CT pelvis w/o & w/ dye
CT abdomen w/o dye
CT abdomen w/ dye
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 29.—DIAGNOSTIC IMAGING
SERVICES—Continued
74170
74175
75635
0067T
.............
.............
.............
.............
CT abdomen w/o & w/ dye
CTA, abdom w/o & w/ dye
CTA abdominal arteries
CT colonography; dx
Family 3 CT and CTA (Head/Brain/Orbit/
Maxillofacial/Neck)
70450
70460
70470
70480
70481
70482
.............
.............
.............
.............
.............
.............
70486 .............
70487 .............
70488 .............
70490 .............
70491 .............
70492 .............
70496 .............
70498 .............
CT head/brain w/o dye
CT head/brain w/ dye
CT head/brain w/o & w/ dye
CT orbit/ear/fossa w/o dye
CT orbit/ear/fossa w/ dye
CT orbit/ear/fossa w/o & w/
dye
CT maxillofacial w/o dye
CT maxillofacial w/ dye
CT maxillofacial w/o & w/
dye
CT soft tissue neck w/o dye
CT soft tissue neck w/ dye
CT soft tissue neck w/o & w/
dye
CTA, head
CTA, neck
Family 4 MRI and MRA (Chest/Abd/Pelvis)
71550
71551
71552
71555
.............
.............
.............
.............
72195
72196
72197
72198
.............
.............
.............
.............
74181 .............
74182 .............
74183 .............
74185 .............
MRI chest w/o dye
MRI chest w/ dye
MRI chest w/o & w/ dye
MRI angio chest w/ or w/o
dye
MRI pelvis w/o dye
MRI pelvis w/ dye
MRI pelvis w/o &w/ dye
MRI angio pelvis w/ or w/o
dye
MRI abdomen w/o dye
MRI abdomen w/ dye
MRI abdomen w/o and w/
dye
MRI angio, abdom w/ or w/o
dye
TABLE 29.—DIAGNOSTIC IMAGING
SERVICES—Continued
72158 .............
Family 7 CT (spine)
72125
72126
72127
72128
72129
72130
72131
72132
72133
.............
.............
.............
.............
.............
.............
.............
.............
.............
70544
70545
70546
70547
70548
70549
70551
70552
70553
.............
.............
.............
.............
.............
.............
.............
.............
.............
MRI orbit/face/neck w/o dye
MRI orbit/face/neck w/ dye
MRI orbit/face/neck w/o & w/
dye
MRA head w/o dye
MRA head w/dye
MRA head w/o & w/dye
MRA neck w/o dye
MRA neck w/dye
MRA neck w/o & w/dye
MRI brain w/o dye
MRI brain w/dye
MRI brain w/o & w/dye
Family 6 MRI and MRA (spine)
72141
72142
72146
72147
72148
72149
72156
72157
.............
.............
.............
.............
.............
.............
.............
.............
VerDate jul<14>2003
MRI neck spine w/o dye
MRI neck spine w/dye
MRI chest spine w/o dye
MRI chest spine w/dye
MRI lumbar spine w/o dye
MRI lumbar spine w/dye
MRI neck spine w/o & w/dye
MRI chest spine w/o & w/
dye
20:18 Aug 05, 2005
Jkt 205001
CT neck spine w/o dye
CT neck spine w/dye
CT neck spine w/o & w/dye
CT chest spine w/o dye
CT chest spine w/dye
CT chest spine w/o & w/dye
CT lumbar spine w/o dye
CT lumbar spine w/dye
CT lumbar spine w/o & w/
dye
Family 8 MRI and MRA (lower extremities)
73718
73719
73720
73721
.............
.............
.............
.............
73722 .............
73723 .............
73725 .............
MRI lower extremity w/o dye
MRI lower extremity w/dye
MRI lower ext w/ & w/o dye
MRI joint of lwr extre w/o
dye
MRI joint of lwr extr w/dye
MRI joint of lwr extr w/o & w/
dye
MRA lower ext w or w/o dye
Family 9 CT and CTA (lower extremities)
73700 .............
73701 .............
73702 .............
73706 .............
CT lower extremity w/o dye
CT lower extremity w/dye
CT lower extremity w/o & w/
dye
CTA lower ext w/o & w/dye
Family 10 Mr and MRI (upper extremities
and joints)
73218 .............
73219 .............
73220 .............
73221 .............
73222 .............
73223 .............
Family 5 MRI and MRA (Head/Brain/Neck)
70540 .............
70542 .............
70543 .............
MRI lumbar spine w/o & w/
dye
MRI upper extr w/o dye
MRI upper extr w/dye
MRI upper extremity w/o &
w/dye
MRI joint upper extr w/o dye
MRI joint upper extr w/dye
MRI joint upper extr w/o &
w/dye
Family 11 CT and CTA (upper extremities)
73200 .............
73201 .............
73202 .............
73206 .............
CT upper extremity w/o dye
CT upper extremity w/dye
CT upper extremity w/o & w/
dye
CTA upper extr w/o & w/dye
K. Therapy Cap
[If you choose to comment on issues in
this section, please include the caption
‘‘THERAPY CAP’’ at the beginning of
your comments.]
Section 1833(g)(1) of the Act applies
an annual, per beneficiary combined
cap on outpatient physical therapy (PT)
and speech-language pathology services,
and a similar separate cap on outpatient
occupational therapy services under
Medicare Part B. This cap was added by
section 4541 of the BBA 1997, Pub. L.
105–33. However, the application of the
caps was suspended from CY 2000
PO 00000
Frm 00089
Fmt 4701
Sfmt 4702
45851
through CY 2002 under section
1833(g)(4) of the Act by section 221 of
the of BBRA 1999, Pub. L. 106–113, and
extended by section 421 of BIPA 2000,
Pub. L. 105–551. The caps were
implemented from September 1, 2003
through December 7, 2003. Section 624
of the MMA reinstated the moratorium
on the application of these caps from
December 8, 2003 through December 31,
2005. Thus, the caps will again become
effective beginning January 1, 2006.
Section 1883(g)(2) of the Act provides
that, for 1999 through 2001, the caps
were both $1500, and for years after
2001, the caps are equal to the
preceding year’s cap increased by the
percentage increase in the MEI (except
that if an increase for a year is not a
multiple of $10, it is rounded to the
nearest multiple of $10). We will
publish the dollar amount for therapy
caps in the final rule, when the MEI is
available. Based on the April 4, 2005
MEI estimate, the estimated value of
therapy caps for 2006 would be $1,750.
L. Chiropractic Services Demonstration
[If you choose to comment on issues in
this section, please include the caption
‘‘CHIROPRACTIC SERVICES’’ at the
beginning of your comments.]
Section 1861(r)(5) of the Act limits
current Medicare coverage for
chiropractic treatment by means of the
manual manipulation of the spine for
the purpose of correcting a subluxation,
defined generally as a malfunction of
the spine. Specifically, Medicare covers
three CPT Codes provided by
chiropractors: 98940 (manipulative
treatment, 1–2 regions of the spine),
98941 (manipulative treatment, 3–4
regions of the spine), and 98942
(manipulative treatment, 5 regions of
the spine). Treatment must be provided
for an active subluxation only, and not
for prevention or maintenance.
Additionally, treatment of the
subluxation must be related to a
neuromusculoskeletal condition where
there is a reasonable expectation of
recovery or functional improvement.
Section 651 of the MMA provides for
a 2-year demonstration to evaluate the
feasibility and advisability of covering
chiropractic services under Medicare.
These services extend beyond the
current coverage for manipulation to
care for neuromusculoskeletal
conditions typical among eligible
beneficiaries, and will cover diagnostic
and other services that a chiropractor is
legally authorized to perform by the
State or jurisdiction in which the
treatment is provided. Physician
approval will not be required for these
services. The demonstration must be
budget neutral and will be conducted in
E:\FR\FM\08AUP2.SGM
08AUP2
45852
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
four sites, two rural and two urban. One
site of each area type must be a health
professional shortage area (HPSA).
On January 28, 2005, we published a
notice in the Federal Register (70 FR
4130) describing the covered services
and site selection for this
demonstration. As recognized in the
notice, the statute requires the Secretary
to ensure that aggregate payments made
under the Medicare program do not
exceed the amount that would have
been paid under the Medicare program
in the absence of this demonstration.
Ensuring budget neutrality requires
that the Secretary develop a strategy for
recouping funds should the
demonstration result in costs higher
than would occur in the absence of the
demonstration. In this case, we stated
we would make adjustments in the
national chiropractor fee schedule to
recover the costs of the demonstration
in excess of the amount estimated to
yield budget neutrality. We indicated
that we will assess budget neutrality by
determining the change in costs based
on a pre/post comparison of costs and
the rate of change for specific diagnoses
that are treated by chiropractors and
physicians in the demonstration sites
and control sites. We will not limit our
analysis to reviewing only chiropractor
claims, because the costs of the
expanded chiropractor services may
have an impact on other Medicare costs.
We anticipate that any necessary
reduction will be made in the 2010 and
2011 fee schedules because it will take
approximately 2 years to complete the
claims analysis. If we determine that the
adjustment for budget neutrality is
greater than 2 percent of spending for
the chiropractor fee schedule codes
(comprised of the 3 currently covered
CPT codes 98940, 98941 and 98942), we
will implement the adjustment over a 2year period. However, if the adjustment
is less than 2 percent of spending under
the chiropractor fee schedule codes, we
will implement the adjustment over a 1year period. We will include the
detailed analysis of budget neutrality
and the proposed offset in the 2009
Federal Register publication of the PFS.
PT services that are performed by
chiropractors under the demonstration
will be included under the PT cap
described in section J above. We are
including these services under the cap
because chiropractors are subject to the
same rules as medical doctors for
therapy services under the
demonstration. Therefore these services
should be included under the therapy
cap. See our Web site https://
www.cms.hhs.gov/researchers/demos/
eccs/ for additional information
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
concerning the chiropractic services
demonstration.
M. Supplemental Payments to Federally
Qualified Health Centers (FQHCs)
Subcontracting With Medicare
Advantage Plans
[If you choose to comment on issues in
this section, please include the caption
‘‘SUPPLEMENTAL PAYMENTS—
FQHCS’’ at the beginning of your
comments.]
Title II of the MMA established the
Medicare Advantage (MA) program. The
MA program replaces the
Medicare+Choice (M+C) program
established under Part C of the Act.
Although the MA program retains many
key features of the M+C program, it
includes several new features, such as
the availability of a regional MA plan
option. Regional MA plans must be
preferred provider organization (PPO)
plans.
Section 237 of the MMA amended
section 1833(a)(3) of the Act to provide
supplemental payments to FQHCs that
contract with MA organizations to, in
general, cover the difference, if any,
between the payment received by the
health center for treating enrollees in
MA plans offered by the MA
organization and the payment that the
FQHC is entitled to receive under the
cost-based all-inclusive payment rate as
set forth in part 405, subpart X. This
new supplemental payment for covered
Medicare FQHC services furnished to
MA enrollees augments the direct
payments made by MA Plans to FQHCs
for covered Medicare FQHC services.
Medicare’s obligation to provide
supplemental payments to FQHCs
applies to centers with direct or indirect
subcontract arrangements following a
written agreement with MA
organizations.
Centers eligible for supplemental
payments under section 1833(a)(3) of
the Act, as revised by Section 237 of the
MMA, include any facility qualified to
furnish FQHC services described in
section 1832(a)(2)(D) of the Act. Only
the following entities are qualified to
furnish FQHC services: (1) entities
receiving a grant under section 330
(other than subsection (h)) of Public
Health Services Act or receiving funding
from this grant under a contract with its
recipient and meets the requirements to
receive this grant; (2) entities
determined by the Secretary to meet the
requirements for receiving this grant; (3)
entities treated by the Secretary, for
purposes of Part B, as a comprehensive
Federally funded health center as of
January 1, 1990; or (4) an outpatient
health program or facility operated by a
tribe or tribal organization receiving
PO 00000
Frm 00090
Fmt 4701
Sfmt 4702
funds under title V of Indian Health
Care Improvement Act.
In order to implement this new
payment provision, CMS must
determine whether the Medicare costbased payments that the FQHC would
be entitled to exceed the amount of
payments received by the center from
the MA organization and, if so, pay the
difference to the FQHC at least
quarterly. In determining the
supplemental payment, the statute also
excludes in the calculation of the
supplemental payments any financial
incentives provided to FQHCs under
their MA arrangements, such as risk
pool payments, bonuses, or withholds.
Managed care organizations
frequently use financial incentives in
their contracts with providers to reduce
unnecessary utilization of services.
These incentives may be negative, such
as withholding a portion of the
capitation payments, if utilization goals
are not satisfied. Incentives may also be
positive, such as a bonus payment if
utilization outcomes are achieved. In
both cases, these incentives (whether
positive or negative) are separate from
the MA organization’s payment for
services provided under its direct or
indirect contract with the FQHC and are
prohibited by statute from being
included in our calculation of
supplemental payments due to the
Medicare FQHC. In other words, in
determining the difference between
payments from the MA organization to
the FQHC and what the FQHC will
receive on a cost basis, we are precluded
from using the incentive payments in
the calculation of the FQHC
supplemental payment. Only capitated
per month per beneficiary or fee-forservice payments from the MA plan for
services furnished to MA enrollees are
included in the calculations of the rate
differential.
Under original Medicare, each center
is paid an all-inclusive per visit rate
based on its reasonable costs as reported
in the FQHC cost report. The payment
is calculated, in general, by dividing the
center’s total allowable cost by the total
number of visits for FQHC services. At
the beginning of the rate year, the
Medicare Fiscal Intermediary (FI)
calculates an interim rate based on
estimated allowable costs and visits
from the center if it is new to the FQHC
program or actual costs and visits from
the previous cost reporting period for
existing FQHCs. The center’s interim
rate is reconciled to actual reasonable
costs at the end of the cost reporting
period.
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Proposed Payment Methodology
We are proposing a supplemental
payment method based on a per visit
calculation subject to an annual
reconciliation. The supplemental
payment for FQHC covered services
rendered to MA enrollees is equal to the
difference between 100 percent of the
FQHC’s all-inclusive cost-based per visit
rate and the average per visit rate
received by the center from the MA plan
in which the enrollee is enrolled, less
any amount the FQHC may charge as
described in section 1857(e)(3)(B) of the
Act. Each center will be required to
submit (for the first rate year) to the
intermediary an estimate of the average
MA payment per visit for covered FQHC
services. Every eligible center will be
required to submit a detailed estimate of
its average per visit payment for
enrollees in each MA plan offered by
the MA organization and any other
information as may be required to
enable the intermediary to accurately
establish an interim supplemental
payment, which will be the difference
between the estimated MA per visit
payment rate and the center’s interim
all-inclusive cost-based per visit rate.
Expected payments from the MA plan
will only be used until actual MA
revenue and visits can be collected on
the center’s FQHC cost report. The
interim and final supplemental payment
amount will vary by center depending
on its current Medicare reimbursement
rates and its contractual arrangements
with MA plans.
Effective January 1, 2006, eligible
FQHCs will report actual revenue
received from the MA plan and visits on
their cost reports. At the end of the cost
reporting period the FI would use actual
MA revenue and visit data along with
the FQHCs’ final all-inclusive payment
rate, to determine the center’s final
actual supplemental per visit payment
for enrollees in the relevant MA plan.
This will serve as the interim rate for
the subsequent rate year. Actual
aggregated supplemental payments will
then be reconciled with aggregated
interim supplemental payments, and
any underpayment or overpayment
thereon will then be accounted for in
determining final Medicare FQHC
program liability at cost settlement.
Necessary changes will be made to the
FQHC cost report to effectuate the
calculation of the supplemental rate.
A supplemental payment will be
made every time a face-to-face
encounter occurs between a MA
enrollee and any one of the following
FQHC covered core practitioners:
physicians, NPs, PAs, clinical nurse
midwives, clinical psychologists, or
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
clinical social workers. The
supplemental payment is made directly
to each qualified center through the
Medicare FI. Each center is responsible
for submitting Medicare claims with the
proper codes for these visits. Necessary
changes will be made to the instructions
for the FQHC claim form to effectuate
the billing and payment of
supplemental payments.
To conform our regulations to the
statute, we are proposing to add
§ 405.2469 to specify the per visit
payment methodology for making
supplemental payments to FQHCs
under contract (directly or indirectly)
with MA organizations.
N. National Coverage Decisions
Timeframes
[If you choose to comment on issues in
this section, please include the caption
‘‘NCD TIMEFRAMES’’ at the beginning
of your comments.]
We have established requirements
concerning the administrative review of
local coverage determinations (LCDs)
and National Coverage Determinations
(NCDs) at 42 CFR part 426, with subpart
C specifically addressing the general
provisions for the review of LCDs and
NCDs. Under our existing regulations in
part 426, subpart C, the Departmental
Appeals Board may stay the
adjudicatory proceedings in certain
circumstances to allow CMS to consider
significant new evidence that is
submitted in the context of a challenge
to an NCD. Our previous regulations at
§ 426.340(e), permitted a brief stay of
the adjudicatory proceedings (not more
than 90 days), for CMS to complete its
reconsideration of the NCD. Those time
frames, although short, were consistent
with the previous process for making
NCDs that did not require publication of
a proposed decision memorandum and
an opportunity for public comment on
the proposed decision memorandum.
Section 731 of the MMA of 2003
modifies certain timeframes in the NCD
review process. Specifically, the MMA
amended section 1862(l) of the Act to
specify that for NCD requests not
requiring an external technology
assessment (TA) or Medicare Coverage
Advisory Committee (MCAC) review,
the decision on the request shall be
made not later than 6 months after the
date the request is received. For those
NCD requests requiring either an
external TA or MCAC review, where a
clinical trial is not requested, the
decision on the request must be made
not later than 9 months after the date
the request is received.
Furthermore, section 731 of the MMA
stipulates that not later than the end of
the 6 or 9 month period described
PO 00000
Frm 00091
Fmt 4701
Sfmt 4702
45853
above, a draft of the proposed decision
must be made available on the CMS
website (or other appropriate means) for
public comment. This comment period
will last 30 days. Comments will be
reviewed and a final decision will be
issued not later than 60 days after the
conclusion of the comment period. A
summary of the public comments
received and responses to the comments
will continue to be included in the final
NCD.
In light of the procedural change
made by section 731 of the MMA that
requires a public comment period before
we can issue a final determination for
NCDs, we are proposing to amend
§ 426.340 to reflect the new timeframes
in the MMA. The regulation is amended
to state that if the CMS informs the
Board that a revision or reconsideration
was or will be initiated, then the Board
will stay the proceedings and set
appropriate timeframes by which the
revision or reconsideration will be
completed, that reflects sufficient time
for the publication of a proposed
determination, a thirty day public
comment period, and time for CMS to
prepare a final determination that
responds to public comments as
specified in section 1862(l) of the Act.
Subsequently, the reference to the 90
day reconsideration period in
§ 426.340(e)(3) will be eliminated for
NCD appeals to reflect the new
timeframes in the MMA. The LCD
timeframes will not be affected by this
change.
O. Coverage of Screening for Glaucoma
[If you choose to comment on issues in
this section, please include the caption
‘‘COVERAGE OF SCREENING—
GLAUCOMA’’ at the beginning of your
comments.]
On January 1, 2002, we implemented
regulations at § 410.23(a)(2), Conditions
for and limitations on coverage of
screening for glaucoma, requiring that
the term ‘‘eligible beneficiary’’ be
defined to include individuals in the
following high risk categories: (i)
Individual with diabetes mellitus; (ii)
Individual with a family history of
glaucoma; or (iii) African-Americans age
50 and over. Based on our review of the
current medical literature, we believe
that there are other beneficiaries who
are at risk for glaucoma and should be
included in the definition of eligible
beneficiary for purposes of the glaucoma
screening benefit.
The Eye Diseases Prevalence Research
Group recently reviewed the literature
on the prevalence of glaucoma in adults
in the United States (Arch Ophthalmol
2004; 122:532–538) and provided
separate data for Hispanic persons. They
E:\FR\FM\08AUP2.SGM
08AUP2
45854
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
reported that Hispanic subjects had a
marked higher prevalence in the oldest
age group. After controlling for age and
gender, rates of open angle glaucoma in
Hispanic persons did not differ
significantly from that among whites,
except for those age 65 years and older.
The prevalence of open angle glaucoma
in Hispanic persons age 65 years and
older was significantly higher than
among whites. Overall, Hispanic
subjects had a significantly lower
prevalence of open angle glaucoma than
African-Americans. One notable
limitation of this review article is that
the data on Hispanic persons came from
a single study of mostly Mexican-born
Hispanics from Arizona (Quigley HA et
al. The prevalence of glaucoma in a
population based study of Hispanic
subjects: proyecto VER. Ann
Ophthalmol 2001; 119:1819–1825). We
believe the evidence is adequate to
conclude that Hispanic persons age 65
and older are at high risk and could
benefit from glaucoma screening.
Therefore in § 410.23(a)(2), we are
proposing to revise the definition of an
eligible beneficiary to include Hispanic
Americans age 65 and over. If this
proposal is adopted in the final rule,
effective January 1, 2006, Hispanic
Americans age 65 and older would
qualify for Medicare coverage and
payment for glaucoma screening
services, if the applicable condition and
limitations on coverage of screening for
glaucoma specified in § 410.23(b) and
(c) are met.
In view of the possibility that it may
be appropriate to include other
individuals in the statutory definition of
those at ‘‘high risk’’ for glaucoma, we
are requesting comments on this issue.
Specifically, we request that anyone
providing us with specific
recommendations on this issue provide
documentation in support of them from
the peer-reviewed medical literature.
P. Physician Referrals for Nuclear
Medicine Services and Supplies to
Health Care Entities With Which They
Have Financial Relationships
[If you choose to comment on issues in
this section, please include the caption
‘‘NUCLEAR MEDICINE SERVICES’’ at
the beginning of your comments.]
1. Background
Under section 1877 of the Act, a
physician may not refer a Medicare
patient for certain designated health
services (DHS) to an entity with which
the physician (or an immediate family
member of the physician) has a financial
relationship, unless an exception
applies. Section 1877 of the Act also
prohibits the DHS entity from
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
submitting claims to Medicare or billing
the beneficiary or any other entity for
Medicare DHS that are furnished as a
result of a prohibited referral. Sections
1877(h)(6)(D) and (E) of the Act define
DHS to include ‘‘[r]adiology services,
including magnetic resonance imaging,
computerized axial tomography and
ultrasound services’’ and ‘‘[r]adiation
therapy services and supplies.’’ This
proposed rule would include diagnostic
and therapeutic nuclear medicine
procedures under the DHS categories for
radiology and certain other imaging
services and radiation therapy services
and supplies, respectively.
On January 9, 1998, we published a
proposed rule (63 FR 1659) that, among
other things, proposed regulatory
definitions for the various DHS
categories listed in the statute. In that
proposed rule, we proposed to include
nuclear medicine services in the
definition of radiology services. In the
January 4, 2001 physician self-referral
Phase I final rule (66 FR 856), we
defined ‘‘radiology and certain other
imaging services’’ and ‘‘radiation
therapy services and supplies’’ at
§ 411.351. We did not include nuclear
medicine services in either definition
because, at that time, we believed that
diagnostic nuclear medicine services
were not commonly considered to be
radiology services and that therapeutic
nuclear medicine services were not
commonly considered to be radiation
therapy services. We received one
comment urging us to include nuclear
medicine services in the definition of
radiology services. In the Phase II final
rule, published on March 26, 2004 (69
FR 16054), we indicated that we were
concerned with the issues raised by the
commenter and that we might revisit the
issue of nuclear medicine in a proposed
rule.
2. Proposal To Include Nuclear
Medicine
Our knowledge of nuclear medicine,
which is based in part on our awareness
of the health care community’s view of
nuclear medicine, has changed
significantly since we published the
Phase I final rule. As a result, we have
reconsidered the question of whether
nuclear medicine services should be
considered a DHS. We are proposing to
amend § 411.351 to include diagnostic
nuclear medicine services in the
definition of ‘‘radiology and certain
other imaging services’’ and to include
therapeutic nuclear medicine services in
the definition of ‘‘radiation therapy
services and supplies.’’ We believe this
change is needed in light of the statute’s
inclusion of radiology and radiation
therapy as DHS. We also believe this
PO 00000
Frm 00092
Fmt 4701
Sfmt 4702
change is appropriate, given the current
manner in which these services are
covered and paid under the Medicare
program. As noted in the Phase I final
rule (66 FR 860) and the Phase II final
rule (69 FR 16071), we interpret the selfreferral prohibition in a manner that is
consistent with existing Medicare
coverage and payment rules. In
addition, we believe nuclear medicine
services (both diagnostic and
therapeutic services and supplies) pose
the same risk of abuse that the Congress
intended to eliminate for other types of
radiology, imaging, and radiation
therapy services and supplies. In
§ 411.351 (Definitions), we would revise
the definition of ‘‘Radiation therapy
services and supplies’’ to remove the
language that excluded therapeutic
nuclear medicine services and supplies
from the definition. We would also
revise the definition of ‘‘Radiology and
certain other imaging services’’ to
remove the language that excluded
diagnostic nuclear medicine services
from the definition. In addition, we
would revise the list of radiology
services on our website and in annual
updates to include CPT and HCPCS
codes that include the diagnostic uses of
nuclear medicine, and the list of
radiation therapy services and supplies
to include the therapeutic use of nuclear
medicine. For purposes of this proposed
rule, we have attached Addendum G,
which contains the codes for all
diagnostic nuclear medicine procedures,
all therapeutic nuclear medicine
procedures, and the nuclear medicine
radiopharmaceuticals. In the final rule,
we intend to include the diagnostic
nuclear medicine services in the list of
codes for ‘‘Radiology and Certain Other
Imaging Services’’ and the therapeutic
nuclear medicine services in the list of
‘‘Radiation Therapy Services and
Supplies.’’ Each radiopharmaceutical
would be included in each category in
which it is used, that is, some may be
included in both categories. We
welcome comment on whether the list
is accurate and complete.
Section 1877(h)(6)(D) of the Act
provides that ‘‘radiology services,
including magnetic resonance imaging,
computerized axial tomography scans,
and ultrasound services’’ are DHS. We
believe it is appropriate to include
nuclear diagnostic services as radiology
services within the meaning of this
statute.
Dorland’s Illustrated Medical
Dictionary, 29th Edition, 2000, at 1512,
defines radiology as ‘‘that branch of the
health sciences dealing with radioactive
substances and radiant energy and with
the diagnosis and treatment of disease
by means of both ionizing (that is,
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
x-rays) and non-ionizing (that is,
ultrasound) radiations.’’ 4 Nuclear
medicine uses very small amounts of
radioactive materials
(radiopharmaceuticals) to diagnose and
treat disease. In nuclear imaging, the
radiopharmaceuticals are detected by
special types of cameras that work with
computers to provide very precise
pictures about the area of the body being
imaged. In treatment or therapy, the
radiopharmaceuticals go directly to the
organ being treated. The amount of
radiation in a typical nuclear imaging
procedure is comparable to that
received during a diagnostic x-ray. The
Society for Nuclear Medicine (SNM)
states that the science of nuclear
medicine, particularly nuclear medicine
imaging, provides physicians with
information about both structure and
function of certain internal body organs.
SNM further states that ‘‘unlike a
diagnostic X-ray where radiation is
passed through the body, nuclear
medicine tracers are taken internally;
external detectors measure the radiation
that they emit.’’ (https://www.snm.org)
The ACR, in its March 26, 2004 letter to
us, stated that nuclear medicine is
considered a part of the specialty of
radiology. It noted that the American
Board of Radiology certifies diagnostic
radiologists through an examination
process that includes nuclear medicine
in both the written and oral exams. The
AMA also recognizes nuclear medicine
as a subspecialty of radiology. The
AMA’s ‘‘Current Procedural
Terminology CPT 2005’’, (2004),
identifies its ‘‘Radiology Guidelines
(including Nuclear Medicine and
Diagnostic Ultrasound)’’ as CPT codes
in the 70000–79999 series. In its
radiology section, at 273–302, the AMA
includes both diagnostic imaging
procedures (including diagnostic
nuclear medicine), and therapeutic
procedures. The radiology subsections
are as follows: Diagnostic Radiology
(Diagnostic Imaging) is comprised of
CPT codes 70010–76499. Diagnostic
Ultrasound is comprised of CPT codes
4 The Encyclopaedia Britannica online explains
that radiology is a branch of medicine using
radiation for the diagnosis and treatment of disease.
It states that ‘‘Radiology originally involved the use
of X rays in the diagnosis of disease and the use
of X rays, gamma rays, and other forms of ionizing
radiation in the treatment of disease. In more recent
years radiology has come also to embrace diagnosis
by a method of organ scanning with the use of
radioactive isotopes and also with non-ionizing
radiation, such as ultrasound waves and nuclear
magnetic resonance. Similarly, the scope of
radiotherapy has extended to include, in the
treatment of cancer, such agents as hormones and
chemotherapeutic drugs.’’ (‘‘radiology.’’
Encyclopaedia Britannica, 2005, Encyclopaedia
Britannica Online 3 June 2005 https://
search.ed.com/eb/article?tocid=9062423.)
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
76506–76999. Radiation Oncology is
comprised of CPT codes 77261–77799.
Nuclear Medicine (Diagnostic) is
comprised of CPT codes 78000–78999,
and Nuclear Medicine (Therapeutic) is
comprised of CPT codes 79005–79999.
We also note that the Medicare statute
places diagnostic nuclear medicine in
the same category as diagnostic
radiology for coverage and payment
purposes. That is, we cover diagnostic
nuclear medicine under our authority in
section 1861(s)(3) of the Act, the same
statutory section that authorizes
coverage for diagnostic X-rays, CT
scans, MRIs, and ultrasound services. In
addition, section 1833(t) of the Act sets
forth Medicare payment for ‘‘outpatient
hospital radiology services (including
diagnostic and therapeutic radiology,
nuclear medicine and CAT scan
procedures, magnetic resonance
imaging, and ultrasound and other
imaging services, but excluding
screening mammography)’’ as described
in section 1833(a)(2)(E)(i) of the Act.
For these reasons, we believe that the
Congress intended ‘‘radiology services’’
in section 1877(h)(6) of the Act to
include diagnostic and therapeutic
nuclear medicine. While we believe that
diagnostic nuclear medicine is a subset
of radiology, even if it is not, it is an
imaging service covered by 1861(s)(3) of
the Act, and of the type that the
Congress intended to prohibit.
Similarly, we believe it is proper to
interpret the DHS category described in
section 1877(h)(6)(E) of the Act,
‘‘radiation therapy services and
supplies’’ to include therapeutic nuclear
medicine services. Radiation therapy is
the treatment of disease (especially
cancer) by exposure to radiation from a
radioactive substance. Therapeutic
nuclear medicine employs radioactive
substances known as radionuclides.
Medicare covers therapeutic nuclear
medicine services and other forms of
radiation therapy under section
1861(s)(4) of the Act, which authorizes
coverage and payment for ‘‘X-ray,
radium, and radioactive isotope
therapy.’’
Although our proposal to include as
DHS diagnostic nuclear medicine
services and therapeutic nuclear
medicine services and supplies is based
primarily on our view that nuclear
medicine services are radiology and
radiation therapy within the meaning of
section 1877(h)(6) of the Act, we would
resolve any doubt on the matter in favor
of our proposal because of the risk of
abuse and anti-competitive behavior
inherent in physician self-referrals for
nuclear medicine services. The risk of
abuse and anti-competitiveness is
exacerbated by the greater affordability
PO 00000
Frm 00093
Fmt 4701
Sfmt 4702
45855
of nuclear medicine equipment, by our
expansive coverage of nuclear medicine
services, and by the setting in which
mostly diagnostic and some therapeutic
nuclear medicine services now are
primarily performed.
At the time we were preparing the
Phase I final rule, the vast majority of
nuclear medicine procedures were
already subject to the physician selfreferral prohibition because they were
primarily performed in hospital
facilities rather than in physicianowned freestanding facilities. Thus,
they were performed as inpatient or
outpatient hospital services and were
therefore DHS subject to the self-referral
prohibition in accordance with section
1877(h)(6)(K) of the Act. Since
publication of the Phase I final rule,
however, many more nuclear medicine
procedures have been performed in
physician offices or in physician-owned
freestanding facilities. This has occurred
for several reasons. First, positron
emission tomography (PET) scanners
may be used outside of a hospital
setting. Second, there have been
significant technological advances; an
entity does not have to own a particle
accelerator to produce the radioactive
tracer necessary for a PET scan because
a small network of pharmacies now
distribute radioactive tracer. Third, our
coverage of PET scans has increased
dramatically. We began covering PET
scans in December 2000. This initial,
limited, coverage was for only a few
types of cancers. Since December 2001,
we have significantly expanded our
coverage to include an increased
number of cancers and other conditions.
In his March 17, 2005 testimony before
the Congress concerning imaging
services, the Executive Director of the
MedPAC noted that diagnostic imaging
services paid under Medicare’s PFS
grew more rapidly than any other type
of physician service between 1999 and
2003. Whereas physician services grew
22 percent in those years, imaging
services grew twice as fast, by 45
percent. This measure is the growth in
the volume and intensity of services per
beneficiary. However, not all imaging
services grew at that rate, and some
grew even faster. Nuclear medicine grew
85 percent between those years (1999
and 2003).
Under Medicare, almost all imaging
services have two distinct parts: (1) The
performance of the test; and (2) the
interpretation of the results by a
physician. If the study is performed in
a physician office, the physician
submits a TC claim and the interpreting
physician submits a PC claim. Tests
performed in a hospital result in a
facility payment rather than a TC claim.
E:\FR\FM\08AUP2.SGM
08AUP2
45856
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Thus, if more imaging services are
performed in physician offices, TC
claims will increase as a share of all fee
schedule imagining claims. An increase
in TC claims occurred between 1999
and 2002, which indicates that imaging
procedures shifted to physician offices.
Because the TC of an imaging service
generally is assigned a higher payment
rate than the PC, growth of TC claims as
a share of all imaging claims leads to
additional payments under the PFS.
These additional payments accounted
for about 20 percent of the growth in the
volume and intensity of imaging
services between 1999 and 2002
(MedPAC 2004).
Recent studies and articles indicate
that risk of abuse for radiology services
(and diagnostic nuclear medicine) will
continue if not specifically prohibited.
The Journal of Radiology reported what
happened after a managed care
organization halted reimbursement to
non-radiologists for some forms of
imaging (other than CT scans, MRIs,
sonography or nuclear medicine) but
left the physicians free to refer their
patients to radiologists if they believe
the imaging they had been conducting
on their patients was needed. The
following specialties were not allowed
to perform any imaging services:
Gastroenterologists, general surgeons,
nephrologists, neurosurgeons,
oncologists, pediatric surgeons, and
physiatrists. The study found that
imaging declined 20 to 25 percent from
what was expected given the previous
trend of imaging growth, and an
absolute decline of 6 percent. Prior to
these prohibitions, non-radiologists
were performing 39 percent of
outpatient radiographs. The 20 to 25
percent decline from the trend was
roughly half of this 39 percent initial
share. That is, the research showed that
approximately half of the imaging
performed by self-referrers ceased when
these self-referrers lost their financial
interest in the services. (The Effect of
Imaging Guidelines on the Number and
Quality of Outpatient Radiographic
Examinations. AJR 2000; 175:9–15.
Harold Moskowitz, Jonathan Sunshine,
Donald Grossman, Leslie Adams, Lynn
Gelinas. See also Recent Rapid Increase
in Utilization of Radionuclide
Myocardial Perfusion Imaging and
Related Procedures; 1996–1998 Practice
Patterns. Radiology 2002; 222:144–148.
David C. Levin, MD, Laurence Parker,
PhD, Charles M. Intenzo, MD, Jonathan
H. Sunshine, PhD.) (Growth in
utilization of Radionuclide Myocardial
Perfusion Imaging (MPI) between 1996
and 1998 was almost 10 times higher
among cardiologists than radiologists).
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Although the Moskowitz study did not
include nuclear imaging, we do not see
a basis for assuming that physician
behavior would be different for nuclear
imaging than it is for other imaging
services. To the contrary, we believe
financial relationships related to
diagnostic and therapeutic nuclear
medicine, including joint ventures and
leases, pose a risk of anti-competitive
behavior and risk of abuse comparable
to that associated with investment
interests in CT, MRI, ultrasound, other
radiology ventures, and radiation
therapy facilities.
Thus, we believe our proposal to
include nuclear medicine as a DHS is
consistent with the intent of the
Congress to prevent over-utilization of
health care services covered by
Medicare and to prohibit physicians
from selecting treatment modalities
based on financial incentives.
We have been told that consultants
and others have been actively
encouraging physicians to participate in
joint ventures to purchase diagnostic
nuclear medicine machines for
investment because Phase I did not
include nuclear medicine services. We
have received many inquiries from
physicians and attorneys asking
whether physician ownership of, and
referral to, nuclear medicine facilities
complies with the physician self-referral
provisions. We are mindful that our
previous guidance, particularly that
provided in the Phase I final rule, may
have encouraged physician investment
in nuclear medicine equipment and
ventures, particularly PET scanners,
which are very expensive and often
require a substantial financial
investment on the part of physicianowners. We are aware that including
nuclear medicine services as DHS will
require that physician-investors in
nuclear medicine equipment (including
PET scanners) divest their ownership or
investment interests or be precluded
from submitting claims to Medicare or
billing the beneficiary or any entity for
the nuclear medicine DHS referred by
physician-owners and performed with
the physician-owned equipment (unless
the arrangement falls within an
exception to section 1877 of the Act).
We are soliciting comments as to
whether, or how, to minimize the
impact on physicians who are currently
parties to arrangements that involve
nuclear medicine services and supplies
(that is, by specifying a delayed effective
date or by grandfathering certain
arrangements).
Q. Sustainable Growth Rate
[If you choose to comment on issues in
this section, please include the caption
PO 00000
Frm 00094
Fmt 4701
Sfmt 4702
‘‘SGR’’ at the beginning of your
comments.]
1. Current Estimate
Sections 1848(d) and (f) of the Act
require the Secretary to set the
physician fee schedule update under the
SGR system. We are currently
forecasting an update of ¥4.3 percent
for 2006, and anticipate further negative
updates in later years. As in the past, we
will include a complete discussion of
our methodology for calculating the
SGR in the final rule.
Underlying the projected rate
reductions is substantial growth in
Medicare spending. The vast majority of
spending growth in 2004 is attributable
to the following five areas:
• An increase in spending for office
visits, with a shift toward longer and
more intense visits.
• Greater utilization of minor
procedures, including physical therapy
and drug administration.
• More patients receiving more
frequent and more complex imaging
services, such as MRIs and
echocardiograms.
• More laboratory and other
physician-ordered tests.
• Higher utilization of physicianadministered prescription drugs.
We would like to understand these
trends further, including which changes
in utilization are likely to be associated
with important health improvements
and which ones may have more
questionable health benefits.
Consequently, we have had discussions
on these topics with numerous
physician and nonphysician groups, as
well as other Medicare stakeholders
such as the Congress and the Medicare
Payment Advisory Commission
(MedPAC).
The AMA has provided us with
several illustrations of recent trends in
medical practice that it believes
contribute to the overall growth in
spending on physicians’ services. For
example, the AMA points out that some
payers are encouraging physicians to
determine the left ventricular valve
function of their patients with
congestive heart failure using an
echocardiogram. Also, five years ago,
statin therapy to lower cholesterol levels
was only recommended for patients as
old as 79. Now, patients as old as 86
may receive statin therapy, resulting in
additional laboratory tests.
The AMA provided many other
examples, and we are evaluating them
to better understand their impact on
physician spending. With regard to the
specific examples mentioned above, we
agree the utilization of these services
has increased. However, in the case of
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
echocardiograms, the 19 percent rate of
increase from 2003 to 2004 is similar to
the increase observed for all imaging
services. There was also a 17 percent
rate of increase in laboratory tests (lipid
panels) consistent with more patients
receiving statin therapy (new
prescriptions require more frequent
visits and more lab tests). However, total
spending for the service was only $42
million.
2. Ongoing Issues
In addition to providing adequate
payments, Medicare’s physician
payment system should encourage
physicians to provide quality care and
prevent avoidable health care costs. We
support MedPAC’s recommendation for
the development of measures related to
the quality and efficiency of care
furnished by physicians. Physicians’
decisions are central to the health care
their patients receive, and there are
substantial variations across geographic
areas and among similar specialties in
the use of services, including those
accounting for most of the spending
growth. We want to work with
physicians in this effort to better
understand the consequences of these
differences in the use of follow-up
visits, imaging procedures, laboratory
testing, minor therapeutic procedures,
and physician-administered drugs for
the health of beneficiaries, and to
identify ways to provide better support
for utilization decisions that clearly
increase the quality of care while
avoiding unnecessary costs for
beneficiaries and the Medicare program.
We are already engaged with the
physician community in developing
useful quality measures, and we expect
to intensify these efforts given the rapid
growth in spending. As an early step in
using such measures to improve care,
we are now exploring means of sharing
information related to quality of care
and use of resources with individual
physicians. We anticipate that only data
showing the quality of care and resource
use in the aggregate would be released
to the public. Some measures can be
derived from claims data with little or
no collection burden (for example,
information on the frequency and
complexity of minor therapy
procedures, imaging procedures, lab
test, and visits for their patients with
chronic illnesses.) We believe that by
providing feedback to physicians
individually and by working with
physician groups to understand and
respond to the overall trends, we can
provide more useful information and
support physicians’ efforts to run more
efficient practices.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
45857
Section 413.180 Procedures for
Requesting Exceptions to Payment Rates
Finally, we continue to work closely
with the medical community, Congress,
MedPAC, and others toward a long-term
approach ensuring adequate physician
payments in the future while also
ensuring Medicare’s payments are made
only for care that is necessary and
beneficial. We are particularly
interested in comments that build on
recent progress on payment reforms to
promote higher quality and avoid
unnecessary costs, and that are
consistent with the President’s
budgetary goal of paying for better value
in Medicare without increasing overall
Medicare costs. For example, we are
interested in ways to promote higherquality ambulatory care that can achieve
offsetting savings by avoiding
complications or unnecessary services.
In addition, it has been suggested that
we have the authority to make certain
administrative adjustments in the SGR
methodology, such as removing Part B
drug payments from the calculation of
both projected and actual expenditures
(retroactive to 1996) that are used to set
the spending target. We encourage
comments regarding possible changes to
the SGR methodology, including the
legal theories that support them. We are
particularly interested in comments on
steps to promote physician payment
adequacy without increasing overall
Medicare costs.
Paragraph (b) specifies the criteria for
a pediatric ESRD facility requesting an
exception to payment rates.
Paragraph (e) outlines the
documentation that a pediatric ESRD
facility must submit to CMS when
requesting an exception to its payment
rates. Paragraph (i) discusses the period
of approval for payment exception
requests. A prospective exception
payment rate approved by CMS applies
for the period from the date the
complete exception request was filed
with its intermediary until thirty days
after the intermediary’s receipt of the
facility’s letter notifying the
intermediary of the facility’s request to
give up its exception rate.
The burden associated with the
requirements in paragraph (e) is the
time and effort required by the facility
to prepare and submit the exception
request to CMS. The burden associated
with the requirement in paragraph (i) is
the time and effort required by the
facility to draft and mail the letter that
notifies the intermediary of the facilities
request to give up its exception rate.
The collection requirement in this
section has not changed. While this
requirement is subject to the PRA, this
requirement is currently approved in
OMB No. 0938–0296.
III. Collection of Information
Requirements
Section 413.184 Payment Exception:
Pediatric Patient Mix
Under the Paperwork Reduction Act
of 1995, we are required to provide 60day notice in the Federal Register and
solicit public comment before a
collection of information requirement is
submitted to the Office of Management
and Budget (OMB) for review and
approval. In order to fairly evaluate
whether an information collection
should be approved by OMB, section
3506(c)(2)(A) of the Paperwork
Reduction Act of 1995 requires that we
solicit comment on the following issues:
• The need for the information
collection and its usefulness in carrying
out the proper functions of our agency.
• The accuracy of our estimate of the
information collection burden.
• The quality, utility, and clarity of
the information to be collected.
• Recommendations to minimize the
information collection burden on the
affected public, including automated
collection techniques.
We are soliciting public comment on
each of these issues for the following
sections of this document that contain
information collection requirements:
Paragraph (b) specifies the
documentation requirements that a
pediatric ESRD facility must meet in
order to qualify for an exception to its
prospective payment rate based on its
pediatric patient mix. In addition to the
other qualifications specified in this
section, this section states that a facility
must submit a listing of all outpatient
dialysis patients (including all home
patients) treated during the most
recently completed and filed cost report.
The burden associated with this
requirement is the time and effort for
the facility to submit a listing of all
outpatient dialysis patients (including
all home patients) treated during the
most recently completed and filed cost
report.
The collection requirement in this
section has not changed. While this
requirement is subject to the PRA, this
requirement is currently approved in
OMB No. 0938–0296.
PO 00000
Frm 00095
Fmt 4701
Sfmt 4702
Section 413.186 Payment Exception:
Self-Dialysis Training Costs in Pediatric
Facilities
In summary, this section outlines the
requirements a pediatric ESRD facility
E:\FR\FM\08AUP2.SGM
08AUP2
45858
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
must meet to qualify for an exception to
the prospective payment rate based on
self-dialysis training costs. Paragraph (e)
states that a facility must provide
specific information to support its
exception request. Paragraph (f) states
that in addition to the other
qualifications outlined in this section,
pediatric ESRD facility must submit
with its exception request a list of
patients, by modality, trained during the
most recent cost report period, in order
to justify its accelerated training
exception request.
The burden associated with these
requirements is the time and effort for
the facility to prepare and submit the
required information to support its
exception request, and the time and
effort for the pediatric ESRD facility to
prepare and submit with its exception
request a list of patients, by modality,
trained during the most recent cost
report period.
The collection requirements in this
section have not changed. While these
requirements are subject to the PRA,
they are currently approved in OMB No.
0938–0296.
Section 414.804 Basis of Payment
In summary, this section requires
manufacturers to report ASP data to
CMS. This section details the process a
manufacturer must follow to calculate
the ASP. The ASP reporting
requirements are discussed in further
detail in the interim final rule with
comment, Medicare Program;
Manufacturer Submission of
Manufacturer’s Average Sales Price
(ASP) Data for Medicare Part B Drugs
and Biologicals, that published on April
2, 2004 in the Federal Register
(69FR17935–17941).
The burden associated with these
requirements is the time and effort
required by manufacturers of Medicare
Part B Drugs and biologicals to prepare
and submit to the required ASP data to
CMS.
While these requirements are subject
to the PRA, the requirements are
currently approved in OMB No. 0938–
0921, with a current expiration date of
September 30, 2007.
We intend to revise this information
collection to include adequate
instructions for manufacturers to report
the ASP, the WAC, and other data
elements. These revisions will be
addressed in detail in a revised
information collection request in
accordance with the Paperwork
Reduction Act of 1995.
We have submitted a copy of this
proposed rule to OMB for its review of
the information collection requirements
described above. These requirements are
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
not effective until they have been
approved by OMB.
If you comment on these information
collection and recordkeeping
requirements, please mail copies
directly to the following:
Centers for Medicare & Medicaid
Services, Office of Strategic Operations
and Regulatory Affairs, Regulations
Development Group, Attn: Jim
Wickliffe, [CMS–1502–P], Room C4–26–
05, 7500 Security Boulevard, Baltimore,
MD 21244–1850; and
Office of Information and Regulatory
Affairs, Office of Management and
Budget, Room 10235, New Executive
Office Building, Washington, DC 20503,
Attn: Christopher Martin, CMS Desk
Officer, CMS–1502–P,
Christopher_Martin@omb.eop.gov. Fax
(202) 395–6974.
IV. Response to Comments
Because of the large number of public
comments we normally receive on
Federal Register documents, we are not
able to acknowledge or respond to them
individually. We will consider all
comments we receive by the date and
time specified in the DATES section of
this preamble, and, when we proceed
with a subsequent document, we will
respond to the comments in the
preamble to that document.
V. Regulatory Impact Analysis
[If you choose to comment on issues in
this section, please include the caption
‘‘IMPACT’’ at the beginning of your
comments.]
We have examined the impact of this
rule as required by Executive Order
12866 (September 1993, Regulatory
Planning and Review), the Regulatory
Flexibility Act (RFA) (September 16,
1980 Pub. L. 96–354), section 1102(b) of
the Social Security Act, the Unfunded
Mandates Reform Act of 1995 (Pub. L.
104–4), and Executive Order 13132.
Executive Order 12866 (as amended
by Executive Order 13258, which
merely reassigns responsibilities of
duties) directs agencies to assess all
costs and benefits of available regulatory
alternatives and, when regulation is
necessary, to select regulatory
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety
effects, distributive impacts, and
equity). A regulatory impact analysis
must be prepared for proposed rules
with economically significant effects
(that is, a proposed rule that would have
an annual effect on the economy of $100
million or more in any one year, or
would adversely affect in a material way
the economy, a sector of the economy,
productivity, competition, jobs, the
PO 00000
Frm 00096
Fmt 4701
Sfmt 4702
environment, public health or safety, or
State, local, or tribal governments or
communities). As indicated in more
detail below, we estimate that the PFS
provisions included in this proposed
rule will redistribute more than $100
million in one year. We are considering
this proposed rule to be economically
significant because its provisions are
estimated to result in an increase,
decrease or aggregate redistribution of
Medicare spending that will exceed
$100 million. Therefore, this proposed
rule is a major rule and we have
prepared a regulatory impact analysis.
The RFA requires that we analyze
regulatory options for small businesses
and other entities. We prepare a
regulatory flexibility analysis unless we
certify that a rule would not have a
significant economic impact on a
substantial number of small entities.
The analysis must include a justification
concerning the reason action is being
taken, the kinds and number of small
entities the rule affects, and an
explanation of any meaningful options
that achieve the objectives with less
significant adverse economic impact on
the small entities.
Section 1102(b) of the Act requires us
to prepare a regulatory impact analysis
for any proposed rule that may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 603 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside a
Metropolitan Statistical Area and has
fewer than 100 beds. We have
determined that this proposed rule
would have minimal impact on small
hospitals located in rural areas. Of 213
hospital-based ESRD facilities located in
rural areas, only 40 are affiliated with
hospitals with fewer than 100 beds.
For purposes of the RFA, physicians,
nonphysician practitioners, and
suppliers are considered small
businesses if they generate revenues of
$6 million or less. Approximately 95
percent of physicians are considered to
be small entities. There are about
875,000 physicians, other practitioners
and medical suppliers that receive
Medicare payment under the PFS.
For purposes of the RFA,
approximately 90 percent of suppliers of
durable medical equipment (DME) and
prosthetic devices are considered small
businesses according to the Small
Business Administration’s (SBA) size
standards. We estimate that 106,000
entities bill Medicare for durable
medical equipment, prosthetics,
orthotics, and supplies (DMEPOS) each
year. Total annual estimated Medicare
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
revenues for DME suppliers exceed
approximately $8.5 billion in 2004. Of
this amount, approximately $1.4 billion
were for nebulizer drugs in 2004. The
vast majority, 95 percent, of retail
pharmacy companies are small
businesses as measured by the SBA size
standard. Approximately, 16,000
pharmacies billed Medicare for
immunosuppressive, oral anti-cancer, or
oral anti-emetic drugs in 2004.
Pharmacies received Medicare revenues
for those drugs of approximately $350
million in 2004.
In addition, most ESRD facilities are
considered small entities, either based
on nonprofit status or by having
revenues of $29 million or less in any
year. We consider a substantial number
of entities to be affected if the proposed
rule is estimated to impact more than 5
percent of the total number of small
entities. Based on our analysis of the
896 nonprofit ESRD facilities
considered small entities in accordance
with the above definitions, we estimate
that the combined impact of the
proposed changes to payment for renal
dialysis services included in this
proposed rule would have a 1.3 percent
increase in overall payments relative to
current overall payments.
The analysis and discussion provided
in this section, as well as elsewhere in
this proposed rule, complies with the
RFA requirements.
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule that may result in expenditures in
any year by State, local, or tribal
governments, in the aggregate, or by the
private sector, of $110 million. Medicare
beneficiaries are considered to be part of
the private sector for this purpose.
We have examined this proposed rule
in accordance with Executive Order
13132 and have determined that this
regulation would not have any
significant impact on the rights, roles, or
responsibilities of State, local, or tribal
governments. A discussion concerning
the impact of this rule on beneficiaries
is found later in this section.
We have prepared the following
analysis, which, together with the
information provided in the rest of this
preamble, meets all assessment
requirements. It explains the rationale
for and purposes of the rule; details the
costs and benefits of the rule; analyzes
alternatives; and presents the measures
we propose to use to minimize the
burden on small entities. As indicated
elsewhere in this proposed rule, we
propose to change our methodology for
calculating resource-based practice
expense RVUs and make a variety of
other changes to our regulations,
payments, or payment policies to ensure
that our payment systems reflect
changes in medical practice and the
relative value of services. We provide
information for each of the policy
changes in the relevant sections of this
proposed rule. We are unaware of any
relevant Federal rules that duplicate,
overlap or conflict with this proposed
rule. The relevant sections of this
proposed rule contain a description of
significant alternatives if applicable.
A. Resource-Based PE RVUs
Table 30 below shows the specialty
level impact on payment of changes to
the PE methodology being proposed for
CY 2006. The columns in the table
demonstrate the estimated impacts on
payments (relative to estimated 2006
payments, absent any adjustment for
inflation or utilization) during each year
of the transition. For example, the first
column displays the impact of blending
25 percent of the PE RVUs calculated
using the methodology we are proposing
with current PE RVUs. The percent of
the RVUs based on the proposed
method increase until the transition is
complete in 2009.
Our estimates of changes in physician
Medicare revenues for PFS services
compare payment rates for CY 2006
with payment rates for CY 2005 using
CY 2004 Medicare utilization for both
years. In general, updating the
utilization data has little or no impact
45859
on total payments to a specialty, but the
practice expense values for a new code
may change because we did not initially
have Medicare utilization data to
determine the specialty mix for the
service. In these cases, we either
assigned the code to a particular
specialty’s practice expense pool based
on the specialty most likely to provide
the service, or we used the ‘‘all
physician’’ practice expense pool to
determine the code’s practice expense
RVUs. While we try to minimize
instability in the practice expense RVUs
for new services by assigning the
specialty that is most likely to perform
the service until such time as we have
actual utilization data, the addition of
actual utilization data may still result in
some change to the practice expense
RVUs during the first few years a code
is in existence.
The estimated payment impacts
reflect the averages for each specialty
based on Medicare utilization. To the
extent that there are year-to-year
changes in the volume and mix of
services provided by a specialty, the
actual impact on total Medicare
revenues may be different than those
shown here. Also, the payment impact
for an individual physician may be
different from the specialty average
impact, based on the mix of services the
physician provides. Because physicians,
practitioners and suppliers, furnish
services to both Medicare and nonMedicare patients and they may receive
substantial Medicare revenues for
services that are not paid under the PFS,
the average change in total revenues for
any specialty, practitioner or supplier,
would be less than the impacts
displayed here. For instance,
independent laboratories receive
approximately 80 percent of their
Medicare revenues from clinical
laboratory services that are not paid
under the PFS. The table shows only the
payment impacts on PFS services.
We modeled the impact of the
proposed changes to the practice
expense methodology and illustrated
the effect in Table 30 below.
TABLE 30.—IMPACT OF PRACTICE EXPENSE CHANGES ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN,
PRACTITIONER AND SUPPLIER SUBCATEGORY
2006 (25%
Blend)
Specialty
Physicians:
Allergy/Immunology ..................................................................................
Anesthesiology .........................................................................................
Cardiac Surgery ........................................................................................
Cardiology .................................................................................................
Colon and Rectal Surgery ........................................................................
Critical Care ..............................................................................................
Dermatology .............................................................................................
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00097
Fmt 4701
Sfmt 4702
2007 (50%
Blend)
0.6%
¥0.7%
¥1.0%
¥0.5%
0.7%
¥0.3%
4.1%
E:\FR\FM\08AUP2.SGM
1.1%
¥1.5%
¥2.0%
¥1.1%
1.5%
¥0.5%
8.4%
08AUP2
2008 (75%
Blend)
1.7%
¥2.2%
¥2.9%
¥1.6%
2.2%
¥0.8%
12.8%
2009 (100%
Blend)
2.3%
¥2.9%
¥3.9%
¥2.1%
3.0%
¥1.0%
17.5%
45860
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 30.—IMPACT OF PRACTICE EXPENSE CHANGES ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN,
PRACTITIONER AND SUPPLIER SUBCATEGORY—Continued
2006 (25%
Blend)
Specialty
Emergency Medicine ................................................................................
Endocrinology ...........................................................................................
Family Practice .........................................................................................
Gastroenterology ......................................................................................
General Practice .......................................................................................
General Surgery .......................................................................................
Geriatrics ..................................................................................................
Hand Surgery ...........................................................................................
Hematology/Oncology ..............................................................................
Infectious Disease ....................................................................................
Internal Medicine ......................................................................................
Interventional Radiology ...........................................................................
Nephrology ...............................................................................................
Neurology .................................................................................................
Neurosurgery ............................................................................................
Nuclear Medicine ......................................................................................
Obstetrics/Gynecology ..............................................................................
Ophthalmology ..........................................................................................
Orthopedic Surgery ..................................................................................
Otolaryngology ..........................................................................................
Pathology ..................................................................................................
Pediatrics ..................................................................................................
Physical Medicine .....................................................................................
Plastic Surgery .........................................................................................
Psychiatry .................................................................................................
Pulmonary Disease ..................................................................................
Radiation Oncology ..................................................................................
Radiology ..................................................................................................
Rheumatology ...........................................................................................
Thoracic Surgery ......................................................................................
Urology .....................................................................................................
Vascular Surgery ......................................................................................
Practitioners:
Audiologist ................................................................................................
Chiropractor ..............................................................................................
Clinical Psychologist .................................................................................
Clinical Social Worker ...............................................................................
Nurse Anesthetist .....................................................................................
Nurse Practitioner .....................................................................................
Optometry .................................................................................................
Oral/Maxillofacial Surgery .........................................................................
Physical/Occupational Therapy ................................................................
Physician Assistants .................................................................................
Podiatry .....................................................................................................
Suppliers:
Diagnostic Testing Facility ........................................................................
Independent Laboratory ...........................................................................
Portable X-Ray Supplier ...........................................................................
The table shows the effect of the
proposed refinements to the PE
methodology. As described in section
II.A.2. in the preamble of this proposed
rule, we are proposing to use the
updated practice expense per hour data
from the accepted supplementary
surveys only in the calculation of
indirect PE, and to utilize a ‘‘bottomup’’ methodology to calculate direct PE.
Even if no other changes were made
to our PE calculation methodology, a
significant redistribution of PE RVUs
would still be produced by the
acceptance of the supplementary PE
surveys from seven specialties and the
corresponding increases in the direct
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Frm 00098
Fmt 4701
Sfmt 4702
2008 (75%
Blend)
2009 (100%
Blend)
¥0.4%
¥0.5%
0.1%
1.4%
0.2%
0.2%
¥0.2%
¥0.5%
0.4%
¥0.1%
¥0.1%
0.2%
¥0.2%
¥0.6%
¥0.7%
¥0.3%
0.0%
¥1.1%
¥0.4%
¥0.6%
1.3%
0.1%
¥0.5%
0.1%
0.0%
¥0.2%
1.9%
0.4%
¥0.9%
¥0.8%
1.8%
0.5%
¥0.8%
¥1.0%
0.1%
2.8%
0.3%
0.3%
¥0.5%
¥1.0%
0.7%
¥0.2%
¥0.3%
0.5%
¥0.4%
¥1.1%
¥1.4%
¥0.5%
0.1%
¥2.2%
¥0.7%
¥1.1%
2.6%
0.2%
¥1.1%
0.1%
0.1%
¥0.4%
3.9%
0.8%
¥1.8%
¥1.5%
3.6%
0.9%
¥1.3%
¥1.5%
0.2%
4.3%
0.5%
0.5%
¥0.7%
¥1.5%
1.1%
¥0.2%
¥0.4%
0.7%
¥0.6%
¥1.7%
¥2.0%
¥0.8%
0.1%
¥3.3%
¥1.1%
¥1.7%
3.9%
0.3%
¥1.6%
0.2%
0.1%
¥0.6%
5.8%
1.2%
¥2.7%
¥2.3%
5.5%
1.4%
¥1.7%
¥1.9%
0.2%
5.7%
0.7%
0.6%
¥1.0%
¥1.9%
1.4%
¥0.3%
¥0.6%
0.9%
¥0.8%
¥2.2%
¥2.7%
¥1.0%
0.2%
¥4.4%
¥1.5%
¥2.2%
5.3%
0.5%
¥2.1%
0.3%
0.1%
¥0.7%
7.9%
1.7%
¥3.6%
¥3.0%
7.3%
1.9%
¥5.8%
¥1.3%
¥0.6%
¥0.6%
¥0.4%
0.1%
¥0.8%
0.8%
1.5%
0.0%
1.3%
¥11.3%
¥2.7%
¥1.1%
¥1.2%
¥0.8%
0.1%
¥1.6%
1.6%
2.9%
0.1%
2.6%
¥16.5%
¥4.0%
¥1.7%
¥1.8%
¥1.2%
0.2%
¥2.4%
2.4%
4.4%
0.1%
3.9%
¥21.3%
¥5.3%
¥2.2%
¥2.4%
¥1.6%
0.2%
¥3.1%
3.2%
6.0%
0.2%
5.3%
¥2.4%
6.4%
0.4%
¥4.7%
13.1%
0.8%
¥7.0%
20.3%
1.1%
¥9.2%
28.0%
1.5%
and indirect PE per hour for these
specialties. As noted in the preamble
discussion regarding our proposal to
change the PE methodology, the
nonphysician work pool was created to
protect codes without physician work
components until further refinement
could occur. Removing these codes from
the nonphysician work pool generally
has a negative impact on these codes
(although we note that we have
consistently indicated this methodology
was an interim approach until we had
better data available). In addition, the
limited number of codes remaining in
the nonphysician work pool would also
experience significant impacts.
PO 00000
2007 (50%
Blend)
Eliminating the nonphysician work pool
would generally negatively impact these
codes remaining in the pool (for
example, certain codes used by
audiology and portable x-ray suppliers).
We believe that much of this impact is
due to the change in the scaling of the
inputs when codes move from the
nonphysician work pool to the
individual specialty pool.
We believe that, in addition to the
increased accuracy and simplicity that
result from using a ‘‘bottom-up’’
approach for direct costs, this proposed
approach also helps mitigate some of
the potentially inequitable
redistribution of practice expense RVUs
E:\FR\FM\08AUP2.SGM
08AUP2
45861
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
resulting from the acceptance of new
specialty-specific survey data. However,
several of the impacts that are shown
require further consideration.
Audiology is clearly negatively
impacted when its services are removed
from the nonphysician work pool,
though the impact is cut nearly in half
when the ‘‘bottom-up’’ approach is used
for the direct costs. This impact is in
large part driven by the decrease in the
PE RVUs for audiology CPT codes
92557, 92567 and 92588, which we
believe may now be more appropriately
priced in our proposal than they were
in the nonphysician work pool that uses
historic charge-based RVUs to
determine the direct practice expense
for a service. However, we would
welcome discussions with audiologists
regarding this impact, so that we can
ensure that the relative costs are
reflected appropriately.
Despite submitting a supplementary
survey that showed higher PE costs per
hour, cardiology is shown to have an
impact of ¥2.1 percent in the last
column of Table 30. This is largely due
to the decrease in direct PE for several
high-volume services resulting from the
adoption of the ‘‘bottom up’’ approach.
For example, the RVUs for the complete
electrocardiogram service, CPT code
93000, decline by 43 percent. The RVUs
for multiple 3-D heart imaging, CPT
Code 78465, decline by 32 percent.
However, it should be noted that, if the
new survey data had not been used to
calculate indirect PE, cardiology would
have had a significantly larger (11
percent) negative impact.
Both physical/occupational therapy
and independent laboratory show
significant positive impacts in the last
column of 6.0 and 28.0 percent,
respectively. For therapy services, we
had previously applied an adjustment
that assigned all therapy services the
therapy practice expense per hour, even
when billed by specialties with higher
costs. Under the top-down
methodology, this adjustment was
applied to both direct and indirect costs.
However, under our proposed
methodology, the practice expense per
hour data would not be used to
calculate direct expenses and this
would eliminate the adjustment for
direct practice expense costs.
The total CPEP/RUC dollars for
supplies and equipment for the services
performed by independent laboratories
are significantly higher than the
aggregate dollars shown by the recent
supplementary survey for these cost
pools. Therefore, under the current topdown methodology, the CPEP/RUC
dollars are scaled down to equal the
survey dollars, and the practice expense
RVUs are consequently reduced. Under
our proposed methodology, the direct
costs would no longer be scaled,
resulting in higher practice expense
RVUs for these services. (This also
results in a positive 5.2 percent impact
for pathologists, who also perform these
services.) Although, as discussed above,
we generally believe the refined CPEP/
RUC data to be more accurate for
calculating direct costs than the SMS or
supplementary survey data, we are
concerned that there is such a
discrepancy between the refined direct
cost inputs and a recent survey. We will
want to discuss this issue with both the
specialty and the RUC to ensure that the
refined CPEP/RUC data accurately
reflect the typical resources needed for
these services. However, as we
indicated above, independent
laboratories receive only approximately
20 percent of their total Medicare
revenues from PFS services, and there
should not be significant impact on
other specialties from this increase for
independent laboratory services.
As discussed in section II.C. of this
proposed rule, we are proposing
technical changes to the calculation of
the malpractice RVUs. We are proposing
to remove the malpractice data for
specialties that occur less than 5 percent
of the time in our data for a procedure
code. In addition, the RUC practice
liability workgroup has written to us
recommending several changes to the
crosswalks used to assign risk factors to
specialties for which we did not have
data otherwise. We are proposing to
accept these recommendations, and, as
also recommended, we are proposing to
use the lowest risk factor of 1.00 for
specialties such as clinical psychology,
licensed clinical social work,
chiropractors, and physical therapists.
We are also proposing to add cardiology
catheterization and angioplasty codes to
the list of codes for which we apply
surgical rather than nonsurgical risk
adjustment factors. Table 31 below
shows the impacts of these proposed
changes. Because the malpractice RVUs
account for less than 4 percent of total
payments, the overall impacts on any
particular specialty are negligible.
TABLE 31.—SPECIALTY IMPACT OF MALPRACTICE RVU CHANGES
Impact of removing aberrant malpractice data
(percent)
Speciality
Physicians:
Allergy/Immunology ..............................................................................................................
Anesthesiology .....................................................................................................................
Cardiac Surgery ....................................................................................................................
Cardiology .............................................................................................................................
Colon and Rectal Surgery ....................................................................................................
Critical Care ..........................................................................................................................
Dermatology .........................................................................................................................
Emergency Medicine ............................................................................................................
Endocrinology .......................................................................................................................
Family Practice .....................................................................................................................
Gastroenterology ..................................................................................................................
General Practice ...................................................................................................................
General Surgery ...................................................................................................................
Geriatrics ..............................................................................................................................
Hand Surgery .......................................................................................................................
Hematology/Oncology ..........................................................................................................
Infectious Disease ................................................................................................................
Internal Medicine ..................................................................................................................
Interventional Radiology .......................................................................................................
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00099
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
0.0
0.0
0.2
0.0
0.0
0.0
¥0.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.1
0.0
0.0
0.0
¥0.1
08AUP2
Impact of
crosswalk
changes (percent)
Combined impacts * (percent)
0.0
0.0
0.1
0.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
¥0.1
0.2
0.1
0.0
0.0
¥0.1
0.0
0.0
0.0
0.0
0.0
0.1
0.0
0.1
0.0
0.0
0.0
¥0.1
45862
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 31.—SPECIALTY IMPACT OF MALPRACTICE RVU CHANGES—Continued
Impact of removing aberrant malpractice data
(percent)
Speciality
Combined impacts * (percent)
0.0
0.0
0.2
¥0.1
0.0
0.0
0.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.0
0.0
0.0
0.0
0.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
¥0.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
¥0.1
0.0
0.0
0.1
0.0
0.0
0.0
¥0.1
0.0
¥0.1
0.0
0.0
0.0
0.0
0.2
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.0
¥0.5
0.0
0.0
¥0.2
0.0
¥0.1
0.0
0.0
0.0
0.0
0.0
¥0.6
¥0.3
¥0.4
0.0
0.0
0.0
0.0
¥0.5
0.0
0.0
0.0
0.0
0.0
Nephrology ...........................................................................................................................
Neurology .............................................................................................................................
Neurosurgery ........................................................................................................................
Nuclear Medicine ..................................................................................................................
Obstetrics/Gynecology ..........................................................................................................
Ophthalmology ......................................................................................................................
Orthopedic Surgery ..............................................................................................................
Otolaryngology ......................................................................................................................
Pathology ..............................................................................................................................
Pediatrics ..............................................................................................................................
Physical Medicine .................................................................................................................
Plastic Surgery .....................................................................................................................
Psychiatry .............................................................................................................................
Pulmonary Disease ..............................................................................................................
Radiation Oncology ..............................................................................................................
Radiology ..............................................................................................................................
Rheumatology .......................................................................................................................
Thoracic Surgery ..................................................................................................................
Urology .................................................................................................................................
Vascular Surgery ..................................................................................................................
Practitioners:
Audiologist ............................................................................................................................
Chiropractor ..........................................................................................................................
Clinical Psychologist .............................................................................................................
Clinical Social Worker ..........................................................................................................
Nurse Anesthetist .................................................................................................................
Nurse Practitioner .................................................................................................................
Optometry .............................................................................................................................
Oral/Maxillofacial Surgery .....................................................................................................
Physical/Occupational Therapy ............................................................................................
Physician Assistants .............................................................................................................
Podiatry .................................................................................................................................
Suppliers:
Diagnostic Testing Facility ....................................................................................................
Independent Laboratory .......................................................................................................
Portable X-Ray Supplier .......................................................................................................
Impact of
crosswalk
changes (percent)
0.0
0.0
0.0
0.0
0.0
0.0
*Sum of the columns may be different due to rounding.
As discussed in section II.J. of this
proposed rule, we are proposing to
reduce payments for technical
components of certain multiple imaging
procedures performed in the same
session within the same imaging
families. In order to calculate the impact
of this proposed change, we examined
2004 PFS carrier claims processed
through March 31, 2005. We extracted
all claims that were billed on the same
day, for the same beneficiary, at the
same provider, for multiple diagnostic
imaging procedures within the same
family of codes. For each subset of
claims, the procedures were arrayed
based on the pricing of the technical
component of these services. We
simulated the effect of the multiple
procedure payment reduction by
accounting for 100 percent of the
highest priced technical component,
and 50 percent of all other technical
components. Note that if the procedure
was billed globally, the professional
component was always calculated at
100 percent of the professional
component (modifier–26) value.
The simulated total allowed charges
for each family of codes includes all
global, technical, and professional
utilization for the family of codes (for
example, the sum of claims where the
multiple procedure payment reduction
would have been in effect, in addition
to claims that would not have been
subject to the multiple procedure
payment reduction). These simulated
totals were then compared to the actual
allowed charges for each family of codes
within the same time period to calculate
the impacts of the proposed change.
Table 32 below shows the actual 2004
allowed charges by family of imaging
procedures and lists the percentage
impact by family if this proposed policy
had been in effect. Family 2 has the
largest (¥18.9 percent) impact, while
Family 11 has the smallest (¥1.3
percent) impact.
TABLE 32.—IMPACT OF MULTIPLE PROCEDURE REDUCTION FOR DIAGNOSTIC IMAGING BY FAMILY OF IMAGING SERVICES
2004 Medicare allowed
charges
($ in millions)
Family
Description of family of imaging procedures
01 ...........
Ultrasound (Chest/Abdomen/Pelvis—Non-Obstetrical ............................................................................
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00100
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
$138
Percentage
impact
(percent)
¥6.8
45863
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 32.—IMPACT OF MULTIPLE PROCEDURE REDUCTION FOR DIAGNOSTIC IMAGING BY FAMILY OF IMAGING SERVICES—
Continued
Family
2004 Medicare allowed
charges
($ in millions)
Description of family of imaging procedures
Percentage
impact
(percent)
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
CT and CTA (Chest/Thorax/Abd/Pelvis) .................................................................................................
CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck) ................................................................................
MRI and MRA (Chest/Abd/Pelvis) ..........................................................................................................
MRI and MRA (Head/Brain/Neck) ...........................................................................................................
MRI and MRA (spine) .............................................................................................................................
CT (spine) ...............................................................................................................................................
MRI and MRA (lower extremities) ...........................................................................................................
CT and CTA (lower extremities) .............................................................................................................
MR and MRI (upper extremities and joints) ............................................................................................
CT and CTA (upper extremities) .............................................................................................................
563
97
105
532
540
24
166
5
107
2
¥18.9
¥2.6
¥4.7
¥6.2
¥4.3
¥4.1
¥3.2
¥2.0
¥2.7
¥1.3
Total for all procedures subject to multiple imaging reductions .............................................................
02
03
04
05
06
07
08
09
10
11
2,276
¥8.3
Using the same data, we also
summarized the dollar value of the
reductions by specialty. Specialtyspecific percentage impacts were
calculated by comparing each
specialty’s 2004 allowed charges for all
Medicare allowed services to the
reduced allowed charges that would
have occurred had this proposal been in
effect. As expected, the most significant
impacts occur among radiologists, who
would experience a ¥2.1 percent
impact. Diagnostic testing facilities
experience a ¥2.9 percent impact. Most
other specialties experience a 0.2
percent payment increase as a result of
the budget neutrality adjustment.
(Because this multiple procedure
reduction adjustment would otherwise
reduce overall payments by 0.2 percent,
it is necessary to include a budget
neutrality adjustment to the RVUs,
resulting in positive impacts for most
specialties.) Table 33 below shows the
percentage impact by specialty in
combination with other proposed
changes.
Table 33 below shows the estimated
change in average payments by
specialty, nonphysician practitioner,
and supplier, resulting from proposed
changes to the calculation of practice
expense and malpractice RVUs, and the
multiple imaging procedure discount.
The first column displays Medicare
allowed charges during 2004 for each
specialty, practitioner, and supplier.
The practice expense changes shown in
the second column represent the first
year impact of a 4-year transition
resulting from all practice expense
revisions including the adoption of the
bottom-up approach and the elimination
of the nonphysician work pool. The
impact shown is identical to the first
column of Table 30. The malpractice
impacts shown in the third column are
identical to those displayed above in
Table 31. The fourth column in Table 33
below demonstrates the impacts for
each specialty of the proposed multiple
imaging procedure discount. The fifth
column shows the combined impact of
all proposed changes by specialty.
The largest impacts in this column are
attributable to the proposed changes to
the PE methodology. The final column
includes the current estimate of the
2006 PFS update factor of ¥4.3 percent.
It also combines the impacts of the
previous three columns. In addition,
this column reflects the expiration of
the transitional adjustment required by
section 303 of the MMA for drug
administration services. This
adjustment was set at 32 percent for
2004 and 3 percent for 2005.
Section 1848(d) and (f) of the Act
requires the Secretary to set the PFS
update under the SGR system. We are
currently forecasting a negative update
of ¥4.3 percent for 2006 and negative
updates for the next few years. As in the
past, we will include a complete
discussion of our methodology for
calculating the SGR in the final rule.
TABLE 33.—IMPACT OF PRACTICE EXPENSE, MALPRACTICE RVUS, MULTIPLE IMAGING DISCOUNT, AND PHYSICIAN FEE
SCHEDULE UPDATE ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, PRACTITIONER, AND SUPPLIER SUBCATEGORY
Medicare
allowed
charges for
2004 ($ in millions)
Specialty
Impact of PE
RVU changes
(percent)
Impact of
malpractice
RVU changes
(percent)
Impact of
multiple imaging discount
(percent)
$165
1,486
385
7,219
118
147
2,033
1,841
301
4,683
1,710
0.6
¥0.7
¥1.0
¥0.5
0.7
¥0.3
4.1
¥0.4
¥0.5
0.1
1.4
0.0
¥0.1
0.2
0.1
0.0
0.0
¥0.1
0.0
0.0
0.0
0.0
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.1
0.1
Physicians:
Allergy\Immunology ..........................
Anesthesiology ..................................
Cardiac Surgery ................................
Cardiology .........................................
Colon and Rectal Surgery ................
Critical Care ......................................
Dermatology ......................................
Emergency Medicine ........................
Endocrinology ...................................
Family Practice .................................
Gastroenterology ..............................
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00101
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
Impact of all
proposed
changes
(percent)
0.8
¥0.6
¥0.5
¥0.2
1.0
¥0.1
4.2
¥0.2
¥0.3
0.2
1.5
Combined
impact: includes update
and drug
admin. trans.
(percent)
¥3.5
¥4.9
¥4.8
¥4.5
¥3.3
¥4.4
¥0.1
¥4.5
¥4.6
¥4.1
¥2.8
45864
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 33.—IMPACT OF PRACTICE EXPENSE, MALPRACTICE RVUS, MULTIPLE IMAGING DISCOUNT, AND PHYSICIAN FEE
SCHEDULE UPDATE ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, PRACTITIONER, AND SUPPLIER SUBCATEGORY—Continued
Combined
impact: includes update
and drug
admin. trans.
(percent)
Medicare
allowed
charges for
2004 ($ in millions)
Specialty
Impact of PE
RVU changes
(percent)
Impact of
malpractice
RVU changes
(percent)
Impact of
multiple imaging discount
(percent)
1,023
2,319
123
68
985
410
9,257
209
1,507
1,284
538
87
599
4,739
3,145
871
915
66
750
279
1,127
1,521
1,308
5,154
400
464
1,782
560
0.2
0.2
¥0.2
¥0.5
0.4
¥0.1
¥0.1
0.2
¥0.2
¥0.6
¥0.7
¥0.3
0.0
¥1.1
¥0.4
¥0.6
1.3
0.1
¥0.5
0.1
0.0
¥0.2
1.9
0.4
¥0.9
¥0.8
1.8
0.5
0.0
0.1
0.0
0.1
0.0
0.0
0.0
¥0.1
0.0
0.0
0.2
¥0.1
0.0
0.0
0.1
0.0
0.0
0.0
¥0.1
0.0
¥0.1
0.0
0.0
0.0
0.0
0.2
0.0
0.0
0.1
0.2
0.2
0.2
0.1
0.2
0.2
¥0.9
0.2
0.0
0.1
¥0.2
0.1
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.1
¥2.1
0.1
0.2
0.0
0.2
0.2
0.4
¥0.1
¥0.2
0.5
0.1
0.1
¥0.8
0.0
¥0.6
¥0.3
¥0.5
0.2
¥1.0
¥0.1
¥0.4
1.5
0.3
¥0.4
0.3
0.1
0.0
2.0
¥1.7
¥0.8
¥0.4
1.8
0.7
¥4.1
¥3.9
¥4.4
¥4.5
¥5.2
¥4.3
¥4.2
¥5.1
¥4.3
¥4.9
¥4.6
¥4.8
¥4.2
¥5.3
¥4.4
¥4.7
¥2.8
¥4.1
¥4.7
¥4.0
¥4.2
¥4.3
¥2.3
¥6.0
¥5.4
¥4.7
¥2.6
¥3.6
31
720
527
345
523
617
720
37
1,283
472
1,487
¥5.8
¥1.3
¥0.6
¥0.6
¥0.4
0.1
¥0.8
0.8
1.5
0.0
1.3
0.0
¥0.6
¥0.3
¥0.4
0.0
0.0
0.0
0.0
¥0.5
0.0
0.0
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
¥5.6
¥1.8
¥0.6
¥0.8
¥0.2
0.2
¥0.6
1.0
1.2
0.3
1.5
¥9.9
¥6.1
¥4.9
¥5.1
¥4.5
¥4.1
¥4.9
¥3.3
¥3.1
¥4.0
¥2.8
1,087
631
96
¥2.4
6.4
0.4
0.0
0.0
0.0
¥2.9
0.2
0.1
¥5.3
6.6
0.5
¥9.6
2.3
¥3.8
General Practice ...............................
General Surgery ...............................
Geriatrics ...........................................
Hand Surgery ....................................
Hematology\Oncology .......................
Infectious Disease ............................
Internal Medicine ..............................
Interventional Radiology ...................
Nephrology ........................................
Neurology ..........................................
Neurosurgery ....................................
Nuclear Medicine ..............................
Obstetrics\Gynecology ......................
Ophthalmology ..................................
Orthopedic Surgery ...........................
Otolaryngology ..................................
Pathology ..........................................
Pediatrics ..........................................
Physical Medicine .............................
Plastic Surgery ..................................
Psychiatry .........................................
Pulmonary Disease ...........................
Radiation Oncology ..........................
Radiology ..........................................
Rheumatology ...................................
Thoracic Surgery ..............................
Urology ..............................................
Vascular Surgery ..............................
Practitioners:
Audiologist ........................................
Chiropractor ......................................
Clinical Psychologist .........................
Clinical Social Worker .......................
Nurse Anesthetist .............................
Nurse Practitioner .............................
Optometry .........................................
Oral\Maxillofacial Surgery .................
Physical\Occupational Therapy ........
Physicians Assistant .........................
Podiatry .............................................
Suppliers:
Diagnostic Testing Facility ................
Independent Laboratory ....................
Portable X-Ray Supplier ...................
Table 34 below shows the impact on
total payments for selected high-volume
procedures of all of the changes
previously discussed. We selected these
procedures because they are the most
commonly provided by a broad
spectrum of physician specialties. There
are separate columns that show the
change in the facility rates and the
nonfacility rates. For an explanation of
facility and nonfacility practice expense
refer to section II.A. in the preamble of
Impact of all
proposed
changes
(percent)
this proposed rule. If we change any of
the proposed provisions following the
consideration of public comments, these
figures may change.
TABLE 34.—IMPACT OF PROPOSED RULE ON PAYMENT FOR SELECTED PROCEDURES
Non-facility
HCPCS
MOD
Description
Old
11721 .........
17000 .........
27130 .........
VerDate jul<14>2003
................
................
................
Debride nail, 6 or more ..............................
Destroy benign/premlg lesion .....................
Total hip arthroplasty ..................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00102
Fmt 4701
New
$39.79
60.64
N/A
Facility
Percent
change
$38.77
62.54
N/A
Sfmt 4702
E:\FR\FM\08AUP2.SGM
¥3
3
N/A
08AUP2
Old
New
$31.08
44.34
1,396.14
$29.60
44.39
1,321.88
Percent
change
¥5
0
¥5
45865
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
TABLE 34.—IMPACT OF PROPOSED RULE ON PAYMENT FOR SELECTED PROCEDURES—Continued
Non-facility
HCPCS
MOD
Description
Old
27244
27447
33533
35301
43239
66821
66984
67210
71010
71010
76091
76091
76092
76092
77427
78465
88305
90801
90862
90935
92012
92014
92980
93000
93010
93015
93307
93510
98941
99203
99213
99214
99222
99223
99231
99232
99233
99236
99239
99243
99244
99253
99254
99261
99262
99263
99283
99284
99291
99292
99302
99303
99312
99313
99348
99350
G0008
G0317
G0344
G0366
G0367
G0368
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
................
................
................
................
................
................
................
................
................
26
................
26
................
26
................
26
26
................
................
................
................
................
................
................
................
................
26
26
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
................
Treat thigh fracture .....................................
Total knee arthroplasty ...............................
CABG, arterial, single .................................
Rechanneling of artery ...............................
Upper GI endoscopy, biopsy ......................
After cataract laser surgery ........................
Cataract surg w/iol, 1 stage .......................
Treatment of retinal lesion ..........................
Chest x-ray .................................................
Chest x-ray .................................................
Mammogram, both breasts ........................
Mammogram, both breasts ........................
Mammogram, screening .............................
Mammogram, screening .............................
Radiation tx management, x5 ....................
Heart image (3d), multiple ..........................
Tissue exam by pathologist ........................
Psy dx interview .........................................
Medication management ............................
Hemodialysis, one evaluation .....................
Eye exam established pat ..........................
Eye exam & treatment ................................
Insert intracoronary stent ............................
Electrocardiogram, complete ......................
Electrocardiogram report ............................
Cardiovascular stress test ..........................
Echo exam of heart ....................................
Left heart catheterization ............................
Chiropractic manipulation ...........................
Office/outpatient visit, new .........................
Office/outpatient visit, est ...........................
Office/outpatient visit, est ...........................
Initial hospital care ......................................
Initial hospital care ......................................
Subsequent hospital care ...........................
Subsequent hospital care ...........................
Subsequent hospital care ...........................
Observ/hosp same date .............................
Hospital discharge day ...............................
Office consultation ......................................
Office consultation ......................................
Initial inpatient consult ................................
Initial inpatient consult ................................
Follow-up inpatient consult .........................
Follow-up inpatient consult .........................
Follow-up inpatient consult .........................
Emergency dept visit ..................................
Emergency dept visit ..................................
Critical care, first hour ................................
Critical care, addï’l 30 min ..................
Nursing facility care ....................................
Nursing facility care ....................................
Nursing fac care, subseq ...........................
Nursing fac care, subseq ...........................
Home visit, est patient ................................
Home visit, est patient ................................
Immunization admin ...................................
ESRD related svs 4+mo 20+yrs .................
Initial preventive exam ................................
EKG for initial prevent exam ......................
EKG tracing for initial prev .........................
EKG interpret & report preve .....................
In the November 15, 2004 PFS final
rule, we showed the combined impact
of PFS and drug payment changes on
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
New
N/A
N/A
N/A
N/A
333.50
248.23
N/A
599.54
28.04
9.47
97.40
45.10
85.65
36.38
172.05
77.31
42.07
153.11
51.92
N/A
65.18
96.26
N/A
26.91
9.10
108.01
49.27
257.32
36.76
97.02
52.68
82.62
N/A
N/A
N/A
N/A
N/A
N/A
N/A
122.79
172.81
N/A
N/A
N/A
N/A
N/A
N/A
N/A
256.57
113.69
87.92
108.39
56.47
79.58
72.01
164.48
18.57
307.73
97.40
26.91
17.81
9.10
Frm 00103
Fmt 4701
Percent
change
N/A
N/A
N/A
N/A
336.27
233.25
N/A
568.15
25.68
9.17
101.39
43.77
83.77
35.33
168.64
74.92
40.14
147.29
50.31
N/A
61.63
91.31
N/A
24.23
8.81
107.55
47.67
252.61
34.78
93.33
50.65
79.62
N/A
N/A
N/A
N/A
N/A
N/A
N/A
118.66
166.69
N/A
N/A
N/A
N/A
N/A
N/A
N/A
243.87
108.60
84.00
103.43
54.03
76.18
68.65
156.46
17.88
294.91
93.69
24.23
15.42
8.81
the total revenues for specialties that
perform a significant volume of drug
administration services. (69 FR 66406)
PO 00000
Facility
Sfmt 4702
N/A
N/A
N/A
N/A
1
¥6
N/A
¥5
¥8
¥3
4
¥3
¥2
¥3
¥2
¥3
¥5
¥4
¥3
N/A
¥5
¥5
N/A
¥10
¥3
0
¥3
¥2
¥5
¥4
¥4
¥4
N/A
N/A
N/A
N/A
N/A
N/A
N/A
¥3
¥4
N/A
N/A
N/A
N/A
N/A
N/A
N/A
¥5
¥4
¥4
¥5
¥4
¥4
¥5
¥5
¥4
¥4
¥4
¥10
¥13
¥3
Old
New
1,134.65
1,507.94
1,923.30
1,128.59
162.20
230.42
684.05
573.39
N/A
9.47
N/A
45.10
N/A
36.38
172.05
77.31
42.07
144.01
48.89
73.14
37.14
60.64
809.11
N/A
9.10
N/A
49.27
257.32
31.83
72.38
35.62
59.12
112.93
157.27
34.11
55.71
79.21
223.22
96.64
93.99
138.70
98.91
142.12
22.36
45.48
67.46
62.15
97.02
207.68
103.84
87.92
108.39
56.47
79.58
N/A
N/A
N/A
307.73
72.76
N/A
N/A
9.10
1,073.62
1,427.92
1,813.54
1,072.23
159.18
216.83
649.50
544.48
N/A
9.17
N/A
43.77
N/A
35.33
166.10
74.92
40.14
137.12
46.77
69.37
35.32
57.66
786.38
N/A
8.81
N/A
47.67
252.61
30.42
69.11
33.96
56.30
107.79
150.29
32.60
53.31
75.74
213.40
92.53
90.08
133.04
94.99
136.30
21.43
43.50
64.57
59.30
92.54
198.33
99.17
84.00
103.43
54.03
76.18
N/A
N/A
N/A
294.91
69.47
N/A
N/A
8.81
Percent
change
¥5
¥5
¥6
¥5
¥2
¥6
¥5
¥5
N/A
¥3
N/A
¥3
N/A
¥3
¥3
¥3
¥5
¥5
¥4
¥5
¥5
¥5
¥3
N/A
¥3
N/A
¥3
¥2
¥4
¥5
¥5
¥5
¥5
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥4
¥5
¥5
¥4
¥4
¥4
¥5
¥4
¥4
N/A
N/A
N/A
¥4
¥5
N/A
N/A
¥3
Although we have not performed a
similar combined impact analysis this
year for all of the specialties considered
E:\FR\FM\08AUP2.SGM
08AUP2
45866
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
last year, we have undertaken a similar
analysis of hematology/oncology. In last
year’s final rule, we announced a oneyear demonstration to collect
information about symptoms for cancer
patients receiving chemotherapy (69 FR
66308). Although this demonstration
was implemented through the
Secretary’s authority under sections
402(a)(1)(B) and 402(a)(2) of the Social
Security Act Amendments of 1967 (Pub.
L. 90–248) and not through
administrative rulemaking, we
discussed the impacts of the additional
payments from this demonstration in
last year’s final rule impact analysis.
of total Medicare revenues for
hematology/oncology are attributed to
drugs, and, for purposes of this analysis,
we are assuming no change in the
payment levels for Part B drugs during
2006. Assuming no changes in
utilization for 2006, we project total
Medicare revenues to oncologists would
decline by 5.6 percent. However, if the
volume of drugs and PFS services
increased at historical rates, total
Medicare revenues for hematology/
oncology would increase by 8.1 percent
between 2005 and 2006.
Therefore, we are also including an
analysis of the impact on payments to
hematology/oncology as this
demonstration project ends. As
indicated in Table 35 below, PFS
services account for approximately 28
percent of Medicare revenues for
hematology/oncology. Medicare
payments for all PFS services provided
by the specialties of hematology/
oncology are projected to decrease by
5.2 percent for 2006. We estimate the
impact of the one-year demonstration
was 15 percent higher payments relative
to PFS payments during 2005. We
estimate that approximately 69 percent
TABLE 35—IMPACT OF DRUG AND PHYSICIAN FEE SCHEDULE PAYMENT CHANGES
Physician Fee Schedule
Specialty
Drugs
All Revenues
Percent of
total medicare
revenues from
fee schedule
(percent)
Change medicare physician
fee schedule
revenues
(percent)
Change oneyear
demonstration
project
(percent)
Percent of
total medicare
revenues from
drugs
Change medicare drug revenues
(percent)
Combined percent change
all medicare
revenues*
Combined percent change
all medicare
revenues with
utilization
increase**
28
¥5.2
¥15
69
0
¥5.6
8.1%
Hematology/Oncology ..
*Note: Reflects changes in total Medicare revenues assuming no changes in utilization. Calculation reflects average changes in fee schedule
payments and for drugs weighted by percent of Medicare revenues.
** Note: We estimate that Medicare payments to oncologists would increase by 8% between 2005 and 2006 if growth in the volume of drugs
and physician fee schedule services were to grow at historical rates, despite the effect of the end of the one-year demonstration project.
B. Geographic Practice Cost Indices
(GPCI)—Payment Localities
As discussed in section II.B. of the
preamble to this proposed rule, we are
proposing two changes to the California
GPCI payment localities. We are
proposing to remove both Santa Cruz
County and Sonoma County from the
Rest of California payment locality, and
make both of those counties separate
payment localities.
In the November 15, 2004 final rule,
we published 2005 and 2006 GPCI and
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
GAF values reflecting the 2 year phasein of the updated GPCI data. For the
Rest of California payment locality that
included Santa Cruz and Sonoma
counties, the 2005 GAF is 1.012, and the
2006 GAF published at that time was
1.017. After removing Santa Cruz
County from the Rest of California
locality, its proposed 2006 GAF
increases to 1.119. Removing Sonoma
County from the Rest of California
locality results in a proposed 2006 GAF
of 1.098 for the new Sonoma County
payment locality. The Rest of California
PO 00000
Frm 00104
Fmt 4701
Sfmt 4702
proposed 2006 GAF is 1.011. Table 36
below shows the impacts of the
proposed changes in the GPCIs and
GAFs. Although only Santa Cruz and
Sonoma Counties and the Rest of
California locality are specifically
impacted by the proposed change, in
Table 36, we are showing the GPCIs and
GAFs for all California payment
localities (the changes from the 2005 to
2006 GAFs for these counties represent
the second year of the transition to
updated GPCIs).
E:\FR\FM\08AUP2.SGM
08AUP2
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Orange ...................................
Los Angeles ...........................
Marin, Napa, Solano ..............
Alameda, Contra Costa .........
San Francisco ........................
San Mateo .............................
Santa Clara ............................
Santa Cruz .............................
Sonoma ..................................
Ventura ..................................
...........................................
County
1.036
1.049
1.025
1.048
1.064
1.061
1.073
1.007
1.007
1.028
1.007
1.21
1.147
1.294
1.303
1.501
1.484
1.46
1.043
1.043
1.152
1.043
PE GPCI
0.954
0.954
0.651
0.651
0.651
0.639
0.604
0.733
0.733
0.744
0.733
MP GPCI
2005 GPCI
1.109
1.088
1.128
1.144
1.239
1.23
1.224
1.012
1.012
1.072
1.012
GAF
1.034
1.041
1.035
1.054
1.06
1.073
1.083
1.014
1.017
1.028
1.007
Work
GPCI
1.236
1.156
1.34
1.371
1.543
1.536
1.54
1.218
1.23
1.179
1.042
PE GPCI
0.954
0.954
0.651
0.651
0.651
0.639
0.604
0.717
0.717
0.744
0.717
MP GPCI
2006 Proposed GPCI
1.119
1.088
1.154
1.177
1.256
1.259
1.265
1.119
1.098
1.083
1.011
GAF
0.9
0.0
2.3
2.9
1.4
2.4
3.3
10.6
8.5
1.0
¥0.1%
Percent
change
from
2005
GAFs
*Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Imperial, Inyo, Kern, Kings, Lake, Lassen, Madera, Mariposa, Mendocino, Merced, Modoc,
Mono, Monterey, Nevada, Placer, Plumas, Riverside, Sacramento, San Benito, San Bernardino, San Joaquin, San Diego, San Luis Obispo, Santa Barbara, Shasta, Sierra, Siskiyou,
Stanislaus, Sutter, Tehama, Trinity, Tulare, Tuolumne, Yolo, Yuba
Anaheim\Santa Ana ........................................
Los Angeles ....................................................
Marin\Napa\Solano .........................................
Oakland\Berkley ..............................................
San Francisco .................................................
San Mateo .......................................................
Santa Clara .....................................................
Santa Cruz ......................................................
Sonoma ...........................................................
Ventura ............................................................
Rest of California* ...........................................
Locality name
Work
GPCI
TABLE 36.—IMPACTS ON CALIFORNIA PAYMENT LOCALITIES
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Frm 00105
Fmt 4701
Sfmt 4702
E:\FR\FM\08AUP2.SGM
08AUP2
45867
45868
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
C. Medicare Telehealth Services
In section II.D. of this proposed rule,
we are proposing to add individual
medical nutrition therapy, as
represented by HCPCS codes G0270,
97802, and 97803, to the list of
telehealth services. We believe that this
change will have little effect on
Medicare expenditures.
D. Contractor Pricing of CPT Codes
97039 and 97139
As discussed earlier in the preamble
of this proposed rule (section II.E.), we
are proposing to have the contractors
value CPT codes 97039 and 97139. This
will make the pricing methodology for
these services consistent with our policy
for other unlisted services and we
believe it will have no significant
impact on Medicare expenditures.
E. ESRD–MMA Related Provisions
The ESRD related provisions in this
proposed rule are discussed in section
II.G. In order to understand the impact
of the proposed changes affecting
payments to different categories of
ESRD facilities, it is necessary to
compare estimated payments under the
current payment system (current
payments) to estimated payments under
the proposed revisions to the composite
rate payment system as set forth in this
proposed rule (proposed payments). To
estimate the impact among various
classes of ESRD facilities, it is
imperative that the estimates of current
payments and proposed payments
contain similar inputs. Therefore, we
simulated payments only for those
ESRD facilities for which we are able to
calculate both current 2005 payments
and proposed 2006 payments.
Due to data limitations, we are unable
to estimate current and proposed
payments for 77 facilities that bill for
ESRD dialysis treatments. ESRD
providers were grouped into the
categories based on characteristics
provided in the Online Survey and
Certification and Reporting (OSCAR)
file and the most recent cost report data
from the Healthcare Cost Report
Information System (HCRIS). We also
used the December 2004 update of CY
2004 Standard Analytical File (SAF)
claims as a basis for Medicare dialysis
treatments and separately billable drugs
and biologicals. While the December
2004 update of the 2004 SAF file is not
complete, we wanted to use the most
recent data available, and plan to use an
updated version of the 2004 SAF file for
the final rule.
TABLE 37—IMPACT OF PROPOSED CHANGES IN PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES
(INCLUDES DRUG AND COMPOSITE RATE PAYMENTS)
[Percent change in total payments to ESRD facilities (both program and beneficiaries)]
Number of
facilities
All .........................................................................................
Independent .........................................................................
Hospital Based .....................................................................
Size:
Small < than 5000 treatments per year .......................
Medium 5000 to 9999 treatments per year ..................
Large > than 10000 treatments per year .....................
Type of Ownership:
Profit ..............................................................................
Nonprofit .......................................................................
Rural .............................................................................
Urban ............................................................................
Region:
New England ................................................................
Middle Atlantic ..............................................................
East North Central ........................................................
West North Central .......................................................
South Atlantic ................................................................
East South Central .......................................................
West South Central ......................................................
Mountain .......................................................................
Pacific ...........................................................................
Puerto Rico ...................................................................
Number of Dialysis treatments
(in millions)
Effect of
changes in
wage index1
Effect of
changes in
drug payments2
Overall effect
3
4,293
3,716
577
29.5
26.1
3.3
0.0
¥0.1
1.3
1.2
1.2
1.0
0.5
0.4
1.2
1,714
1,724
855
4.9
12.4
12.1
¥0.5
0.1
0.2
1.1
1.3
1.2
0.1
0.6
0.6
3,388
896
1,189
3,104
23.8
5.6
6.0
23.5
¥0.2
1.0
¥0.6
0.2
1.2
1.1
1.1
1.2
0.4
1.0
0.1
0.6
143
521
651
333
975
342
585
226
486
31
1.1
3.9
4.6
1.6
6.8
2.2
4.1
1.3
3.7
0.3
3.7
2.1
¥1.9
¥0.9
¥0.3
¥1.6
¥1.3
¥0.6
2.6
¥1.6
1.6
1.5
0.9
1.0
1.2
1.1
1.1
1.1
1.5
0.7
2.9
1.9
¥0.8
¥0.2
0.4
¥0.4
¥0.3
0.0
2.2
¥0.7
1 This column shows the effect of wage changes to composite rate payments to ESRD providers. Composite rate payments computed using
the current wage index are compared to composite rate payments using the proposed wage index changes.
2 This column shows the effect of the changes in drug payments to ESRD providers. These include proposed changes In payment for separately billable drugs (2006 ASP+6) and the 8.9% drug add-on compared to current payment for separately billable drugs (2005 AAP) and the current 8.7 percent drug add-on.
3 This column shows the percent change between proposed and current payments to ESRD facilities. The proposed payments include the
wage adjusted composite rate, and the 8.9% drug add-on times treatments plus proposed payment for separately billable drugs. The current payment to ESRD facilities includes the current wage adjusted composite rate times treatments plus current drug payments for separately billable
drugs.
Table 37 above shows the impact of
this year’s proposed changes to
payments to hospital based and
independent ESRD facilities. We have
included both composite rate payments
as well as payments for separately
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
billable drugs and biologicals because
both are affected by the proposed
changes. The first column of Table 37
identifies the type of ESRD provider, the
second column indicates the number of
ESRD facilities for each type, and the
PO 00000
Frm 00106
Fmt 4701
Sfmt 4702
third column indicates the number of
dialysis treatments.
The fourth column shows the effect of
proposed changes to the ESRD wage
index as it affects the composite rate
payments to ESRD facilities. The fourth
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
column compares aggregate wage
adjusted composite rate payments using
the proposed ESRD wage index
compared to the current ESRD wage
adjusted composite rate payments. The
overall effect to all ESRD providers in
aggregate is zero because the proposed
ESRD wage index has been multiplied
by a budget neutrality factor to comply
with the statutory requirement that any
wage index revisions be done in a
manner that results in the same
aggregate amount of expenditures as
would have been made without any
changes in the wage index. The percent
changes shown in the fifth and sixth
columns are the result of the increase to
the drug add-on and the changes in drug
prices which are explained in section G
below.
The fifth column shows the effect of
the proposed changes in drug payments
to ESRD providers. Current payments
for drugs represent 2005 Medicare
reimbursement using AAP prices for the
top ten drugs (as discussed earlier in
this preamble). Current Medicare
spending for the top ten drugs is
estimated using 2005 AAP prices times
actual drug utilization from 2004
claims. (EPO units are estimated using
payments because the units field on
bills represents the number of EPO
administrations rather than the number
of EPO units). Spending under the
proposed change is 2005 ASP +6
percent for the top ten drugs times
actual drug utilization from 2004
claims. The proposed prices for these
top ten drugs are discussed earlier in
this preamble. In order to simulate what
ASP +6 percent pricing will be in 2006
we inflated the 2005 first quarter ASP
+6 prices by a forecast of the PPI for
prescription drugs (5.7 percent annual
growth from 2005 to 2006).
Proposed payment for drugs in 2006
also includes the 8.9 percent drug addon to the composite rate. This amount
is computed by multiplying the wage
adjusted composite rate for each
provider times dialysis treatments from
2004 claims. Column 5 is computed by
comparing spending under the proposed
payment for drugs (ASP +6 percent
inflated to 2006) including the 8.9
percent drug add-on amount to
spending under current payments for
drugs with the current drug add-on of
8.7 percent. In order to make column 5
comparable with rest of Table 38,
current composite rate payments to
ESRD facilities were included in both
current and proposed spending
calculations.
We did not simulate any case mix in
this impact table because 2004 claims
data do not include the new data fields
(height and weight) that are needed to
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
calculate case mix. These data fields
were not required be reported by
providers until January 1, 2005.
However, we have not proposed any
changes to case mix for calendar year
2006.
Column 6 shows the overall effect of
all changes in drug and composite rate
payments to ESRD providers. The
overall effect is measured as the
difference between proposed payment
with all MMA changes as proposed in
this rule and current payment. Proposed
payment is computed by multiplying
the composite rate for each provider
(with both the proposed wage index and
the 8.9 percent drug add-on) times
dialysis treatments from 2004. In
addition, the proposed payment
includes payments for separately
billable drugs under the ASP +6 drug
pricing inflated to 2006 levels. Current
payment is the current wage adjusted
composite rate for each provider times
dialysis treatments from 2004 claims
plus current AAP priced drug payments
for separately billable drugs with the
current 8.7 percent drug add-on.
The overall impact to ESRD providers
in aggregate is 0.5 percent. Among the
two separately shown effects, the effect
of changes to the wage index has the
most variation among provider type but
is budget neutral in aggregate. The effect
of change in drug payments contributes
most to the overall effect, but varies
little among provider types.
We also note that the proposed
revisions to the composite rate
exceptions process will have no impact
on payments to ESRD providers since
we have only proposed changes in
process and these changes do not affect
which providers will be eligible for
exceptions nor the amount of the
exception.
F. Payment for Covered Outpatient
Drugs and Biologicals
As discussed in section II.H. of this
proposed rule, the proposal to pay a
reduced supplying fee for each
Medicare Part B oral drug prescription,
after the first one, supplied to a
beneficiary during a month is estimated
to reduce total Federal expenditures by
$8 million in 2006, and $30 million over
the five-year period, CY 2006 to 2010.
The preamble seeks comment on an
appropriate inhalation drug dispensing
fee amount for 2006. The effect on
Federal expenditures of a potential
change to the inhalation drug
dispensing fee would depend on the
dispensing fee amount established.
PO 00000
Frm 00107
Fmt 4701
Sfmt 4702
45869
G. Private Contracts and Opt-Out
Provision
The changes discussed in section II.I.
of this proposed rule, with respect to
private contracts and the opt-out
provision, are currently estimated to
have no significant impact on Medicare
expenditures. However, we believe the
changes will clarify that the
consequences for the failure to maintain
opt-out will apply regardless of whether
the physician or practitioner was
notified by the carrier.
H. FQHC Supplemental Payment
Provision
Section 237 of the MMA amended
section 1833(a)(3) of Act to provide
supplemental payments to FQHCs that
contract with Medicare Advantage (MA)
organizations to cover the difference, if
any, between the payment received by
the health center for treating MA
enrollees and the payment to which the
FQHC would be entitled to receive
under its cost-based all-inclusive
payment rate. We estimate that this new
MMA payment provision for FQHC
services will not increase Medicare
payments. In other words, this MMA
provision would have no budgetary
impact on the Medicare trust fund due
to the fact that a supplemental payment
would only be made when the MA
payment to the health center is less than
its original FQHC cost based rate.
Consequently, no additional Medicare
expenditures would be needed to pay
the center up to what it would have
received under original Medicare.
I. National Coverage Decisions
Timeframes
The proposed changes to § 426.340
discussed in section II.N. of this
proposed rule, are made in order to
conform certain timeframes in the
regulation to meet legislative changes
made by the MMA of 2003. These
changes to the regulation will meet
Congressional intent in the development
of NCDs, and will conform the
regulation to the overall NCD process.
There will be no budget implications as
a result of these changes.
J. Coverage of Screening for Glaucoma
As discussed in section II.O. of the
preamble to this proposed rule, we
would expand the definition of an
eligible beneficiary under the glaucoma
screening benefit to include Hispanic
Americans age 65 and over, effective
January 1, 2006, subject to certain
frequency and other limitations on
coverage. At present, § 410.23(a)(2)
(Conditions for and limitations on
coverage of screening for glaucoma)
defines the term ‘‘eligible beneficiary’’
E:\FR\FM\08AUP2.SGM
08AUP2
45870
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
to include individuals in the following
high risk categories:
• Individual with diabetes mellitus.
• Individual with a family history of
glaucoma.
• African-Americans age 50 and over.
Based on the projected utilization of
these screening services and related
medically necessary follow-up tests and
treatment that may be required for the
additional beneficiaries screened, we
estimate that this expanded benefit will
result in an increase in Medicare
payments to ophthalmologists or
optometrists who will provide these
screening tests and related follow-up
tests and treatment. However, this is not
expected to have a significant cost
impact on the Medicare program.
K. Physician Referral for Nuclear
Medicine Services
This proposal, which is discussed in
section II.P. of this proposed rule,
would primarily affect physicians and
health care entities that furnish items
and services to Medicare beneficiaries.
We have attempted to minimize its
effect by interpreting the law in a
practical and realistic manner. We are
unable to quantify the number of
physicians who have either an
ownership or an investment interest in
entities that furnish nuclear medicine
services and/or supplies. Even if we
assume that a substantial number of
physicians have ownership or
investment interests in these types of
entities, we believe that, in general, the
economic impact on these physicians
would not necessarily be substantial, for
the reasons stated below.
Physician owners/investors of entities
that furnish nuclear medicine services
and supplies in a manner that satisfies
the requirements of the in-office
ancillary services exception would not
be affected by this proposed rule. In
addition, physician ownership of or
investment in entities that furnish
nuclear medicine services and supplies
to residents of rural areas would not be
affected by this requirement.
If a physician’s ownership or
investment interest would lead to a
prohibition on his or her referrals to that
entity, the physician has two options.
First, he or she can stop making referrals
to that entity and make referrals to
another entity. Second, the physician
can divest himself or herself of the
interest. While the impact on an
individual physician may be significant,
we do not believe that physicians, in
general, will be significantly affected if
they have to stop making referrals to an
entity in which they have an ownership
interest. We have come to this
conclusion because we assume that the
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
majority of physicians receive most of
their income from the services they
personally furnish, not from nuclear
medicine services performed by entities
that they own. In addition, we assume
that, unless the physician established
the entity to serve only his or her
patients, the entity receives referrals
from other physicians. Thus, the
physician may still receive a return on
the ownership or investment. We do not
believe that the second option
(divestiture of the ownership interest)
would necessarily have a significant
economic effect. However, we assume,
that, at least from an economic
standpoint, most physicians invest in
entities because they are income
producing. If an investment is
successful, a physician may have little
difficulty finding new investors willing
to take over the physician’s investment.
The physician, in turn, can then invest
the monies received in some other
investment. We believe the cost of
divestiture will vary from situation to
situation.
We also do not believe that
beneficiary access to medically
necessary nuclear medicine services
would be threatened simply because
most physician ownership of entities
that furnish nuclear medicine services
would be prohibited. As indicated
above, we see no reason why medically
necessary nuclear medicine services
could not be furnished by entities
owned by those not in a position to refer
such services.
We expect that this proposed rule
may result in savings to both the
Medicare and Medicaid programs by
minimizing anti-competitive business
arrangements as well as financial
incentives that encourage overutilization of costly nuclear medicine
services. (See David Armstrong, ‘‘MRI
and CT Centers Offer Doctors Way to
Profit on Scans,’’ Wall Street Journal,
May 2, 2005, et al.) We cannot gauge
with any certainty the extent of these
savings to either program at this time.
L. Alternatives Considered
This proposed rule contains a range of
policies, including some proposals
related to specific MMA provisions. The
preamble provides descriptions of the
statutory provisions that are addressed,
identifies those policies when discretion
has been exercised, presents rationale
for our decisions and, where relevant,
alternatives that were considered.
M. Impact on Beneficiaries
There are a number of changes made
in this proposed rule that would have
an effect on beneficiaries. In general, we
believe these changes will improve
PO 00000
Frm 00108
Fmt 4701
Sfmt 4702
beneficiary access to services that are
currently covered or will expand the
Medicare benefit package to include
new services. As explained in more
detail below, the regulatory provisions
may affect beneficiary liability in some
cases. Any changes in aggregate
beneficiary liability from a particular
provision will be a function of the
coinsurance (20 percent if applicable for
the particular provision after the
beneficiary has met the deductible) and
the effect of the aggregate cost (savings)
of the provision on the calculation of
the Medicare Part B premium rate
(generally 25 percent of the provision’s
cost or savings).
To illustrate this point, as shown in
Table 34, the 2005 national payment
amount in the nonfacility setting for
CPT code 99203 (Office/outpatient visit,
new), is $97.02 which means that
currently a beneficiary is responsible for
20 percent of this amount, or $19.40.
Under this proposed rule the 2006
national payment amount in the
nonfacility setting for CPT code 99203,
as shown in Table 34, is $93.33 which
means that, in 2006, the beneficiary
coinsurance for this service would be
$18.66.
Very few of the changes we are
proposing impact overall payments and
therefore will affect Medicare
beneficiaries’ coinsurance liability.
Proposals discussed above that do affect
overall spending would similarly
impact beneficiaries’ coinsurance.
For example, we have tried to ensure
that the proposal concerning physician
self-referral for nuclear medicine
services would not adversely impact the
medical care of Medicare or Medicaid
patients. While we recognize that these
proposed revisions may have an impact
on current arrangements under which
patients are receiving medical care,
there are other ways to structure these
arrangements so that patients may
continue to receive medically necessary
nuclear medicine services. In almost all
cases, we believe this proposal
concerning physician referral for
nuclear medicine services should not
require substantial changes in delivery
arrangements and would help minimize
anti-competitive behavior that can affect
where a beneficiary receives health care
services and possibly the quality of the
services furnished. We also believe it
will minimize the number of medically
unnecessary nuclear medicine
procedures billed to the Medicare and
Medicaid programs.
N. Accounting Statement
As required by OMB Circular A–4
(available at https://www.whitehouse.
gov/omb/circulars/a004/a–4.pdf), in
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Table 38 below, we have prepared an
accounting statement showing the
classification of the expenditures
associated with the provisions of this
proposed rule. This table includes the
impact of the proposed changes in this
rule on providers and suppliers and
encompasses the anticipated negative
update to the physician fee schedule
based on the statutory SGR formula.
Expenditures are classified as
transfers to Medicare providers/or
45871
suppliers (that is, ESRD facilities and
physicians, other practitioners and
medical suppliers that receive payment
under the physician fee schedule or
Medicare Part B).
TABLE 38.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM CY 2005 TO THE CY
2006
[in millions]
Category
Transfers
Annualized Monetized Transfers ........................
From Whom To Whom? .....................................
Negative transfer-Estimated decrease in expenditures ($1,860).
Federal Government To ESRD Medicare Providers; physicians, other practitioners and suppliers who receive payment under the Medicare Physician Fee Schedule; and Medicare
Suppliers billing for Part B drugs.
In accordance with the provisions of
Executive Order 12866, this final rule
was reviewed by the Office of
Management and Budget.
List of Subjects
42 CFR Part 405
Administrative practice and
procedure, Health facilities, Health
professions, Kidney diseases, Medical
devices, Medicare, Reporting and
recordkeeping requirements, Rural
areas, X-rays.
42 CFR Part 410
Health facilities, Health professions,
Kidney diseases, Laboratories,
Medicare, Reporting and recordkeeping
requirements, Rural areas, X-rays.
42 CFR Part 411
42 CFR Part 413
Health facilities, Kidney diseases,
Medicare, Reporting and recordkeeping
requirements.
42 CFR Part 414
Administrative practice and
procedure, Health facilities, Health
professions, Kidney diseases, Medicare,
Reporting and recordkeeping
requirements.
42 CFR Part 426
Administrative practice and
procedure, Medicare, Reporting and
recordkeeping requirements.
For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services proposes to amend
42 CFR chapter IV as set forth below:
20:18 Aug 05, 2005
1. The authority citation for part 405
continues to read as follows:
Authority: Secs. 1102, 1861, 1862(a), 1871,
1874, 1881, and 1886(k) of the Social
Security Act (42 U.S.C. 1302, 1395x,
1395y(a), 1395hh, 1395kk, 1395rr, and
1395ww(k)), and sec. 353 of the Public
Health Service Act (42 U.S.C. 263a).
Subpart D—Private Contracts
2. Section 405.435 is amended by—
A. Revising introductory text in
paragraph (b).
B. Adding paragraph (d).
The revision and addition read as
follows:
§ 405.435
Failure to maintain opt-out.
*
Kidney diseases, Medicare, Physician
Referral, Reporting and recordkeeping
requirements.
VerDate jul<14>2003
PART 405—FEDERAL HEALTH
INSURANCE FOR THE AGED AND
DISABLED
Jkt 205001
*
*
*
*
(b) If a physician or practitioner fails
to maintain opt-out in accordance with
paragraph (a) of this section, then, for
the remainder of the opt-out period,
except as provided by paragraph (d) of
this section—
*
*
*
*
*
(d) If a physician or practitioner
demonstrates that he or she has taken
good faith efforts to maintain opt-out
(including by refunding amounts in
excess of the charge limits to
beneficiaries with whom he or she did
not sign a private contract) within 45
days of a notice from the carrier of a
violation of paragraph (a) of this section,
then the requirements of paragraphs
(b)(1) through (b)(8) of this section are
not applicable. In situations where a
violation of paragraph (a) of this section
is not discovered by the carrier during
the 2-year opt-out period when the
violation actually occurred, then the
requirements of paragraphs (b)(1)
through (b)(8) of this section are
applicable from the date that the first
violation of paragraph (a) of this section
PO 00000
Frm 00109
Fmt 4701
Sfmt 4702
occurred until the end of the opt-out
period during which the violation
occurred (unless the physician or
practitioner takes good faith efforts,
within 45 days of any notice from the
carrier that the physician or practitioner
failed to maintain opt-out, or the
physician’s or practitioner’s discovery
of the failure to maintain opt-out,
whichever is earlier, to correct his or her
violations of paragraph (a) of this
section, for example, by refunding the
amounts in excess of the charge limits
to beneficiaries with whom he or she
did not sign a private contract).
*
*
*
*
*
Subpart X—Rural Health Clinic and
Federally Qualified Health Center
Services
3. Add § 405.2469 to read as follows:
§ 405.2469 Federally Qualified Health
Centers supplemental payments.
Federally Qualified Health Centers
under contract (directly or indirectly)
with Medicare Advantage plans are
eligible for supplemental payments for
covered Federally Qualified Health
Center services furnished to enrollees in
Medicare Advantage plans offered by
the Medicare Advantage organization to
cover the difference, if any, between
their payments from the Medicare
Advantage plan and what they would
receive under the cost-based Federally
Qualified Health Center payment
system.
(a) Calculation of supplemental
payment. (1) The supplemental payment
for Federally Qualified Health Center
covered services provided to Medicare
patients enrolled in Medicare
Advantage plans is based on—
(i) The difference between payments
received by the center from the
Medicare Advantage plan as determined
on a per visit basis;
E:\FR\FM\08AUP2.SGM
08AUP2
45872
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
(ii) The Federally Qualified Health
Center’s all-inclusive cost-based per
visit rate as set forth in this subpart;
(iii) Less any amount the FQHC may
charge as described in section
1857(e)(3)(B) of the Act.
(2) Any financial incentives provided
to Federally Qualified Health Centers
under their Medicare Advantage
contracts, such as risk pool payments,
bonuses, or withholds, are prohibited
from being included in the calculation
of supplemental payments due to the
Federally Qualified Health Center.
(b) Per visit supplemental payment. A
supplemental payment required under
this section is made to the Federally
Qualified Health Center when a covered
face-to-face encounter occurs between a
Medicare Advantage enrollee and a
practitioner as set forth in § 405.4563.
PART 410—SUPPLEMENTARY
MEDICAL INSURANCE (SMI)
BENEFITS
4. The authority citation for part 410
continues to read as follows:
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395hh).
5. Section 410.23 is amended by
revising paragraph (a)(2)(i) through (iv)
to read as follows:
§ 410.23 Screening for glaucoma:
Conditions for and limitations on coverage.
(a) * * *
(2) * * *
(i) Individual with diabetes mellitus.
(ii) Individual with a family history of
glaucoma.
(iii) African-Americans age 50 and
over.
(iv) Hispanic-Americans age 65 and
over.
*
*
*
*
*
6. Section 410.78 is amended by—
A. Revising paragraph (b)
introductory text.
B. Adding paragraph (b)(2)(viii).
The revision and addition read as
follows:
Telehealth services
*
*
*
*
*
(b) General rule. Medicare Part B pays
for office and other outpatient visits,
professional consultation, psychiatric
diagnostic interview examination,
individual psychotherapy,
pharmacologic management, end stage
renal disease related services included
in the monthly capitation payment
(except for one visit per month to
examine the access site), and individual
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PART 411—EXCLUSIONS FROM
MEDICARE AND LIMITATIONS ON
MEDICARE PAYMENT
7. The authority citation for part 411
continues to read as follows:
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395hh).
Subpart J—Financial Relationships
Between Physicians and Entities
Furnishing Designated Health Services
8. Section 411.351 is amended by—
A. Revising the definition ‘‘Radiation
therapy services and supplies’’.
B. Revising the definition ‘‘Radiology
and certain other imaging services’’.
The revisions read as follows:
§ 411.351
Subpart B—Medical and Other Health
Services
§ 410.78
medical nutrition therapy furnished by
an interactive telecommunications
system if the following conditions are
met:
(2) * * *
(viii) A registered dietician or
nutrition professional as described in
§ 410.134.
*
*
*
*
*
Definitions.
*
*
*
*
*
Radiation therapy services and
supplies means those particular services
and supplies so identified on the List of
CPT/HCPCS Codes. All services and
supplies identified on the List of CPT/
HCPCS Codes are radiation therapy
services and supplies for purposes of
this subpart. Any service or supply not
specifically identified as radiation
therapy services or supplies on the List
of CPT/HCPCS Codes is not a radiation
therapy service or supply for purposes
of this subpart. The list of codes
identifying radiation therapy services
and supplies are those covered under
section 1861(s)(4) of the Act and
§ 410.35 of this chapter.
Radiation and certain other imaging
services means those particular services
so identified on the List of CPT/HCPCS
Codes. All services so identified on the
List of CPT/HCPCS Codes are radiology
and certain other imaging services for
purposes of this subpart. Any service
not specifically identified as radiology
and certain other imaging services on
the List of CPT/HCPCS Codes, is not a
radiology or certain other imaging
service for purposes of this subpart. The
list of codes identifying radiology and
certain other imaging services includes
the professional and technical
components of any diagnostic test or
procedure using x-rays, ultrasound, or
other imaging services, computerized
axial tomography, or magnetic
resonance imaging, or diagnostic
PO 00000
Frm 00110
Fmt 4701
Sfmt 4702
nuclear medicine, as covered under
section 1861(s)(3) of the Act and
§ 410.32 and § 410.34 of this chapter,
but does not include—
(1) X-ray, fluoroscopy, or ultrasound
procedures that require the insertion of
a needle, catheter, tube, or probe
through the skin or into a body orifice.
(2) Radiology procedures that are
integral to the performance of a nonradiological medical procedure and
performed—
(i) During the nonradiological medical
procedure; or
(ii) Immediately following the nonradiological medical procedure where
necessary to confirm placement of an
item placed during the nonradiological
medical procedure.
*
*
*
*
*
PART 413—PRINCIPLES OF
REASONABLE COST
REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE
SERVICES; PROSPECTIVELY
DETERMINED PAYMENT RATES FOR
SKILLED NURSING FACILITIES
9. The authority citation for part 413
continues to read as follows:
Authority: Secs. 1102, 1812(d), 1814(b),
1815, 1833(a), (i), and (n), 1871, 1881, 1883,
and 1886 of the Social Security Act (42
U.S.C. 1302, 1395D(D), 1395f(b), 1395g,
13951(a), (i), and (n), 1395hh, 1395rr, 1395tt,
and 1395ww).
Subpart H—Payment for End-Stage
Renal Disease (ESRD) Services and
Organ Procurement Costs
10. Section 413.170 is amended by
revising paragraph (b) to read as follows:
§ 413.170
Scope.
*
*
*
*
*
(b) Providing procedures and criteria
under which a pediatric ESRD facility
(an ESRD facility with at least a 50
percent pediatric patient mix) may
receive an exception to the prospective
payment rates; and
*
*
*
*
*
11. Section 413.174 is amended by—
A. Revising paragraph (f).
B. Removing paragraph (g).
The revisions read as follows:
§ 413.174 Prospective rates for hospitalbased and independent ESRD facilities.
*
*
*
*
*
(f) Additional payment for separately
billable drugs. CMS makes an additional
payment for certain drugs furnished to
ESRD patients by a Medicare-approved
ESRD facility. CMS makes this payment
directly to the ESRD facility. Payment
for these drugs is made—
(1) Only on an assignment basis,
directly to the facility which must
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
accept, as payment in full, the amount
that CMS determines;
(2) Subject to the Part B deductible
and coinsurance;
(3) To hospital-based facilities in
accordance with the cost reimbursement
rules set forth in this part, except for
erythropoietin/epogen (commonly
called EPO), which is paid the same
amount as independent facilities; and
(4) To independent facilities in
accordance with the methodology set
forth in § 405.517 of this chapter.
12. Section 413.180 is amended by—
A. Revising paragraphs (b) and (d)
B. Removing paragraphs (e) and (k).
C. Redesignating paragraphs (f)
through (j) as paragraphs (e) through (i).
D. Redesignating paragraphs (l) and
(m) as paragraphs (j) and (k).
The amendment reads as follows:
§ 413.180 Procedures for requesting
exceptions to payment rates.
*
*
*
*
*
(b) Criteria for requesting an
exception. If a pediatric ESRD facility
projects on the basis of prior year costs
and utilization trends that it has an
allowable cost per treatment higher than
its prospective rate set under § 413.174,
and if these excess costs are attributable
to one or more of the factors in
§ 413.182, the facility may request, in
accordance with paragraph (e) of this
section, that CMS approve an exception
to that rate and set a higher prospective
payment rate.
*
*
*
*
*
(d) Payment rate exception request.
Effective October 1, 2002, CMS may
approve exceptions to a pediatric ESRD
facility’s updated prospective payment
rate, if the pediatric ESRD facility did
not have an approved exception rate as
of October 1, 2002. A pediatric ESRD
facility may request an exception to its
payment rate at any time after it is in
operation for at least 12 consecutive
months.
*
*
*
*
*
13. Section 413.182 is revised to read
as follows:
§ 413.182 Criteria for approval of
exception requests.
(a) CMS may approve exceptions to a
pediatric ESRD facility’s prospective
payment rate if the pediatric ESRD
facility did not have an approved
exception rate as of October 1, 2002.
(b) The pediatric ESRD facility must
demonstrate, by convincing objective
evidence, that its total per treatment
costs are reasonable and allowable
under the relevant cost reimbursement
principles of part 413 and that its per
treatment costs in excess of its payment
rate are directly attributable to any of
the following criteria:
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
(1) Pediatric patient mix, as specified
in § 413.184.
(2) Self-dialysis training costs in
pediatric facilities, as specified in
§ 413.186
14. Section 413.184 is amended by
revising paragraphs (a) and (b)(1) to read
as follows:
§ 413.184 Payment exception: Pediatric
patient mix.
(a) Qualifications. To qualify for an
exception to its prospective payment
rate based on its pediatric patient mix
a facility must demonstrate that—
(1) At least 50 percent of its patients
are individuals under 18 years of age;
(2) Its nursing personnel costs are
allocated properly between each mode
of care;
(3) The additional nursing hours per
treatment are not the result of an excess
number of employees;
(4) Its pediatric patients require a
significantly higher staff-to-patient ratio
than typical adult patients; and
(5) These services, procedures, or
supplies and its per treatment costs are
clearly prudent and reasonable when
compared to those of pediatric facilities
with a similar patient mix.
(b) Documentation. (1) A pediatric
ESRD facility must submit a listing of all
outpatient dialysis patients (including
all home patients) treated during the
most recently completed and filed cost
report (in accordance with cost
reporting requirements under § 413.198)
showing—
(i) Age of patients and percentage of
patients under the age of 18;
(ii) Individual patient diagnosis;
(iii) Home patients and ages;
(iv) In-facility patients, staff-assisted,
or self-dialysis;
(v) Diabetic patients; and
(vi) Patients isolated because of
contagious disease.
*
*
*
*
*
§ 413.186
[Removed]
15. Section 413.186 is removed.
§ 413.188
[Removed]
16. Section 413.188 is removed.
17. Redesignate § 413.190 as § 413.186
and revise the newly designated
§ 413.186 to read as follows:
§ 413.186 Payment exception: Self-dialysis
training costs in pediatric facilities.
(a) Qualification. To qualify for an
exception to the prospective payment
rate based on self-dialysis training costs,
the pediatric ESRD facility must
establish that it incurs per treatment
costs for furnishing self-dialysis and
home dialysis training that exceed the
facility’s payment rate for the training
sessions.
PO 00000
Frm 00111
Fmt 4701
Sfmt 4702
45873
(b) Justification. To justify its
exception request, a facility must—
(1) Separately identify those elements
contributing to its costs in excess of the
composite training rate; and
(2) Demonstrate that its per treatment
costs are reasonable and allowable.
(c) Criteria for determining proper
cost reporting. CMS considers the
pediatric ESRD facility’s total costs, cost
finding and apportionment, including
its allocation of costs, to determine if
costs are properly reported by treatment
modality.
(d) Limitation of exception requests.
Exception requests for a higher training
rate are limited to those cost
components relating to training such as
technical staff, medical supplies, and
the special costs of education (manuals
and education materials). These
requests may include overhead and
other indirect costs to the extent that
these costs are directly attributable to
the additional training costs.
(e) Documentation. The pediatric
ESRD facility must provide the
following information to support its
exception request:
(1) A copy of the facility’s training
program.
(2) Computation of the facility’s cost
per treatment for maintenance sessions
and training sessions including an
explanation of the cost difference
between the two modalities.
(3) Class size and patients’ training
schedules.
(4) Number of training sessions
required, by treatment modality, to train
patients.
(5) Number of patients trained for the
current year and the prior 2 years on a
monthly basis.
(6) Projection for the next 12 months
of future training candidates.
(7) The number and qualifications of
staff at training sessions.
(f) Accelerated training exception. (1)
A pediatric ESRD facility may bill
Medicare for a dialysis training session
only when a patient receives a dialysis
treatment (normally three times a week
for hemodialysis). Continuous cycling
peritoneal dialysis (CCPD) and
continuous ambulatory peritoneal
dialysis (CAPD) are daily treatment
modalities; ESRD facilities are paid the
equivalent of three hemodialysis
treatments for each week that CCPD and
CAPD treatments are provided.
(2) If a pediatric ESRD facility elects
to train all its patients using a particular
treatment modality more often than
during each dialysis treatment and, as a
result, the number of billable training
dialysis sessions is less than the number
of actual training sessions, the facility
E:\FR\FM\08AUP2.SGM
08AUP2
45874
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
may request a composite rate exception,
limited to the lesser of the—
(i) Facility’s projected training cost
per treatment; or
(ii) Cost per treatment the facility
receives in training a patient if it had
trained patients only during a dialysis
treatment, that is, three times per week.
(3) An ESRD facility may bill a
maximum of 25 training sessions per
patient for hemodialysis training and 15
sessions for CCPD and CAPD training.
(4) In computing the payment amount
under an accelerated training exception,
CMS uses a minimum number of
training sessions per patient (15 for
hemodialysis and 5 for CAPD and
CCPD) when the facility actually
provides fewer than the minimum
number of training sessions.
(5) To justify an accelerated training
exception request, an ESRD facility
must document that a significant
number of training sessions for a
particular modality are provided during
a shorter but more condensed period.
(6) The facility must submit with the
exception request a list of patients, by
modality, trained during the most recent
cost report period. The list must include
each beneficiary’s—
(i) Name;
(ii) Age; and
(iii) Training status (completed, not
completed, being retrained, or in the
process of being trained).
(7) The total treatments from the
patient list must be the same as the total
treatments reported on the cost report
filed with the request.
§ 413.192
[Removed]
18. Section 413.192 is removed.
PART 414—PAYMENT FOR PART B
MEDICAL AND OTHER HEALTH
SERVICES
19. The authority citation for part 414
continues to read as follows:
Authority: Secs. 1102, 1871, and 1881(b)(1)
of the Social Security Act (42 U.S.C. 1302,
1395hh, and 1395rr(b)(1)).
Subpart B—Physicians and Other
Practitioners
20. Section 414.65 is amended by
revising paragraph (a)(1) to read as
follows:.
§ 414.65
Payment for telehealth services
(a) * * *
(1) The Medicare payment amount for
office or other outpatient visits,
consultation, individual psychotherapy,
psychiatric diagnostic interview
examination, pharmacologic
management, end stage renal disease
related services included in the monthly
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
capitation payment (except for one visit
per month to examine the access site),
and individual medical nutrition
therapy furnished via an interactive
telecommunications system is equal to
the current fee schedule amount
applicable for the service of the
physician or practitioner.
*
*
*
*
*
21. Section 414.802 is amended by
adding definitions of ‘‘direct sales’’ and
‘‘indirect sales’’ to read as follows:
§ 414.802
Definitions
*
*
*
*
*
Direct Sales means sales directly from
the manufacturer to the provider (for
example, physician or other health care
provider) or supplier.
*
*
*
*
*
Indirect Sales means from the
manufacturer to a wholesaler,
distributor, or similar entity that sells to
others in the distribution chain. Indirect
sales also include any sale subject to the
average sales price reporting
requirement that is not a direct sale.
*
*
*
*
*
22. Section 414.804(a) is amended by:
A. Redesignating paragraphs (a)(3),
(a)(4), (a)(5), and (a)(6), as paragraphs
(a)(4), (a)(5), (a)(6), and (a)(7).
B. Adding a new paragraph (a)(3).
C. Revising newly redesignated
paragraph (a)(4).
The redesignations and revisions read
as follows:
§ 414.804
Basis of payment.
(a) * * *
(3) In calculating the manufacturer’s
average sales price, a manufacturer
must—
(i) Calculate the average sales price for
direct sales;
(ii) Calculate the average sales price
for indirect sales; and
(iii) Calculate the weighted average of
the results from paragraphs (a)(3)(i) and
(a)(3)(ii). Example. [(ASP for direct sales
× direct sales units) + (ASP for indirect
sales × indirect sales units)]/(direct sales
units + indirect units sales units).
(4) To the extent that data on price
concessions, as described in paragraph
(a)(2) of this section, are available on a
lagged basis, the manufacturer must
estimate this amount in accordance with
the methodology described in
paragraphs (a)(4)(i) through (a)(4)(iv) of
this section, for each of the amounts
calculated under paragraphs (a)(3)(i)
and (a)(3)(ii) of this section, before
calculating the weighted average
described in paragraph (a)(3)(iii) of this
section.
(i) For each National Drug Code, the
manufacturer calculates a percentage
PO 00000
Frm 00112
Fmt 4701
Sfmt 4702
equal to the sum of the price
concessions for the most recent 12month period available associated with
sales subject to the average sales price
reporting requirement divided by the
total in dollars for the sales subject to
the average sales price reporting
requirement for the same 12-month
period.
(ii) The manufacturer then multiplies
the percentage described in paragraph
(a)(4)(i) of this section by the total in
dollars for the sales subject to the
average sales price reporting
requirement for the quarter being
submitted. (The manufacturer must
carry a sufficient number of decimal
places in the calculation of the price
concessions percentage in order to
round accurately the net total sales
amount for the quarter to the nearest
whole dollar.) The result of this
multiplication is then subtracted from
the total in dollars for the sales subject
to the average sales price reporting
requirement for the quarter being
submitted.
(iii) The manufacturer then uses the
result of the calculation described in
paragraph (a)(4)(ii) of this section as the
numerator and the number of units sold
in the quarter as the denominator to
calculate the manufacturer’s average
sales price for the National Drug Code
in the quarter being submitted.
(iv) Example. The total lagged price
concessions (discounts, rebates, etc.)
over the most recent 12-month period
available associated with direct sales for
National Drug Code 12345–6789–01
subject to the ASP reporting
requirement equal $200,000. The total
in dollars for the direct sales subject to
the average sales price reporting
requirement for the same period equals
$600,000. The lagged price concessions
percentage for this period equals
200,000/600,000 = .33333. The total in
dollars for the direct sales subject to the
average sales price reporting
requirement for the quarter being
reported equals $50,000 for 10,000
direct sales units sold. Assuming no
non-lagged price concessions apply, the
manufacturer’s average sales price
calculation for direct sales for this
National Drug Code for this quarter is:
$50,000—(0.33333 × $50,000) = $33,334
(net total direct sales amount); $33,334/
10,000 = $3.33 (average sales price for
direct sales). The average sales price for
indirect sales is calculated
independently.
*
*
*
*
*
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Subpart L—Supplying and Dispensing
Fees
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395hh).
23. Section 414.1001 is amended by
revising paragraph (a) as follows:
25. The heading for part 426 is revised
to read as set forth above.
§ 414.1001
Basis of payment.
(a) A supplying fee of $24 is paid to
a supplier for the first prescription of
drugs and biologicals described in
sections 1861(s)(2)(J), 1861(s)(2)(Q), and
1861(s)(2)(T) of the Act that that
supplier provided to a beneficiary
during a month. A supplying fee of $8
is paid to a supplier for each
prescription of drugs and biologicals
described in sections 1861(s)(2)(J),
1861(s)(2)(Q), and 1861(s)(2)(T) of the
Act, after the first one, that that supplier
provided to a beneficiary during a
month.
*
*
*
*
*
PART 426—REVIEW OF NATIONAL
COVERAGE DETERMINATIONS AND
LOCAL COVERAGE
DETERMINATIONS
24. The authority citation for part 426
continues to read as follows:
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
Subpart C—General Provisions for the
Review of LCDs and NCDs
26. Section 426.340 is amended by—
A. Revising paragraph (e)(2).
B. Adding paragraph (e)(3).
C. Revising paragraph (f)(2).
D. Adding paragraph (f)(3).
The revisions and additions read as
follows:
§ 426.340 Procedures for review of new
evidence.
*
*
*
*
*
(e) * * *
(2) For LCDs, sets a reasonable
timeframe, not more than 90 days, by
which the contractor completes the
reconsideration.
(3) For NCDs, sets a reasonable
timeframe, in compliance with the
timeframes specified in section 1862(1)
of the Act, by which CMS completes the
reconsideration.
PO 00000
Frm 00113
Fmt 4701
Sfmt 4702
45875
(f) * * *
(2) For LCDs, the 90-day
reconsideration timeframe is not met.
(3) For NCDs, the reconsideration
timeframe as specified by the Board, in
compliance with section 1862(1) of the
Act, is not met.
*
*
*
*
*
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program).
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program).
Dated: July 12, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: July 18, 2005.
Michael O. Leavitt,
Secretary.
E:\FR\FM\08AUP2.SGM
08AUP2
45876
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
Note: These addenda will not appear in the
Code of Federal Regulations.
Addendum A—Explanation and Use of
Addenda B
The addenda on the following pages
provide various data pertaining to the
Medicare fee schedule for physicians’
services furnished in 2006. Addendum
B contains the RVUs for work, nonfacility practice expense, facility
practice expense, and malpractice
expense, and other information for all
services included in the physician fee
schedule.
In previous years, we have listed
many services in Addendum B that are
not paid under the physician fee
schedule. To avoid publishing as many
pages of codes for these services, we are
not including clinical laboratory codes
and most alpha-numeric codes
(Healthcare Common Procedure Coding
System (HCPCS) codes not included in
CPT) in Addendum B.
Addendum B—2006 Relative Value
Units and Related Information Used in
Determining Medicare Payments For
2006
This addendum contains the
following information for each CPT
code and alphanumeric HCPCS code,
except for alphanumeric codes
beginning with B (enteral and parenteral
therapy), E (durable medical
equipment), K (temporary codes for
nonphysicians’ services or items), or L
(orthotics), and codes for
anesthesiology.
1. CPT/HCPCS code. This is the CPT
or alphanumeric HCPCS number for the
service. Alphanumeric HCPCS codes are
included at the end of this addendum.
2. Modifier. A modifier is shown if
there is a technical component (modifier
TC) and a professional component (PC)
(modifier –26) for the service. If there is
a PC and a TC for the service,
Addendum B contains three entries for
the code: One for the global values (both
professional and technical); one for
modifier –26 (PC); and one for modifier
TC. The global service is not designated
by a modifier, and physicians must bill
using the code without a modifier if the
physician furnishes both the PC and the
TC of the service.
Modifier –53 is shown for a
discontinued procedure. There will be
RVUs for the code (CPT code 45378)
with this modifier.
3. Status indicator. This indicator
shows whether the CPT/HCPCS code is
in the physician fee schedule and
whether it is separately payable if the
service is covered.
A = Active code. These codes are
separately payable under the fee
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
schedule if covered. There will be RVUs
for codes with this status. The presence
of an ‘‘A’’ indicator does not mean that
Medicare has made a national coverage
determination regarding the coverage of
the service. Carriers remain responsible
for coverage decisions in the absence of
a national Medicare policy.
B = Bundled code. Payment for
covered services is always bundled into
payment for other services not specified.
If RVUs are shown, they are not used for
Medicare payment. If these services are
covered, payment for them is subsumed
by the payment for the services to which
they are incident. (An example is a
telephone call from a hospital nurse
regarding care of a patient.)
C = Carrier-priced code. Carriers will
establish RVUs and payment amounts
for these services, generally on a caseby-case basis following review of
documentation, such as an operative
report.
D = Deleted/discontinued code. These
codes are deleted effective with the
beginning of the calendar year.
E = Excluded from physician fee
schedule by regulation. These codes are
for items or services that CMS chose to
exclude from the physician fee schedule
payment by regulation. No RVUs are
shown, and no payment may be made
under the physician fee schedule for
these codes. Payment for them, if they
are covered, continues under reasonable
charge or other payment procedures.
F = Deleted/discontinued codes.
(Code not subject to a 90-day grace
period.) These codes are deleted
effective with the beginning of the year
and are never subject to a grace period.
This indicator is no longer effective
with the 2006 physician fee schedule as
of January 1, 2006.
G = Code not valid for Medicare
purposes. Medicare does not recognize
codes assigned this status. Medicare
uses another code for reporting of, and
payment for, these services. (Code
subject to a 90 day grace period.) This
indicator is no longer effective with the
2006 physician fee schedule as of
January 1, 2006.
H = Deleted modifier. For 2000 and
later years, either the TC or PC
component shown for the code has been
deleted and the deleted component is
shown in the data base with the H status
indicator.
I = Not valid for Medicare purposes.
Medicare uses another code for the
reporting of, and the payment for these
services. (Code NOT subject to a 90-day
grace period.)
N = Noncovered service. These codes
are noncovered services. Medicare
payment may not be made for these
PO 00000
Frm 00114
Fmt 4701
Sfmt 4702
codes. If RVUs are shown, they are not
used for Medicare payment.
P = Bundled or excluded code. There
are no RVUs for these services. No
separate payment is made for them
under the physician fee schedule.
—If the item or service is covered as
incident to a physician’s service and
is furnished on the same day as a
physician’s service, payment for it is
bundled into the payment for the
physician’s service to which it is
incident (an example is an elastic
bandage furnished by a physician
incident to a physician’s service).
—If the item or service is covered as
other than incident to a physician’s
service, it is excluded from the
physician fee schedule (for example,
colostomy supplies) and is paid under
the other payment provisions of the
Act.
R = Restricted coverage. Special
coverage instructions apply. If the
service is covered and no RVUs are
shown, it is carrier-priced.
T = Injections. There are RVUs for
these services, but they are only paid if
there are no other services payable
under the physician fee schedule billed
on the same date by the same provider.
If any other services payable under the
physician fee schedule are billed on the
same date by the same provider, these
services are bundled into the service(s)
for which payment is made.
X = Exclusion by law. These codes
represent an item or service that is not
within the definition of ‘‘physicians’
services’’ for physician fee schedule
payment purposes. No RVUs are shown
for these codes, and no payment may be
made under the physician fee schedule.
(Examples are ambulance services and
clinical diagnostic laboratory services.)
4. Description of code. This is an
abbreviated version of the narrative
description of the code.
5. Physician work RVUs. These are the
RVUs for the physician work for this
service in 2005. Codes that are not used
for Medicare payment are identified
with a ‘‘+.’’
6. Non-facility practice expense
RVUs. These are the fully implemented
resource-based practice expense RVUs
for non-facility settings.
7. Facility practice expense RVUs.
These are the fully implemented
resource-based practice expense RVUs
for facility settings.
8. Malpractice expense RVUs. These
are the RVUs for the malpractice
expense for the service for 2005.
9. Facility total. This is the sum of the
work, fully implemented facility
practice expense, and malpractice
expense RVUs.
E:\FR\FM\08AUP2.SGM
08AUP2
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
10. Non-facility total. This is the sum
of the work, fully implemented nonfacility practice expense, and
malpractice expense RVUs.
11. Global period. This indicator
shows the number of days in the global
period for the code (0, 10, or 90 days).
An explanation of the alpha codes
follows:
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
MMM = The code describes a service
furnished in uncomplicated maternity
cases including antepartum care,
delivery, and postpartum care. The
usual global surgical concept does not
apply. See the 1999 Physicians’ Current
Procedural Terminology for specific
definitions.
XXX = The global concept does not
apply.
PO 00000
Frm 00115
Fmt 4701
Sfmt 4755
45877
YYY = The global period is to be set
by the carrier (for example, unlisted
surgery codes).
ZZZ = Code related to another service
that is always included in the global
period of the other service. (Note:
Physician work and practice expense
are associated with intra service time
and in some instances the post service
time.)
E:\FR\FM\08AUP2.SGM
08AUP2
45878
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION
CPT 1
HCPCS 2
0003T
0008T
0010T
0016T
0017T
0018T
0019T
0020T
0021T
0023T
0024T
0026T
0027T
0028T
0029T
0030T
0031T
0032T
0033T
0034T
0035T
0036T
0037T
0038T
0039T
0040T
0041T
0042T
0043T
0044T
0045T
0046T
0047T
0048T
0049T
0050T
0051T
0052T
0053T
0054T
0055T
0056T
0058T
0059T
0060T
0061T
0062T
0063T
0064T
0065T
0066T
0066T
0066T
0067T
0067T
0067T
0068T
0069T
0070T
0071T
0072T
0073T
0074T
0075T
0075T
0075T
0076T
0076T
0076T
0077T
0078T
0079T
0080T
0081T
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
Status
C
C
C
C
C
C
I
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
N
N
N
C
C
C
C
C
C
C
C
A
N
C
C
C
C
C
C
C
C
C
C
C
Physician
work
RVUs 3
Description
Cervicography .............................................
Upper gi endoscopy w/suture .....................
Tb test, gamma interferon ...........................
Thermotx choroid vasc lesion .....................
Photocoagulat macular drusen ...................
Transcranial magnetic stimul ......................
Extracorp shock wave tx, ms ......................
Extracorp shock wave tx, ft .........................
Fetal oximetry, trnsvag/cerv ........................
Phenotype drug test, hiv 1 ..........................
Transcath cardiac reduction ........................
Measure remnant lipoproteins .....................
Endoscopic epidural lysis ............................
Dexa body composition study .....................
Magnetic tx for incontinence .......................
Antiprothrombin antibody ............................
Speculoscopy ..............................................
Speculoscopy w/direct sample ....................
Endovasc taa repr incl subcl .......................
Endovasc taa repr w/o subcl .......................
Insert endovasc prosth, taa .........................
Endovasc prosth, taa, add-on .....................
Artery transpose/endovas taa .....................
Rad endovasc taa rpr w/cover ....................
Rad s/i, endovasc taa repair .......................
Rad s/i, endovasc taa prosth ......................
Detect ur infect agnt w/cpas .......................
Ct perfusion w/contrast, cbf ........................
Co expired gas analysis ..............................
Whole body photography ............................
Whole body photography ............................
Cath lavage, mammary duct(s ....................
Cath lavage, mammary duct(s) ...................
Implant ventricular device ...........................
External circulation assist ............................
Removal circulation assist ...........................
Implant total heart system ...........................
Replace component heart syst ...................
Replace component heart syst ...................
Bone surgery using computer .....................
Bone surgery using computer .....................
Bone surgery using computer .....................
Cryopreservation, ovary tiss ........................
Cryopreservation, oocyte ............................
Electrical impedance scan ..........................
Destruction of tumor, breast ........................
Rep intradisc annulus;1 lev .........................
Rep intradisc annulus;>1lev ........................
Spectroscop eval expired gas .....................
Ocular photoscreen bilat .............................
Ct colonography;screen ..............................
Ct colonography;screen ..............................
Ct colonography;screen ..............................
Ct colonography;dx .....................................
Ct colonography;dx .....................................
Ct colonography;dx .....................................
Interp/rept heart sound ................................
Analysis only heart sound ...........................
Interp only heart sound ...............................
U/s leiomyomata ablate <200 .....................
U/s leiomyomata ablate >200 .....................
Delivery, comp imrt .....................................
Online physician e/m ...................................
Perq stent/chest vert art ..............................
Perq stent/chest vert art ..............................
Perq stent/chest vert art ..............................
S&i stent/chest vert art ................................
S&i stent/chest vert art ................................
S&i stent/chest vert art ................................
Cereb therm perfusion probe ......................
Endovasc aort repr w/device .......................
Endovasc visc extnsn repr ..........................
Endovasc aort repr rad s&i .........................
Endovasc visc extnsn s&i ...........................
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
16.71
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Facility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Malpractice
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.13
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00116
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
16.84
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Facility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45879
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
0082T
0083T
0084T
0085T
0086T
0087T
0088T
0500F
0501F
0502F
0503F
1000F
1001F
10021
10022
1002F
10040
10060
10061
10080
10081
10120
10121
10140
10160
10180
11000
11001
11004
11005
11006
11008
11010
11011
11012
11040
11041
11042
11043
11044
11055
11056
11057
11100
11101
11200
11201
11300
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
11441
11442
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
..........
..........
.........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
C
C
C
C
C
C
C
I
I
I
I
I
I
A
A
I
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Stereotactic rad delivery ..............................
Stereotactic rad tx mngmt ...........................
Temp prostate urethral stent .......................
Breath test heart reject ................................
L ventricle fill pressure ................................
Sperm eval hyaluronan ...............................
Rf tongue base vol reduxn ..........................
Initial prenatal care visit ..............................
Prenatal flow sheet ......................................
Subsequent prenatal care ...........................
Postpartum care visit ...................................
Tobacco use, smoking, assess ...................
Tobacco use, non-smoking .........................
Fna w/o image .............................................
Fna w/image ................................................
Assess anginal symptom/level ....................
Acne surgery ...............................................
Drainage of skin abscess ............................
Drainage of skin abscess ............................
Drainage of pilonidal cyst ............................
Drainage of pilonidal cyst ............................
Remove foreign body ..................................
Remove foreign body ..................................
Drainage of hematoma/fluid ........................
Puncture drainage of lesion ........................
Complex drainage, wound ..........................
Debride infected skin ...................................
Debride infected skin add-on ......................
Debride genitalia & perineum ......................
Debride abdom wall ....................................
Debride genit/per/abdom wall .....................
Remove mesh from abd wall ......................
Debride skin, fx ...........................................
Debride skin/muscle, fx ...............................
Debride skin/muscle/bone, fx ......................
Debride skin, partial ....................................
Debride skin, full ..........................................
Debride skin/tissue ......................................
Debride tissue/muscle .................................
Debride tissue/muscle/bone ........................
Trim skin lesion ...........................................
Trim skin lesions, 2 to 4 ..............................
Trim skin lesions, over 4 .............................
Biopsy, skin lesion .......................................
Biopsy, skin add-on .....................................
Removal of skin tags ...................................
Remove skin tags add-on ...........................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Shave skin lesion ........................................
Exc tr-ext b9+marg 0.5 < cm ......................
Exc tr-ext b9+marg 0.6-1 cm ......................
Exc tr-ext b9+marg 1.1-2 cm ......................
Exc tr-ext b9+marg 2.1-3 cm ......................
Exc tr-ext b9+marg 3.1-4 cm ......................
Exc tr-ext b9+marg > 4.0 cm ......................
Exc h-f-nk-sp b9+marg 0.5 < ......................
Exc h-f-nk-sp b9+marg 0.6-1 ......................
Exc h-f-nk-sp b9+marg 1.1-2 ......................
Exc h-f-nk-sp b9+marg 2.1-3 ......................
Exc h-f-nk-sp b9+marg 3.1-4 ......................
Exc h-f-nk-sp b9+marg > 4 cm ...................
Exc face-mm b9+marg 0.5 < cm ................
Exc face-mm b9+marg 0.6-1 cm .................
Exc face-mm b9+marg 1.1-2 cm .................
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.27
1.27
0.00
1.18
1.17
2.40
1.17
2.45
1.22
2.70
1.53
1.20
2.25
0.60
0.30
10.33
13.78
12.64
5.01
4.20
4.95
6.88
0.50
0.82
1.12
2.38
3.07
0.43
0.61
0.79
0.81
0.41
0.77
0.29
0.51
0.85
1.05
1.24
0.67
0.99
1.14
1.41
0.73
1.05
1.20
1.62
0.85
1.23
1.51
1.79
2.06
2.77
0.98
1.42
1.63
2.01
2.43
3.78
1.06
1.48
1.72
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.11
2.51
0.00
1.12
1.27
1.90
2.98
3.91
2.14
3.47
1.83
1.62
2.95
0.61
0.24
NA
NA
NA
NA
6.68
7.80
11.37
0.55
0.68
0.98
3.33
4.38
0.60
0.68
0.78
1.38
0.37
1.11
0.17
1.05
1.22
1.43
1.73
0.91
1.20
1.41
1.56
1.19
1.35
1.57
1.95
1.98
2.08
2.26
2.43
2.74
3.08
1.79
2.11
2.30
2.61
2.87
3.50
2.19
2.35
2.59
Facility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.53
0.44
0.00
0.84
0.94
1.49
1.07
1.48
0.94
1.75
1.29
1.08
1.93
0.21
0.11
3.80
5.42
4.73
1.97
2.57
2.29
3.73
0.21
0.32
0.43
2.54
3.65
0.17
0.23
0.29
0.39
0.20
0.78
0.12
0.21
0.39
0.46
0.52
0.27
0.42
0.49
0.58
0.32
0.49
0.55
0.71
0.88
1.01
1.07
1.32
1.40
1.64
0.93
1.10
1.33
1.45
1.60
2.09
1.29
1.47
1.55
Malpractice
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.10
0.08
0.00
0.05
0.12
0.26
0.11
0.24
0.12
0.33
0.19
0.14
0.35
0.07
0.04
0.67
0.96
1.28
0.61
0.66
0.74
1.16
0.06
0.10
0.13
0.32
0.43
0.05
0.07
0.10
0.03
0.02
0.04
0.02
0.03
0.04
0.05
0.07
0.07
0.07
0.07
0.13
0.04
0.05
0.06
0.10
0.06
0.10
0.13
0.17
0.21
0.32
0.09
0.13
0.16
0.20
0.25
0.44
0.08
0.13
0.16
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00117
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3.48
3.86
0.00
2.35
2.56
4.56
4.27
6.60
3.49
6.49
3.56
2.96
5.55
1.28
0.58
NA
NA
NA
NA
11.54
13.49
19.41
1.11
1.60
2.23
6.03
7.88
1.08
1.36
1.68
2.22
0.80
1.92
0.48
1.59
2.11
2.53
3.04
1.65
2.27
2.63
3.10
1.96
2.45
2.83
3.67
2.89
3.42
3.91
4.39
5.01
6.16
2.86
3.66
4.09
4.83
5.55
7.72
3.33
3.97
4.47
Facility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.90
1.79
0.00
2.07
2.24
4.15
2.36
4.17
2.28
4.77
3.01
2.43
4.53
0.88
0.45
14.80
20.16
18.64
7.59
7.43
7.98
11.78
0.77
1.24
1.68
5.25
7.15
0.65
0.91
1.18
1.23
0.63
1.59
0.43
0.75
1.28
1.57
1.83
1.01
1.48
1.70
2.13
1.09
1.59
1.81
2.43
1.79
2.35
2.72
3.28
3.67
4.73
2.00
2.66
3.12
3.66
4.28
6.30
2.43
3.08
3.43
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
010
010
010
010
010
010
010
010
010
010
000
ZZZ
000
000
000
ZZZ
010
000
000
000
000
000
010
010
000
000
000
000
ZZZ
010
ZZZ
000
000
000
000
000
000
000
000
000
000
000
000
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
45880
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
11443
11444
11446
11450
11451
11462
11463
11470
11471
11600
11601
11602
11603
11604
11606
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
11719
11720
11721
11730
11732
11740
11750
11752
11755
11760
11762
11765
11770
11771
11772
11900
11901
11920
11921
11922
11950
11951
11952
11954
11960
11970
11971
11975
11976
11977
11980
11981
11982
11983
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
R
R
R
R
A
A
A
N
R
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Exc face-mm b9+marg 2.1-3 cm .................
Exc face-mm b9+marg 3.1-4 cm .................
Exc face-mm b9+marg > 4 cm ...................
Removal, sweat gland lesion ......................
Removal, sweat gland lesion ......................
Removal, sweat gland lesion ......................
Removal, sweat gland lesion ......................
Removal, sweat gland lesion ......................
Removal, sweat gland lesion ......................
Exc tr-ext mlg+marg 0.5 < cm ....................
Exc tr-ext mlg+marg 0.6-1 cm .....................
Exc tr-ext mlg+marg 1.1-2 cm .....................
Exc tr-ext mlg+marg 2.1-3 cm .....................
Exc tr-ext mlg+marg 3.1-4 cm .....................
Exc tr-ext mlg+marg > 4 cm .......................
Exc h-f-nk-sp mlg+marg 0.5 < ....................
Exc h-f-nk-sp mlg+marg 0.6-1 .....................
Exc h-f-nk-sp mlg+marg 1.1-2 .....................
Exc h-f-nk-sp mlg+marg 2.1-3 .....................
Exc h-f-nk-sp mlg+marg 3.1-4 .....................
Exc h-f-nk-sp mlg+mar > 4 cm ...................
Exc face-mm malig+marg 0.5 < ..................
Exc face-mm malig+marg 0.6-1 ..................
Exc face-mm malig+marg 1.1-2 ..................
Exc face-mm malig+marg 2.1-3 ..................
Exc face-mm malig+marg 3.1-4 ..................
Exc face-mm mlg+marg > 4 cm ..................
Trim nail(s) ..................................................
Debride nail, 1-5 ..........................................
Debride nail, 6 or more ...............................
Removal of nail plate ..................................
Remove nail plate, add-on ..........................
Drain blood from under nail ........................
Removal of nail bed ....................................
Remove nail bed/finger tip ..........................
Biopsy, nail unit ...........................................
Repair of nail bed ........................................
Reconstruction of nail bed ..........................
Excision of nail fold, toe ..............................
Removal of pilonidal lesion .........................
Removal of pilonidal lesion .........................
Removal of pilonidal lesion .........................
Injection into skin lesions ............................
Added skin lesions injection ........................
Correct skin color defects ...........................
Correct skin color defects ...........................
Correct skin color defects ...........................
Therapy for contour defects ........................
Therapy for contour defects ........................
Therapy for contour defects ........................
Therapy for contour defects ........................
Insert tissue expander(s) .............................
Replace tissue expander .............................
Remove tissue expander(s) ........................
Insert contraceptive cap ..............................
Removal of contraceptive cap .....................
Removal/reinsert contra cap .......................
Implant hormone pellet(s) ...........................
Insert drug implant device ...........................
Remove drug implant device ......................
Remove/insert drug implant ........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
Repair superficial wound(s) .........................
2.29
3.15
4.49
2.74
3.95
2.52
3.95
3.26
4.41
1.31
1.80
1.95
2.19
2.40
3.43
1.19
1.76
2.09
2.62
3.07
4.30
1.35
2.16
2.60
3.11
4.03
5.95
0.17
0.32
0.54
1.13
0.57
0.37
1.86
2.68
1.31
1.58
2.90
0.69
2.62
5.74
6.98
0.52
0.80
1.61
1.93
0.49
0.84
1.19
1.69
1.85
9.09
7.06
2.13
1.48
1.78
3.31
1.48
1.48
1.78
3.31
1.70
1.86
2.24
2.87
3.67
4.12
1.76
1.99
2.46
3.20
3.93
4.71
5.53
Nonfacility
PE
RVUs
2.96
3.52
4.17
4.91
6.43
5.04
6.59
4.98
6.48
2.68
2.86
3.00
3.22
3.52
4.22
2.65
2.86
3.14
3.49
3.90
4.79
2.74
3.19
3.59
3.98
4.87
5.96
0.27
0.36
0.46
1.08
0.46
0.59
2.27
3.09
1.70
2.68
3.00
1.91
3.43
5.69
7.42
0.72
0.76
3.44
3.70
1.08
1.13
1.47
1.81
2.32
NA
NA
8.65
1.50
1.75
2.31
1.12
1.82
2.03
2.51
1.91
1.97
2.24
2.73
3.28
3.69
2.06
2.20
2.49
3.03
3.45
NA
NA
Facility
PE
RVUs
1.78
2.14
2.71
2.02
2.52
2.03
2.67
2.28
2.76
0.96
1.21
1.25
1.31
1.37
1.70
0.94
1.22
1.37
1.55
1.74
2.34
1.09
1.50
1.67
1.91
2.39
3.38
0.07
0.12
0.21
0.42
0.22
0.36
1.76
2.95
0.78
1.71
2.27
0.80
1.49
3.32
5.05
0.22
0.38
1.08
1.24
0.24
0.41
0.51
0.67
0.89
10.12
5.95
3.67
0.57
0.66
1.25
0.58
0.67
0.82
1.51
0.75
0.87
0.98
1.16
1.47
1.76
0.76
0.90
1.02
1.21
1.48
1.84
2.19
Malpractice
RVUs
0.22
0.30
0.43
0.34
0.53
0.32
0.54
0.40
0.58
0.10
0.12
0.12
0.16
0.20
0.36
0.09
0.12
0.14
0.20
0.27
0.45
0.11
0.16
0.19
0.26
0.37
0.61
0.02
0.04
0.07
0.14
0.07
0.04
0.22
0.35
0.14
0.21
0.36
0.08
0.33
0.74
0.89
0.02
0.03
0.24
0.29
0.07
0.06
0.11
0.16
0.25
1.31
1.05
0.32
0.17
0.21
0.37
0.13
0.12
0.17
0.23
0.15
0.17
0.21
0.27
0.35
0.45
0.16
0.18
0.23
0.29
0.37
0.47
0.64
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00118
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
5.48
6.97
9.09
7.99
10.90
7.88
11.08
8.64
11.47
4.09
4.78
5.07
5.58
6.13
8.01
3.93
4.74
5.38
6.30
7.23
9.54
4.20
5.52
6.38
7.34
9.27
12.53
0.46
0.72
1.07
2.36
1.10
1.00
4.35
6.12
3.15
4.47
6.26
2.68
6.37
12.18
15.29
1.26
1.59
5.30
5.92
1.65
2.03
2.77
3.66
4.42
NA
NA
11.10
3.15
3.74
5.99
2.73
3.43
3.98
6.05
3.76
4.00
4.70
5.87
7.29
8.26
3.99
4.37
5.19
6.52
7.74
NA
NA
Facility
total
4.30
5.59
7.63
5.10
7.00
4.86
7.16
5.93
7.75
2.38
3.14
3.32
3.66
3.98
5.49
2.22
3.11
3.60
4.36
5.07
7.09
2.55
3.82
4.45
5.28
6.79
9.94
0.26
0.48
0.82
1.69
0.86
0.77
3.85
5.98
2.23
3.50
5.53
1.57
4.44
9.80
12.92
0.76
1.21
2.93
3.47
0.80
1.31
1.82
2.52
3.00
20.51
14.07
6.12
2.22
2.66
4.93
2.19
2.28
2.78
5.04
2.60
2.90
3.43
4.30
5.49
6.33
2.68
3.07
3.72
4.70
5.78
7.02
8.37
Global
010
010
010
090
090
090
090
090
090
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
000
000
000
000
ZZZ
000
010
010
000
010
010
010
010
090
090
000
000
000
000
ZZZ
000
000
000
000
090
090
090
XXX
000
XXX
000
XXX
XXX
XXX
010
010
010
010
010
010
010
010
010
010
010
010
010
45881
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
12020
12021
12031
12032
12034
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052
12053
12054
12055
12056
12057
13100
13101
13102
13120
13121
13122
13131
13132
13133
13150
13151
13152
13153
13160
14000
14001
14020
14021
14040
14041
14060
14061
14300
14350
15000
15001
15050
15100
15101
15120
15121
15200
15201
15220
15221
15240
15241
15260
15261
15342
15343
15350
15351
15400
15401
15570
15572
15574
15576
15600
15610
15620
15630
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Closure of split wound .................................
Closure of split wound .................................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Layer closure of wound(s) ...........................
Repair of wound or lesion ...........................
Repair of wound or lesion ...........................
Repair wound/lesion add-on .......................
Repair of wound or lesion ...........................
Repair of wound or lesion ...........................
Repair wound/lesion add-on .......................
Repair of wound or lesion ...........................
Repair of wound or lesion ...........................
Repair wound/lesion add-on .......................
Repair of wound or lesion ...........................
Repair of wound or lesion ...........................
Repair of wound or lesion ...........................
Repair wound/lesion add-on .......................
Late closure of wound .................................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin tissue rearrangement ..........................
Skin graft .....................................................
Skin graft add-on .........................................
Skin pinch graft ...........................................
Skin split graft ..............................................
Skin split graft add-on .................................
Skin split graft ..............................................
Skin split graft add-on .................................
Skin full graft ...............................................
Skin full graft add-on ...................................
Skin full graft ...............................................
Skin full graft add-on ...................................
Skin full graft ...............................................
Skin full graft add-on ...................................
Skin full graft ...............................................
Skin full graft add-on ...................................
Cultured skin graft, 25 cm ...........................
Culture skn graft addl 25 cm .......................
Skin homograft ............................................
Skin homograft add-on ................................
Skin heterograft ...........................................
Skin heterograft add-on ...............................
Form skin pedicle flap .................................
Form skin pedicle flap .................................
Form skin pedicle flap .................................
Form skin pedicle flap .................................
Skin graft .....................................................
Skin graft .....................................................
Skin graft .....................................................
Skin graft .....................................................
2.63
1.84
2.15
2.47
2.93
3.43
4.05
4.67
2.37
2.75
3.15
3.64
4.25
4.65
2.47
2.78
3.13
3.46
4.43
5.24
5.96
3.13
3.92
1.24
3.31
4.33
1.44
3.79
5.95
2.19
3.81
4.45
6.33
2.38
10.48
5.89
8.48
6.59
10.06
7.88
11.49
8.51
12.29
11.76
9.62
4.00
1.00
4.30
9.06
1.72
9.84
2.68
8.04
1.32
7.88
1.19
9.05
1.86
10.06
2.23
1.00
0.25
4.00
1.00
4.00
1.00
9.22
9.28
9.89
8.70
1.91
2.42
2.95
3.28
Nonfacility
PE
RVUs
3.78
1.82
2.69
4.16
3.55
5.25
5.50
6.07
2.89
3.58
3.70
5.20
6.30
6.42
3.52
3.56
3.83
4.13
5.03
6.86
6.58
4.22
5.05
1.27
4.29
5.26
1.54
4.58
6.47
1.80
4.92
5.08
6.56
2.07
NA
8.20
10.09
9.07
10.93
9.46
11.70
9.39
12.73
12.16
NA
3.98
1.32
6.91
12.29
3.48
11.33
4.31
9.81
2.51
9.79
2.30
10.88
2.54
11.18
2.85
1.86
0.09
6.20
NA
4.14
1.79
10.97
9.50
10.88
9.94
7.11
4.58
7.48
7.06
Facility
PE
RVUs
1.88
1.40
1.06
1.76
1.47
2.09
2.47
2.88
1.20
1.49
1.61
2.22
2.68
2.99
1.47
1.46
1.55
1.64
2.12
2.95
3.62
2.26
2.65
0.56
2.29
2.75
0.62
2.63
4.16
1.02
2.70
3.10
3.96
1.11
7.03
5.35
6.90
6.37
8.08
7.06
8.59
7.32
9.39
8.95
7.01
2.14
0.40
4.97
7.58
1.11
7.57
1.75
6.07
0.60
6.51
0.55
7.76
0.89
8.47
1.36
0.54
0.09
3.75
0.36
3.97
0.43
6.57
6.27
7.59
6.72
2.95
3.30
3.77
4.05
Malpractice
RVUs
0.30
0.24
0.17
0.16
0.25
0.39
0.55
0.66
0.19
0.17
0.27
0.41
0.54
0.58
0.20
0.17
0.23
0.30
0.45
0.59
0.56
0.26
0.26
0.13
0.26
0.25
0.15
0.26
0.32
0.18
0.34
0.31
0.40
0.24
1.54
0.59
0.82
0.64
0.81
0.62
0.73
0.68
0.76
1.16
1.34
0.54
0.14
0.57
1.28
0.24
1.16
0.36
0.98
0.19
0.84
0.16
0.92
0.23
0.69
0.21
0.12
0.03
0.51
0.14
0.47
0.14
1.34
1.20
1.20
0.87
0.27
0.35
0.35
0.34
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00119
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
6.71
3.90
5.01
6.80
6.73
9.07
10.10
11.40
5.46
6.50
7.12
9.25
11.09
11.64
6.19
6.50
7.18
7.89
9.91
12.69
13.11
7.60
9.23
2.64
7.85
9.84
3.13
8.63
12.74
4.18
9.06
9.83
13.30
4.69
NA
14.68
19.39
16.30
21.80
17.95
23.92
18.58
25.78
25.09
NA
8.52
2.46
11.78
22.63
5.45
22.32
7.34
18.82
4.02
18.51
3.65
20.85
4.63
21.93
5.29
2.98
0.37
10.71
NA
8.61
2.93
21.53
19.98
21.97
19.51
9.29
7.36
10.77
10.68
Facility
total
4.80
3.48
3.39
4.39
4.64
5.91
7.07
8.21
3.77
4.41
5.03
6.27
7.47
8.22
4.15
4.40
4.91
5.40
7.00
8.78
10.15
5.64
6.82
1.93
5.86
7.32
2.21
6.68
10.43
3.39
6.85
7.86
10.69
3.74
19.05
11.83
16.20
13.61
18.95
15.55
20.81
16.51
22.44
21.87
17.97
6.68
1.54
9.84
17.91
3.08
18.57
4.79
15.09
2.12
15.23
1.90
17.72
2.98
19.22
3.80
1.66
0.37
8.26
1.50
8.43
1.57
17.13
16.75
18.68
16.29
5.13
6.07
7.07
7.66
Global
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
ZZZ
010
010
ZZZ
010
010
ZZZ
010
010
010
ZZZ
090
090
090
090
090
090
090
090
090
090
090
000
ZZZ
090
090
ZZZ
090
ZZZ
090
ZZZ
090
ZZZ
090
ZZZ
090
ZZZ
010
ZZZ
090
ZZZ
090
ZZZ
090
090
090
090
090
090
090
090
45882
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
15650
15732
15734
15736
15738
15740
15750
15756
15757
15758
15760
15770
15775
15776
15780
15781
15782
15783
15786
15787
15788
15789
15792
15793
15810
15811
15819
15820
15821
15822
15823
15824
15825
15826
15828
15829
15831
15832
15833
15834
15835
15836
15837
15838
15839
15840
15841
15842
15845
15850
15851
15852
15860
15876
15877
15878
15879
15920
15922
15931
15933
15934
15935
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
R
R
A
A
A
A
A
A
R
R
R
A
A
A
A
A
A
A
A
R
R
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
A
A
R
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Transfer skin pedicle flap ............................
Muscle-skin graft, head/neck ......................
Muscle-skin graft, trunk ...............................
Muscle-skin graft, arm .................................
Muscle-skin graft, leg ..................................
Island pedicle flap graft ...............................
Neurovascular pedicle graft ........................
Free myo/skin flap microvasc .....................
Free skin flap, microvasc ............................
Free fascial flap, microvasc ........................
Composite skin graft ...................................
Derma-fat-fascia graft ..................................
Hair transplant punch grafts ........................
Hair transplant punch grafts ........................
Abrasion treatment of skin ..........................
Abrasion treatment of skin ..........................
Abrasion treatment of skin ..........................
Abrasion treatment of skin ..........................
Abrasion, lesion, single ...............................
Abrasion, lesions, add-on ............................
Chemical peel, face, epiderm .....................
Chemical peel, face, dermal .......................
Chemical peel, nonfacial .............................
Chemical peel, nonfacial .............................
Salabrasion ..................................................
Salabrasion ..................................................
Plastic surgery, neck ...................................
Revision of lower eyelid ..............................
Revision of lower eyelid ..............................
Revision of upper eyelid ..............................
Revision of upper eyelid ..............................
Removal of forehead wrinkles .....................
Removal of neck wrinkles ...........................
Removal of brow wrinkles ...........................
Removal of face wrinkles ............................
Removal of skin wrinkles ............................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Excise excessive skin tissue .......................
Graft for face nerve palsy ...........................
Graft for face nerve palsy ...........................
Flap for face nerve palsy ............................
Skin and muscle repair, face ......................
Removal of sutures .....................................
Removal of sutures .....................................
Dressing change not for burn .....................
Test for blood flow in graft ..........................
Suction assisted lipectomy ..........................
Suction assisted lipectomy ..........................
Suction assisted lipectomy ..........................
Suction assisted lipectomy ..........................
Removal of tail bone ulcer ..........................
Removal of tail bone ulcer ..........................
Remove sacrum pressure sore ...................
Remove sacrum pressure sore ...................
Remove sacrum pressure sore ...................
Remove sacrum pressure sore ...................
Remove sacrum pressure sore ...................
Remove sacrum pressure sore ...................
Remove hip pressure sore ..........................
Remove hip pressure sore ..........................
Remove hip pressure sore ..........................
Remove hip pressure sore ..........................
Remove hip pressure sore ..........................
Remove thigh pressure sore .......................
Remove thigh pressure sore .......................
Remove thigh pressure sore .......................
Remove thigh pressure sore .......................
3.97
17.85
17.80
16.28
17.93
10.25
11.41
35.25
35.25
35.12
8.75
7.53
3.96
5.54
7.29
4.85
4.32
4.29
2.03
0.33
2.09
4.92
1.86
3.74
4.74
5.39
9.39
5.15
5.72
4.45
7.05
0.00
0.00
0.00
0.00
0.00
12.40
11.59
10.64
10.85
11.67
9.35
8.44
7.13
9.39
13.27
23.28
37.98
12.58
0.78
0.86
0.86
1.95
0.00
0.00
0.00
0.00
7.96
9.91
9.25
10.85
12.70
14.58
12.38
14.22
9.35
11.43
11.46
12.70
21.58
7.55
10.72
11.39
12.64
Nonfacility
PE
RVUs
7.20
17.55
17.23
17.29
17.10
11.22
NA
NA
NA
NA
10.37
NA
4.40
5.71
11.64
7.37
9.54
7.10
3.43
1.02
7.25
8.43
7.34
6.85
0.00
5.30
NA
6.76
7.13
5.66
7.64
0.00
0.00
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
8.28
NA
8.67
NA
NA
NA
NA
1.53
1.62
1.77
NA
0.00
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
4.12
11.84
11.96
10.85
11.35
8.29
8.81
19.96
20.93
20.93
7.07
6.55
1.34
2.82
8.13
5.36
6.31
4.35
1.39
0.16
3.43
5.00
4.59
4.57
3.74
4.65
7.02
5.38
5.55
4.37
6.27
0.00
0.00
0.00
0.00
0.00
7.99
8.13
7.89
7.50
7.42
6.64
7.16
5.93
6.28
9.70
14.69
22.25
9.08
0.30
0.30
0.32
0.77
0.00
0.00
0.00
0.00
5.45
7.03
5.58
7.66
7.84
10.04
7.99
9.53
6.02
9.13
8.36
9.36
13.97
5.30
7.67
7.57
8.75
Malpractice
RVUs
0.42
1.99
2.61
2.45
2.65
0.63
1.42
4.61
3.89
4.23
0.85
1.05
0.52
0.72
0.67
0.34
0.34
0.28
0.11
0.04
0.11
0.20
0.13
0.19
0.51
0.80
0.97
0.40
0.45
0.37
0.50
0.00
0.00
0.00
0.00
0.00
1.75
1.66
1.49
1.61
1.60
1.34
1.18
0.58
1.22
1.32
2.54
4.93
0.81
0.05
0.06
0.09
0.27
0.00
0.00
0.00
0.00
1.04
1.42
1.25
1.52
1.78
2.09
1.76
2.06
1.31
1.66
1.65
1.84
3.16
1.04
1.49
1.60
1.79
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00120
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
11.59
37.38
37.64
36.03
37.68
22.11
NA
NA
NA
NA
19.97
NA
8.88
11.97
19.61
12.56
14.20
11.67
5.58
1.40
9.46
13.55
9.33
10.78
5.25
11.49
NA
12.31
13.30
10.48
15.20
0.00
0.00
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
17.90
NA
19.28
NA
NA
NA
NA
2.36
2.54
2.72
NA
0.00
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
8.50
31.67
32.36
29.58
31.92
19.17
21.65
59.82
60.07
60.28
16.66
15.13
5.82
9.08
16.09
10.55
10.96
8.92
3.54
0.53
5.63
10.12
6.59
8.50
8.99
10.84
17.38
10.93
11.72
9.19
13.82
0.00
0.00
0.00
0.00
0.00
22.14
21.39
20.02
19.96
20.69
17.33
16.78
13.64
16.89
24.28
40.51
65.16
22.47
1.13
1.22
1.27
2.99
0.00
0.00
0.00
0.00
14.44
18.36
16.08
20.03
22.32
26.71
22.14
25.81
16.68
22.23
21.47
23.90
38.71
13.88
19.88
20.56
23.18
Global
090
090
090
090
090
090
090
090
090
090
090
090
000
000
090
090
090
090
010
ZZZ
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
XXX
000
000
000
000
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45883
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
15956
15958
15999
16000
16010
16015
16020
16025
16030
16035
16036
17000
17003
17004
17106
17107
17108
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283
17284
17286
17304
17305
17306
17307
17310
17340
17360
17380
17999
19000
19001
19020
19030
19100
19101
19102
19103
19110
19112
19120
19125
19126
19140
19160
19162
19180
19182
19200
19220
19240
19260
19271
19272
19290
19291
19295
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Remove thigh pressure sore .......................
Remove thigh pressure sore .......................
Removal of pressure sore ...........................
Initial treatment of burn(s) ...........................
Treatment of burn(s) ...................................
Treatment of burn(s) ...................................
Treatment of burn(s) ...................................
Treatment of burn(s) ...................................
Treatment of burn(s) ...................................
Incision of burn scab, initi ...........................
Escharotomy; add’l incision .........................
Destroy benign/premlg lesion ......................
Destroy lesions, 2-14 ..................................
Destroy lesions, 15 or more ........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruct lesion, 1-14 ...................................
Destruct lesion, 15 or more .........................
Chemical cautery, tissue .............................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
Destruction of skin lesions ..........................
1 stage mohs, up to 5 spec ........................
2 stage mohs, up to 5 spec ........................
3 stage mohs, up to 5 spec ........................
Mohs addl stage up to 5 spec ....................
Mohs any stage > 5 spec each ...................
Cryotherapy of skin .....................................
Skin peel therapy ........................................
Hair removal by electrolysis ........................
Skin tissue procedure ..................................
Drainage of breast lesion ............................
Drain breast lesion add-on ..........................
Incision of breast lesion ..............................
Injection for breast x-ray .............................
Bx breast percut w/o image ........................
Biopsy of breast, open ................................
Bx breast percut w/image ...........................
Bx breast percut w/device ...........................
Nipple exploration ........................................
Excise breast duct fistula ............................
Removal of breast lesion ............................
Excision, breast lesion ................................
Excision, addl breast lesion ........................
Removal of breast tissue ............................
Partial mastectomy ......................................
P-mastectomy w/ln removal ........................
Removal of breast .......................................
Removal of breast .......................................
Removal of breast .......................................
Removal of breast .......................................
Removal of breast .......................................
Removal of chest wall lesion ......................
Revision of chest wall .................................
Extensive chest wall surgery .......................
Place needle wire, breast ............................
Place needle wire, breast ............................
Place breast clip, percut ..............................
15.53
15.49
0.00
0.89
0.87
2.35
0.80
1.85
2.08
3.75
1.50
0.60
0.15
2.80
4.59
9.17
13.21
0.65
0.92
0.50
0.91
1.17
1.58
1.79
1.94
2.34
1.32
1.49
1.77
2.05
2.60
3.21
1.17
1.72
2.04
2.65
3.22
4.44
7.61
2.86
2.86
2.86
0.95
0.76
1.43
0.00
0.00
0.84
0.42
3.57
1.53
1.27
3.19
2.00
3.70
4.30
3.67
5.56
6.06
2.94
5.14
5.99
13.54
8.81
7.74
15.50
15.73
16.01
15.45
18.91
21.56
1.27
0.63
0.00
Nonfacility
PE
RVUs
NA
NA
0.00
0.84
NA
NA
1.24
1.71
2.09
NA
NA
1.09
0.12
2.58
4.81
7.66
9.87
1.65
1.79
1.23
1.33
1.83
2.13
2.32
2.51
2.79
1.89
2.01
2.25
2.48
2.87
3.26
1.80
2.15
2.43
2.86
3.26
4.01
9.35
4.64
4.79
4.39
1.74
0.38
1.51
0.00
0.00
1.97
0.25
6.18
3.03
2.06
4.65
3.99
11.81
5.75
5.89
4.56
4.77
NA
7.05
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.01
1.27
2.74
Facility
PE
RVUs
10.47
10.73
0.00
0.25
0.61
1.13
0.57
0.94
1.10
1.59
0.59
0.59
0.08
1.71
3.35
5.50
7.77
0.75
0.87
0.34
0.69
0.91
1.11
1.18
1.19
1.26
0.94
1.07
1.21
1.31
1.53
1.72
0.87
1.18
1.35
1.58
1.82
2.44
3.85
1.46
1.47
1.49
0.51
0.36
0.96
0.00
0.00
0.32
0.15
2.67
0.53
0.43
1.98
0.68
1.26
2.87
2.69
3.06
3.28
0.98
3.39
3.41
6.26
5.00
4.72
7.87
8.17
8.15
10.76
17.32
18.30
0.44
0.22
NA
Malpractice
RVUs
2.21
2.25
0.00
0.08
0.09
0.32
0.08
0.19
0.24
0.46
0.20
0.03
0.01
0.11
0.35
0.63
0.54
0.05
0.05
0.06
0.04
0.05
0.06
0.07
0.08
0.09
0.05
0.06
0.07
0.08
0.10
0.16
0.05
0.07
0.08
0.11
0.13
0.23
0.30
0.11
0.11
0.11
0.03
0.05
0.06
0.00
0.00
0.08
0.04
0.45
0.09
0.16
0.39
0.14
0.30
0.57
0.48
0.73
0.80
0.38
0.69
0.79
1.79
1.18
1.04
1.92
2.07
2.12
2.13
2.62
2.99
0.07
0.04
0.01
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00121
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
0.00
1.81
NA
NA
2.13
3.75
4.41
NA
NA
1.73
0.28
5.49
9.75
17.46
23.62
2.35
2.76
1.79
2.28
3.05
3.78
4.19
4.53
5.23
3.27
3.56
4.10
4.62
5.56
6.63
3.03
3.94
4.55
5.61
6.60
8.68
17.26
7.61
7.76
7.36
2.72
1.19
3.00
0.00
0.00
2.89
0.71
10.20
4.65
3.50
8.23
6.13
15.81
10.62
10.04
10.85
11.63
NA
12.88
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.36
1.94
2.75
Facility
total
28.21
28.47
0.00
1.22
1.58
3.81
1.45
2.99
3.43
5.80
2.29
1.22
0.24
4.62
8.29
15.30
21.52
1.45
1.84
0.90
1.64
2.13
2.76
3.04
3.22
3.69
2.31
2.63
3.06
3.44
4.23
5.08
2.09
2.98
3.47
4.34
5.17
7.11
11.76
4.42
4.44
4.45
1.49
1.17
2.46
0.00
0.00
1.24
0.61
6.68
2.15
1.86
5.56
2.83
5.25
7.74
6.84
9.35
10.14
4.29
9.22
10.19
21.59
14.99
13.50
25.29
25.98
26.28
28.34
38.84
42.85
1.78
0.89
NA
Global
090
090
YYY
000
000
000
000
000
000
090
ZZZ
010
ZZZ
010
090
090
090
010
010
000
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
010
000
000
000
000
ZZZ
010
010
000
YYY
000
ZZZ
090
000
000
010
000
000
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
000
ZZZ
ZZZ
45884
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
19296
19297
19298
19316
19318
19324
19325
19328
19330
19340
19342
19350
19355
19357
19361
19364
19366
19367
19368
19369
19370
19371
19380
19396
19499
20000
20005
2000F
20100
20101
20102
20103
20150
20200
20205
20206
20220
20225
20240
20245
20250
20251
20500
20501
20520
20525
20526
20550
20551
20552
20553
20600
20605
20610
20612
20615
20650
20660
20661
20662
20663
20664
20665
20670
20680
20690
20692
20693
20694
20802
20805
20808
20816
20822
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
.........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
I
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Place po breast cath for rad .......................
Place breast cath for rad .............................
Place breast rad tube/caths ........................
Suspension of breast ..................................
Reduction of large breast ............................
Enlarge breast .............................................
Enlarge breast with implant .........................
Removal of breast implant ..........................
Removal of implant material .......................
Immediate breast prosthesis .......................
Delayed breast prosthesis ...........................
Breast reconstruction ..................................
Correct inverted nipple(s) ............................
Breast reconstruction ..................................
Breast reconstruction ..................................
Breast reconstruction ..................................
Breast reconstruction ..................................
Breast reconstruction ..................................
Breast reconstruction ..................................
Breast reconstruction ..................................
Surgery of breast capsule ...........................
Removal of breast capsule .........................
Revise breast reconstruction .......................
Design custom breast implant .....................
Breast surgery procedure ............................
Incision of abscess ......................................
Incision of deep abscess .............................
Blood pressure, measured ..........................
Explore wound, neck ...................................
Explore wound, chest ..................................
Explore wound, abdomen ...........................
Explore wound, extremity ............................
Excise epiphyseal bar .................................
Muscle biopsy ..............................................
Deep muscle biopsy ....................................
Needle biopsy, muscle ................................
Bone biopsy, trocar/needle .........................
Bone biopsy, trocar/needle .........................
Bone biopsy, excisional ...............................
Bone biopsy, excisional ...............................
Open bone biopsy .......................................
Open bone biopsy .......................................
Injection of sinus tract .................................
Inject sinus tract for x-ray ............................
Removal of foreign body .............................
Removal of foreign body .............................
Ther injection, carp tunnel ...........................
Inj tendon sheath/ligament ..........................
Inj tendon origin/insertion ............................
Inj trigger point, 1/2 muscl ...........................
Inject trigger points, =/> 3 ...........................
Drain/inject, joint/bursa ................................
Drain/inject, joint/bursa ................................
Drain/inject, joint/bursa ................................
Aspirate/inj ganglion cyst ............................
Treatment of bone cyst ...............................
Insert and remove bone pin ........................
Apply, rem fixation device ...........................
Application of head brace ...........................
Application of pelvis brace ..........................
Application of thigh brace ............................
Halo brace application .................................
Removal of fixation device ..........................
Removal of support implant ........................
Removal of support implant ........................
Apply bone fixation device ..........................
Apply bone fixation device ..........................
Adjust bone fixation device .........................
Remove bone fixation device ......................
Replantation, arm, complete .......................
Replant forearm, complete ..........................
Replantation hand, complete ......................
Replantation digit, complete ........................
Replantation digit, complete ........................
3.64
1.72
6.01
10.69
15.63
5.85
8.46
5.68
7.60
6.33
11.20
8.93
7.58
18.17
19.27
41.02
21.29
25.74
32.43
29.84
8.06
9.36
9.15
2.17
0.00
2.12
3.42
0.00
10.08
3.23
3.94
5.30
13.70
1.46
2.35
0.99
1.27
1.87
3.24
7.79
5.03
5.56
1.23
0.76
1.85
3.50
0.94
0.75
0.75
0.66
0.75
0.66
0.68
0.79
0.70
2.28
2.23
2.52
4.89
6.07
5.43
8.07
1.31
1.74
3.35
3.52
6.41
5.86
4.16
41.17
50.03
61.68
30.95
25.60
Nonfacility
PE
RVUs
117.96
NA
39.56
NA
NA
NA
NA
NA
NA
NA
NA
13.03
9.85
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.17
0.00
2.70
3.50
0.00
NA
5.85
7.18
8.22
NA
2.95
3.79
6.34
4.29
22.84
NA
NA
NA
NA
2.10
2.87
2.81
8.59
0.94
0.69
0.67
0.70
0.79
0.66
0.75
0.92
0.70
3.38
2.35
2.95
NA
NA
NA
NA
2.06
10.66
8.36
NA
NA
NA
6.78
NA
NA
NA
NA
NA
Facility
PE
RVUs
1.50
0.62
2.35
7.30
10.79
4.79
6.33
4.88
5.88
3.03
8.67
6.95
4.63
15.13
12.09
22.83
11.31
16.16
18.34
17.81
6.70
7.60
7.48
1.02
0.00
1.73
2.23
0.00
4.35
1.57
1.88
3.29
7.00
0.74
1.17
0.66
0.79
1.17
2.48
6.39
3.45
4.09
1.46
0.26
1.70
2.55
0.51
0.23
0.32
0.20
0.21
0.35
0.35
0.41
0.35
1.82
1.54
1.58
4.82
5.39
4.71
6.89
1.32
2.02
3.59
2.45
3.67
5.26
3.93
20.55
32.77
40.74
35.39
32.40
Malpractice
RVUs
0.36
0.17
0.43
1.64
2.92
0.84
1.33
0.91
1.26
1.06
1.83
1.41
0.92
2.93
2.92
6.22
3.24
4.03
5.52
4.50
1.29
1.62
1.44
0.30
0.00
0.25
0.46
0.00
1.21
0.44
0.49
0.75
2.03
0.23
0.33
0.07
0.08
0.22
0.44
1.31
1.02
1.15
0.12
0.04
0.21
0.51
0.13
0.09
0.08
0.05
0.04
0.08
0.08
0.11
0.10
0.20
0.31
0.59
1.14
0.56
0.94
1.74
0.19
0.28
0.56
0.59
1.05
0.98
0.71
3.81
4.84
6.86
4.52
4.18
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00122
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
121.96
NA
46.00
NA
NA
NA
NA
NA
NA
NA
NA
23.37
18.34
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.65
0.00
5.07
7.37
0.00
NA
9.52
11.61
14.27
NA
4.64
6.47
7.40
5.65
24.94
NA
NA
NA
NA
3.46
3.67
4.88
12.60
2.01
1.54
1.50
1.41
1.58
1.40
1.52
1.83
1.50
5.87
4.90
6.05
NA
NA
NA
NA
3.57
12.68
12.27
NA
NA
NA
11.65
NA
NA
NA
NA
NA
Facility
total
5.49
2.52
8.79
19.63
29.34
11.48
16.11
11.47
14.74
10.42
21.70
17.28
13.12
36.23
34.28
70.07
35.84
45.93
56.30
52.15
16.05
18.57
18.07
3.50
0.00
4.10
6.10
0.00
15.64
5.24
6.31
9.34
22.73
2.44
3.86
1.72
2.15
3.27
6.16
15.48
9.50
10.80
2.81
1.06
3.77
6.55
1.58
1.07
1.15
0.91
1.00
1.09
1.11
1.31
1.15
4.31
4.09
4.68
10.85
12.02
11.08
16.70
2.82
4.04
7.50
6.56
11.14
12.10
8.80
65.53
87.64
109.28
70.86
62.18
Global
000
ZZZ
000
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
000
YYY
010
010
XXX
010
010
010
010
090
000
000
000
000
000
010
010
010
010
010
000
010
010
000
000
000
000
000
000
000
000
000
010
010
000
090
090
090
090
010
010
090
090
090
090
090
090
090
090
090
090
45885
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
20824
20827
20838
20900
20902
20910
20912
20920
20922
20924
20926
20930
20931
20936
20937
20938
20950
20955
20956
20957
20962
20969
20970
20972
20973
20974
20975
20979
20982
20999
21010
21015
21025
21026
21029
21030
21031
21032
21034
21040
21044
21045
21046
21047
21048
21049
21050
21060
21070
21076
21077
21079
21080
21081
21082
21083
21084
21085
21086
21087
21088
21089
21100
21110
21116
21120
21121
21122
21123
21125
21127
21137
21138
21139
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
B
A
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Replantation thumb, complete ....................
Replantation thumb, complete ....................
Replantation foot, complete ........................
Removal of bone for graft ...........................
Removal of bone for graft ...........................
Remove cartilage for graft ...........................
Remove cartilage for graft ...........................
Removal of fascia for graft ..........................
Removal of fascia for graft ..........................
Removal of tendon for graft ........................
Removal of tissue for graft ..........................
Spinal bone allograft ...................................
Spinal bone allograft ...................................
Spinal bone autograft ..................................
Spinal bone autograft ..................................
Spinal bone autograft ..................................
Fluid pressure, muscle ................................
Fibula bone graft, microvasc .......................
Iliac bone graft, microvasc ..........................
Mt bone graft, microvasc .............................
Other bone graft, microvasc ........................
Bone/skin graft, microvasc ..........................
Bone/skin graft, iliac crest ...........................
Bone/skin graft, metatarsal .........................
Bone/skin graft, great toe ............................
Electrical bone stimulation ..........................
Electrical bone stimulation ..........................
Us bone stimulation .....................................
Ablate, bone tumor(s) perq .........................
Musculoskeletal surgery ..............................
Incision of jaw joint ......................................
Resection of facial tumor ............................
Excision of bone, lower jaw ........................
Excision of facial bone(s) ............................
Contour of face bone lesion ........................
Excise max/zygoma b9 tumor .....................
Remove exostosis, mandible ......................
Remove exostosis, maxilla ..........................
Excise max/zygoma mlg tumor ...................
Excise mandible lesion ................................
Removal of jaw bone lesion ........................
Extensive jaw surgery .................................
Remove mandible cyst complex .................
Excise lwr jaw cyst w/repair ........................
Remove maxilla cyst complex .....................
Excis uppr jaw cyst w/repair .......................
Removal of jaw joint ....................................
Remove jaw joint cartilage ..........................
Remove coronoid process ..........................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Prepare face/oral prosthesis .......................
Maxillofacial fixation ....................................
Interdental fixation .......................................
Injection, jaw joint x-ray ...............................
Reconstruction of chin .................................
Reconstruction of chin .................................
Reconstruction of chin .................................
Reconstruction of chin .................................
Augmentation, lower jaw bone ....................
Augmentation, lower jaw bone ....................
Reduction of forehead .................................
Reduction of forehead .................................
Reduction of forehead .................................
30.95
26.42
41.43
5.58
7.56
5.34
6.35
5.31
6.61
6.48
5.53
0.00
1.81
0.00
2.80
3.03
1.26
39.23
39.29
40.67
39.29
43.94
43.09
43.02
45.78
0.62
2.61
0.62
7.28
0.00
10.14
5.29
10.06
4.85
7.72
4.50
3.25
3.25
16.18
4.50
11.86
16.18
13.01
18.76
13.51
18.01
10.77
10.23
8.21
13.43
33.77
22.35
25.11
22.90
20.88
19.31
22.52
9.01
24.93
24.93
0.00
0.00
4.22
5.21
0.81
4.93
7.65
8.53
11.16
10.62
11.12
9.83
12.19
14.62
Nonfacility
PE
RVUs
NA
NA
NA
8.42
NA
NA
NA
NA
7.41
NA
NA
0.00
NA
0.00
NA
NA
6.35
NA
NA
NA
NA
NA
NA
NA
NA
0.71
NA
0.77
105.12
0.00
NA
NA
12.30
7.94
9.32
6.45
5.29
5.45
15.67
6.51
NA
NA
NA
NA
NA
NA
NA
NA
NA
12.00
29.60
20.43
23.16
21.14
18.48
17.90
21.12
8.28
22.34
22.11
0.00
0.00
11.76
10.08
4.08
10.42
9.92
NA
NA
55.80
48.12
NA
NA
NA
Facility
PE
RVUs
34.30
34.08
21.78
5.50
6.66
5.04
5.63
4.26
4.87
5.69
4.66
0.00
0.90
0.00
1.41
1.52
0.97
23.52
24.03
18.69
25.76
25.78
24.61
20.22
24.42
0.53
1.67
0.33
12.41
0.00
7.28
4.86
9.24
6.20
6.85
4.96
3.62
3.51
12.29
4.70
9.18
12.08
11.91
13.17
12.13
12.78
9.31
8.51
7.03
9.44
24.40
16.13
18.23
16.42
14.83
13.57
16.44
6.79
18.15
18.05
0.00
0.00
4.79
8.54
0.34
7.29
7.81
8.55
10.59
8.18
9.27
7.48
9.25
11.13
Malpractice
RVUs
4.61
3.66
1.12
0.94
1.30
0.71
0.69
0.66
0.70
1.04
0.87
0.00
0.43
0.00
0.54
0.64
0.20
4.89
7.01
7.05
6.55
4.79
6.60
5.30
5.54
0.11
0.51
0.09
0.69
0.00
1.11
0.70
1.32
0.60
0.94
0.54
0.48
0.47
1.71
0.54
1.12
1.52
1.85
2.12
1.76
1.59
1.47
1.38
1.27
1.99
4.55
3.15
3.74
3.20
3.11
2.88
2.18
1.27
3.71
3.44
0.00
0.00
0.34
0.72
0.06
0.60
0.90
1.07
1.40
0.79
1.52
1.32
1.74
1.18
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00123
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
14.95
NA
NA
NA
NA
14.72
NA
NA
0.00
NA
0.00
NA
NA
7.81
NA
NA
NA
NA
NA
NA
NA
NA
1.44
NA
1.49
113.09
0.00
NA
NA
23.68
13.39
17.98
11.49
9.01
9.16
33.56
11.55
NA
NA
NA
NA
NA
NA
NA
NA
NA
27.42
67.91
45.94
52.01
47.24
42.47
40.09
45.82
18.56
50.98
50.48
0.00
0.00
16.32
16.01
4.95
15.95
18.47
NA
NA
67.21
60.76
NA
NA
NA
Facility
total
69.86
64.16
64.34
12.02
15.52
11.09
12.67
10.23
12.18
13.22
11.06
0.00
3.15
0.00
4.74
5.18
2.43
67.64
70.33
66.42
71.60
74.51
74.30
68.54
75.74
1.26
4.78
1.04
20.38
0.00
18.53
10.86
20.62
11.65
15.50
10.00
7.35
7.23
30.19
9.74
22.17
29.79
26.77
34.05
27.40
32.37
21.56
20.12
16.50
24.85
62.72
41.63
47.08
42.52
38.82
35.76
41.15
17.07
46.79
46.42
0.00
0.00
9.35
14.47
1.21
12.82
16.36
18.15
23.15
19.59
21.91
18.63
23.18
26.93
Global
090
090
090
090
090
090
090
090
090
090
090
XXX
ZZZ
XXX
ZZZ
ZZZ
000
090
090
090
090
090
090
090
090
000
000
000
000
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
010
090
090
090
090
090
090
000
090
090
090
090
090
090
090
090
090
45886
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21175
21179
21180
21181
21182
21183
21184
21188
21193
21194
21195
21196
21198
21199
21206
21208
21209
21210
21215
21230
21235
21240
21242
21243
21244
21245
21246
21247
21248
21249
21255
21256
21260
21261
21263
21267
21268
21270
21275
21280
21282
21295
21296
21299
21300
21310
21315
21320
21325
21330
21335
21336
21337
21338
21339
21340
21343
21344
21345
21346
21347
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct midface, lefort .........................
Reconstruct orbit/forehead ..........................
Reconstruct orbit/forehead ..........................
Reconstruct entire forehead ........................
Reconstruct entire forehead ........................
Contour cranial bone lesion ........................
Reconstruct cranial bone ............................
Reconstruct cranial bone ............................
Reconstruct cranial bone ............................
Reconstruction of midface ...........................
Reconst lwr jaw w/o graft ............................
Reconst lwr jaw w/graft ...............................
Reconst lwr jaw w/o fixation ........................
Reconst lwr jaw w/fixation ...........................
Reconstr lwr jaw segment ...........................
Reconstr lwr jaw w/advance .......................
Reconstruct upper jaw bone .......................
Augmentation of facial bones ......................
Reduction of facial bones ............................
Face bone graft ...........................................
Lower jaw bone graft ...................................
Rib cartilage graft ........................................
Ear cartilage graft ........................................
Reconstruction of jaw joint ..........................
Reconstruction of jaw joint ..........................
Reconstruction of jaw joint ..........................
Reconstruction of lower jaw ........................
Reconstruction of jaw ..................................
Reconstruction of jaw ..................................
Reconstruct lower jaw bone ........................
Reconstruction of jaw ..................................
Reconstruction of jaw ..................................
Reconstruct lower jaw bone ........................
Reconstruction of orbit ................................
Revise eye sockets .....................................
Revise eye sockets .....................................
Revise eye sockets .....................................
Revise eye sockets .....................................
Revise eye sockets .....................................
Augmentation, cheek bone .........................
Revision, orbitofacial bones ........................
Revision of eyelid ........................................
Revision of eyelid ........................................
Revision of jaw muscle/bone ......................
Revision of jaw muscle/bone ......................
Cranio/maxillofacial surgery ........................
Treatment of skull fracture ..........................
Treatment of nose fracture ..........................
Treatment of nose fracture ..........................
Treatment of nose fracture ..........................
Treatment of nose fracture ..........................
Treatment of nose fracture ..........................
Treatment of nose fracture ..........................
Treat nasal septal fracture ..........................
Treat nasal septal fracture ..........................
Treat nasoethmoid fracture .........................
Treat nasoethmoid fracture .........................
Treatment of nose fracture ..........................
Treatment of sinus fracture .........................
Treatment of sinus fracture .........................
Treat nose/jaw fracture ...............................
Treat nose/jaw fracture ...............................
Treat nose/jaw fracture ...............................
18.11
18.82
19.59
19.95
20.72
21.78
25.25
28.32
30.53
34.47
42.40
46.46
27.82
33.19
22.26
25.20
9.91
32.20
35.33
38.26
22.47
17.15
19.85
17.24
18.92
14.17
16.01
14.11
10.23
6.72
10.23
10.77
10.77
6.72
14.06
12.96
20.80
11.86
11.86
12.47
22.65
11.48
17.52
16.72
16.20
16.53
31.50
28.44
18.91
24.49
10.23
11.24
6.03
3.49
1.53
4.25
0.00
0.72
0.58
1.51
1.85
3.77
5.38
8.62
5.72
2.71
6.46
8.10
10.77
12.96
19.73
8.17
10.61
12.70
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
23.47
10.88
27.25
47.37
NA
10.18
NA
NA
NA
NA
14.32
NA
NA
12.29
16.75
NA
NA
NA
NA
NA
NA
NA
11.66
NA
NA
NA
NA
NA
0.00
2.00
2.16
4.19
3.89
NA
NA
NA
NA
5.96
NA
NA
NA
NA
NA
9.82
NA
NA
Facility
PE
RVUs
13.41
12.75
14.37
13.66
15.04
14.88
16.60
21.89
22.45
23.33
27.95
27.92
13.53
17.38
13.72
14.96
7.23
18.55
20.24
21.33
18.35
12.42
13.45
14.61
15.41
12.46
8.90
12.46
9.29
7.90
9.15
9.24
7.79
6.28
11.95
11.42
17.27
11.91
9.62
8.83
17.07
9.24
12.47
15.70
11.48
13.26
23.50
19.87
18.95
19.69
7.09
7.91
5.78
4.35
2.51
4.95
0.00
0.26
0.15
1.81
1.58
8.21
9.26
9.38
9.31
3.49
13.21
13.20
8.17
14.86
15.85
7.04
11.91
15.39
Malpractice
RVUs
2.35
2.38
1.66
2.84
3.09
1.84
2.55
2.30
2.48
6.64
8.18
4.13
3.55
4.83
2.80
3.48
1.32
2.80
4.47
5.70
1.69
2.23
2.02
1.64
2.07
1.44
1.39
1.33
1.09
0.90
1.30
1.53
1.29
0.61
2.24
1.78
3.25
1.25
1.19
1.35
2.83
1.55
2.48
2.38
1.50
0.97
3.42
2.62
1.70
3.65
0.72
1.29
0.42
0.26
0.16
0.34
0.00
0.13
0.05
0.14
0.18
0.31
0.56
0.74
0.55
0.28
0.82
0.96
1.15
1.47
2.43
0.92
1.21
1.47
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00124
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
34.79
18.50
38.78
59.67
NA
17.52
NA
NA
NA
NA
27.37
NA
NA
25.32
36.76
NA
NA
NA
NA
NA
NA
NA
22.61
NA
NA
NA
NA
NA
0.00
2.85
2.79
5.84
5.92
NA
NA
NA
NA
8.95
NA
NA
NA
NA
NA
18.91
NA
NA
Facility
total
33.87
33.95
35.62
36.45
38.85
38.51
44.40
52.51
55.46
64.44
78.53
78.51
44.90
55.40
38.78
43.65
18.46
53.56
60.04
65.29
42.52
31.81
35.32
33.50
36.40
28.07
26.30
27.90
20.61
15.52
20.68
21.54
19.85
13.62
28.25
26.15
41.33
25.02
22.67
22.65
42.54
22.28
32.47
34.80
29.18
30.76
58.42
50.93
39.56
47.83
18.04
20.45
12.23
8.10
4.20
9.54
0.00
1.11
0.78
3.46
3.61
12.29
15.20
18.74
15.59
6.48
20.49
22.26
20.09
29.28
38.01
16.13
23.73
29.55
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
000
000
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
45887
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
21348
21355
21356
21360
21365
21366
21385
21386
21387
21390
21395
21400
21401
21406
21407
21408
21421
21422
21423
21431
21432
21433
21435
21436
21440
21445
21450
21451
21452
21453
21454
21461
21462
21465
21470
21480
21485
21490
21493
21494
21495
21497
21499
21501
21502
21510
21550
21555
21556
21557
21600
21610
21615
21616
21620
21627
21630
21632
21685
21700
21705
21720
21725
21740
21742
21743
21750
21800
21805
21810
21820
21825
21899
21920
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
C
A
Physician
work
RVUs 3
Description
Treat nose/jaw fracture ...............................
Treat cheek bone fracture ...........................
Treat cheek bone fracture ...........................
Treat cheek bone fracture ...........................
Treat cheek bone fracture ...........................
Treat cheek bone fracture ...........................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat eye socket fracture ............................
Treat mouth roof fracture ............................
Treat mouth roof fracture ............................
Treat mouth roof fracture ............................
Treat craniofacial fracture ...........................
Treat craniofacial fracture ...........................
Treat craniofacial fracture ...........................
Treat craniofacial fracture ...........................
Treat craniofacial fracture ...........................
Treat dental ridge fracture ...........................
Treat dental ridge fracture ...........................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Treat lower jaw fracture ..............................
Reset dislocated jaw ...................................
Reset dislocated jaw ...................................
Repair dislocated jaw ..................................
Treat hyoid bone fracture ............................
Treat hyoid bone fracture ............................
Treat hyoid bone fracture ............................
Interdental wiring .........................................
Head surgery procedure .............................
Drain neck/chest lesion ...............................
Drain chest lesion ........................................
Drainage of bone lesion ..............................
Biopsy of neck/chest ...................................
Remove lesion, neck/chest .........................
Remove lesion, neck/chest .........................
Remove tumor, neck/chest .........................
Partial removal of rib ...................................
Partial removal of rib ...................................
Removal of rib .............................................
Removal of rib and nerves ..........................
Partial removal of sternum ..........................
Sternal debridement ....................................
Extensive sternum surgery ..........................
Extensive sternum surgery ..........................
Hyoid myotomy & suspension .....................
Revision of neck muscle .............................
Revision of neck muscle/rib ........................
Revision of neck muscle .............................
Revision of neck muscle .............................
Reconstruction of sternum ..........................
Repair stern/nuss w/o scope .......................
Repair sternum/nuss w/scope .....................
Repair of sternum separation ......................
Treatment of rib fracture .............................
Treatment of rib fracture .............................
Treatment of rib fracture(s) .........................
Treat sternum fracture .................................
Treat sternum fracture .................................
Neck/chest surgery procedure ....................
Biopsy soft tissue of back ...........................
16.69
3.77
4.15
6.46
14.96
17.78
9.17
9.17
9.71
10.13
12.69
1.40
3.27
7.01
8.62
12.38
5.14
8.33
10.40
7.05
8.62
25.36
17.25
28.06
2.71
5.38
2.98
4.87
1.98
5.54
6.46
8.10
9.80
11.91
15.35
0.61
3.99
11.86
1.27
6.28
5.69
3.86
0.00
3.81
7.12
5.74
2.06
4.35
5.57
8.89
6.89
14.62
9.88
12.04
6.79
6.81
17.38
18.15
13.01
6.19
9.61
5.68
6.99
16.51
0.00
0.00
10.77
0.96
2.76
6.86
1.28
7.41
0.00
2.06
Nonfacility
PE
RVUs
NA
6.07
6.99
NA
NA
NA
NA
NA
NA
NA
NA
2.60
7.77
NA
NA
NA
9.62
NA
NA
NA
NA
NA
NA
NA
7.43
10.05
7.70
9.77
12.37
11.18
NA
26.43
29.34
NA
NA
1.72
8.73
NA
NA
NA
NA
8.88
0.00
6.31
NA
NA
3.85
5.54
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
0.00
NA
NA
1.78
NA
0.00
3.54
Facility
PE
RVUs
10.81
3.42
4.41
5.80
10.51
11.02
8.06
6.88
8.67
7.58
8.75
1.82
3.44
5.92
6.66
8.63
8.32
7.89
9.02
9.40
7.96
15.91
12.37
17.82
6.26
8.32
6.71
8.44
4.74
10.71
6.17
12.53
12.71
9.63
11.78
0.19
7.76
9.55
0.53
3.42
8.55
7.77
0.00
3.73
5.42
5.42
1.74
3.17
4.05
5.23
5.68
8.68
6.42
7.95
5.72
6.17
11.45
10.81
9.82
4.74
5.43
2.87
5.31
8.37
0.00
0.00
5.94
1.31
3.20
4.93
1.70
6.25
0.00
1.48
Malpractice
RVUs
2.48
0.34
0.46
0.74
1.69
2.49
0.97
0.97
1.08
0.90
1.44
0.15
0.38
0.73
0.94
1.44
0.73
0.99
1.27
0.70
0.81
2.78
1.98
3.09
0.38
0.78
0.33
0.63
0.27
0.74
0.82
0.98
1.27
1.50
1.96
0.06
0.51
1.96
0.12
0.57
0.46
0.50
0.00
0.43
0.97
0.80
0.16
0.56
0.65
1.08
0.99
3.07
1.45
1.86
0.98
1.02
2.58
2.65
1.06
0.32
1.43
0.91
1.21
2.36
0.00
0.00
1.63
0.09
0.38
0.94
0.16
1.11
0.00
0.14
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00125
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
10.18
11.60
NA
NA
NA
NA
NA
NA
NA
NA
4.15
11.41
NA
NA
NA
15.49
NA
NA
NA
NA
NA
NA
NA
10.52
16.21
11.01
15.27
14.62
17.46
NA
35.51
40.41
NA
NA
2.39
13.23
NA
NA
NA
NA
13.24
0.00
10.55
NA
NA
6.08
10.45
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
1.05
NA
NA
3.22
NA
0.00
5.74
Facility
total
29.98
7.52
9.02
13.00
27.16
31.29
18.20
17.01
19.46
18.61
22.88
3.37
7.09
13.67
16.22
22.45
14.19
17.20
20.69
17.15
17.39
44.05
31.60
48.96
9.34
14.48
10.02
13.94
7.00
16.99
13.46
21.60
23.78
23.05
29.09
0.86
12.25
23.37
1.92
10.27
14.70
12.12
0.00
7.97
13.52
11.96
3.96
8.08
10.27
15.19
13.57
26.37
17.75
21.85
13.50
14.00
31.42
31.60
23.89
11.26
16.47
9.46
13.51
27.24
0.00
0.00
18.35
2.36
6.34
12.74
3.15
14.78
0.00
3.68
Global
090
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
090
090
090
090
090
090
YYY
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
010
45888
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
21925
21930
21935
22100
22101
22102
22103
22110
22112
22114
22116
22210
22212
22214
22216
22220
22222
22224
22226
22305
22310
22315
22318
22319
22325
22326
22327
22328
22505
22520
22521
22522
22532
22533
22534
22548
22554
22556
22558
22585
22590
22595
22600
22610
22612
22614
22630
22632
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22851
22852
22855
22899
22900
22999
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
Physician
work
RVUs 3
Description
Biopsy soft tissue of back ...........................
Remove lesion, back or flank ......................
Remove tumor, back ...................................
Remove part of neck vertebra ....................
Remove part, thorax vertebra .....................
Remove part, lumbar vertebra ....................
Remove extra spine segment .....................
Remove part of neck vertebra ....................
Remove part, thorax vertebra .....................
Remove part, lumbar vertebra ....................
Remove extra spine segment .....................
Revision of neck spine ................................
Revision of thorax spine ..............................
Revision of lumbar spine .............................
Revise, extra spine segment .......................
Revision of neck spine ................................
Revision of thorax spine ..............................
Revision of lumbar spine .............................
Revise, extra spine segment .......................
Treat spine process fracture .......................
Treat spine fracture .....................................
Treat spine fracture .....................................
Treat odontoid fx w/o graft ..........................
Treat odontoid fx w/graft .............................
Treat spine fracture .....................................
Treat neck spine fracture ............................
Treat thorax spine fracture ..........................
Treat each add spine fx ..............................
Manipulation of spine ..................................
Percut vertebroplasty thor ...........................
Percut vertebroplasty lumb .........................
Percut vertebroplasty add’l ..........................
Lat thorax spine fusion ................................
Lat lumbar spine fusion ...............................
Lat thor/lumb, add’l seg ...............................
Neck spine fusion ........................................
Neck spine fusion ........................................
Thorax spine fusion .....................................
Lumbar spine fusion ....................................
Additional spinal fusion ...............................
Spine & skull spinal fusion ..........................
Neck spinal fusion .......................................
Neck spine fusion ........................................
Thorax spine fusion .....................................
Lumbar spine fusion ....................................
Spine fusion, extra segment .......................
Lumbar spine fusion ....................................
Spine fusion, extra segment .......................
Fusion of spine ............................................
Fusion of spine ............................................
Fusion of spine ............................................
Fusion of spine ............................................
Fusion of spine ............................................
Fusion of spine ............................................
Kyphectomy, 1-2 segments .........................
Kyphectomy, 3 or more ...............................
Exploration of spinal fusion .........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert spine fixation device ..........................
Insert pelv fixation device ............................
Reinsert spinal fixation ................................
Remove spine fixation device .....................
Apply spine prosth device ...........................
Remove spine fixation device .....................
Remove spine fixation device .....................
Spine surgery procedure .............................
Remove abdominal wall lesion ...................
Abdomen surgery procedure .......................
4.49
5.00
17.97
9.74
9.82
9.82
2.34
12.75
12.82
12.82
2.32
23.83
19.43
19.46
6.04
21.38
21.53
21.53
6.04
2.05
2.62
8.85
21.51
24.01
18.31
19.60
19.21
4.61
1.87
8.92
8.35
4.31
24.01
23.14
6.00
25.83
18.63
23.47
22.29
5.53
20.52
19.40
16.15
16.03
21.01
6.44
20.85
5.23
18.26
30.89
36.29
26.28
30.28
32.72
31.84
36.46
10.85
12.55
0.00
12.59
13.47
16.45
11.96
12.42
13.81
6.00
18.52
9.53
6.71
9.02
15.14
0.00
5.80
0.00
Nonfacility
PE
RVUs
5.12
5.82
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.25
2.72
9.37
NA
NA
NA
NA
NA
NA
NA
60.09
54.29
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
0.00
Facility
PE
RVUs
3.24
3.39
9.46
7.39
7.57
7.89
1.17
8.96
9.03
9.02
1.14
15.05
12.99
13.43
3.04
13.33
11.12
13.85
3.00
1.86
2.28
7.16
13.09
14.38
11.94
12.41
12.28
2.21
0.92
5.24
5.08
1.70
14.47
13.34
2.95
15.46
12.07
14.33
12.94
2.72
13.02
12.54
10.93
11.12
13.81
3.25
13.27
2.59
12.40
19.00
22.00
15.86
17.84
19.47
18.38
19.51
7.73
6.31
0.00
6.32
6.41
8.49
5.91
6.16
6.82
3.09
11.40
6.80
3.27
6.60
9.43
0.00
3.22
0.00
Malpractice
RVUs
0.60
0.66
2.47
2.13
1.90
1.87
0.44
2.76
2.52
2.63
0.50
5.44
3.90
3.91
1.29
5.06
4.12
4.18
1.29
0.39
0.50
1.85
5.28
6.03
3.87
4.42
3.98
0.94
0.36
1.71
1.60
0.82
4.34
3.15
1.25
5.59
4.45
4.34
3.15
1.25
4.78
4.40
3.72
3.52
4.46
1.38
4.72
1.16
3.75
6.15
6.98
4.92
5.13
5.28
6.45
7.65
2.29
2.78
0.00
2.74
2.85
3.18
2.85
2.95
2.99
1.15
3.89
2.04
1.49
1.89
3.51
0.00
0.76
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00126
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
10.20
11.48
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.69
5.84
20.07
NA
NA
NA
NA
NA
NA
NA
70.72
64.24
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
0.00
Facility
total
8.33
9.05
29.90
19.26
19.28
19.58
3.96
24.47
24.36
24.46
3.96
44.31
36.32
36.80
10.37
39.78
36.78
39.56
10.34
4.31
5.40
17.86
39.89
44.41
34.12
36.43
35.47
7.76
3.15
15.87
15.03
6.83
42.82
39.63
10.20
46.88
35.15
42.14
38.39
9.50
38.32
36.34
30.80
30.67
39.28
11.08
38.84
8.98
34.41
56.04
65.27
47.07
53.25
57.46
56.67
63.63
20.87
21.63
0.00
21.64
22.73
28.12
20.72
21.53
23.62
10.24
33.80
18.37
11.47
17.50
28.08
0.00
9.78
0.00
Global
090
090
090
090
090
090
ZZZ
090
090
090
ZZZ
090
090
090
ZZZ
090
090
090
ZZZ
090
090
090
090
090
090
090
090
ZZZ
010
010
010
ZZZ
090
090
ZZZ
090
090
090
090
ZZZ
090
090
090
090
090
ZZZ
090
ZZZ
090
090
090
090
090
090
090
090
090
ZZZ
XXX
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
090
090
ZZZ
090
090
YYY
090
YYY
45889
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
23000
23020
23030
23031
23035
23040
23044
23065
23066
23075
23076
23077
23100
23101
23105
23106
23107
23120
23125
23130
23140
23145
23146
23150
23155
23156
23170
23172
23174
23180
23182
23184
23190
23195
23200
23210
23220
23221
23222
23330
23331
23332
23350
23395
23397
23400
23405
23406
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23470
23472
23480
23485
23490
23491
23500
23505
23515
23520
23525
23530
23532
23540
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of calcium deposits ......................
Release shoulder joint .................................
Drain shoulder lesion ..................................
Drain shoulder bursa ...................................
Drain shoulder bone lesion .........................
Exploratory shoulder surgery ......................
Exploratory shoulder surgery ......................
Biopsy shoulder tissues ..............................
Biopsy shoulder tissues ..............................
Removal of shoulder lesion .........................
Removal of shoulder lesion .........................
Remove tumor of shoulder ..........................
Biopsy of shoulder joint ...............................
Shoulder joint surgery .................................
Remove shoulder joint lining .......................
Incision of collarbone joint ...........................
Explore treat shoulder joint .........................
Partial removal, collar bone ........................
Removal of collar bone ...............................
Remove shoulder bone, part .......................
Removal of bone lesion ..............................
Removal of bone lesion ..............................
Removal of bone lesion ..............................
Removal of humerus lesion ........................
Removal of humerus lesion ........................
Removal of humerus lesion ........................
Remove collar bone lesion ..........................
Remove shoulder blade lesion ....................
Remove humerus lesion .............................
Remove collar bone lesion ..........................
Remove shoulder blade lesion ....................
Remove humerus lesion .............................
Partial removal of scapula ...........................
Removal of head of humerus ......................
Removal of collar bone ...............................
Removal of shoulder blade .........................
Partial removal of humerus .........................
Partial removal of humerus .........................
Partial removal of humerus .........................
Remove shoulder foreign body ...................
Remove shoulder foreign body ...................
Remove shoulder foreign body ...................
Injection for shoulder x-ray ..........................
Muscle transfer,shoulder/arm ......................
Muscle transfers ..........................................
Fixation of shoulder blade ...........................
Incision of tendon & muscle ........................
Incise tendon(s) & muscle(s) ......................
Repair rotator cuff, acute ............................
Repair rotator cuff, chronic ..........................
Release of shoulder ligament .....................
Repair of shoulder .......................................
Repair biceps tendon ..................................
Remove/transplant tendon ..........................
Repair shoulder capsule .............................
Repair shoulder capsule .............................
Repair shoulder capsule .............................
Repair shoulder capsule .............................
Repair shoulder capsule .............................
Repair shoulder capsule .............................
Reconstruct shoulder joint ...........................
Reconstruct shoulder joint ...........................
Revision of collar bone ................................
Revision of collar bone ................................
Reinforce clavicle ........................................
Reinforce shoulder bones ...........................
Treat clavicle fracture ..................................
Treat clavicle fracture ..................................
Treat clavicle fracture ..................................
Treat clavicle dislocation .............................
Treat clavicle dislocation .............................
Treat clavicle dislocation .............................
Treat clavicle dislocation .............................
Treat clavicle dislocation .............................
4.36
8.94
3.43
2.75
8.62
9.21
7.12
2.27
4.16
2.39
7.64
16.10
6.03
5.58
8.24
5.96
8.63
7.11
9.40
7.56
6.89
9.10
7.84
8.49
10.35
8.69
6.86
6.90
9.52
8.54
8.16
9.39
7.24
9.82
12.08
12.49
14.57
17.75
23.93
1.85
7.38
11.62
1.00
16.85
16.14
13.55
8.38
10.79
12.45
13.32
9.98
13.31
9.99
10.48
13.41
14.38
15.38
15.31
15.86
14.23
17.15
21.11
11.18
13.44
11.86
14.22
2.08
3.69
7.41
2.16
3.60
7.31
8.02
2.23
Nonfacility
PE
RVUs
8.16
NA
7.02
7.33
NA
NA
NA
2.71
7.54
3.59
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.54
NA
NA
3.39
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.79
4.29
NA
2.77
4.40
NA
NA
2.79
Facility
PE
RVUs
4.28
7.31
2.81
2.62
7.93
7.61
6.22
1.60
3.89
1.75
5.45
9.99
5.48
5.15
6.90
5.51
7.15
6.24
7.32
6.89
5.09
7.23
6.88
6.70
8.07
7.14
5.82
6.08
8.10
8.60
8.18
8.92
5.98
7.48
8.44
8.72
10.48
11.47
15.31
1.81
6.57
9.02
0.35
12.46
11.05
9.73
6.69
8.07
9.10
9.58
7.73
10.51
7.84
7.99
9.53
10.11
11.01
10.42
10.83
11.02
11.86
13.97
8.49
9.57
8.43
10.37
2.44
3.74
6.34
2.67
3.83
5.75
6.76
2.28
Malpractice
RVUs
0.68
1.54
0.57
0.46
1.47
1.60
1.24
0.20
0.63
0.34
1.13
2.33
1.04
0.96
1.42
0.99
1.49
1.23
1.62
1.30
1.08
1.49
1.35
1.32
1.80
1.50
1.12
1.01
1.65
1.47
1.37
1.63
1.17
1.70
1.93
2.02
2.48
3.05
3.94
0.24
1.27
2.02
0.06
2.93
2.73
2.29
1.45
1.87
2.16
2.31
1.73
2.31
1.73
1.82
2.32
2.49
2.66
2.59
2.76
2.46
2.98
3.66
1.94
2.33
1.47
2.46
0.30
0.61
1.28
0.34
0.46
1.20
1.38
0.29
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00127
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
13.20
NA
11.01
10.54
NA
NA
NA
5.18
12.33
6.33
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.64
NA
NA
4.45
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.17
8.59
NA
5.28
8.46
NA
NA
5.31
Facility
total
9.32
17.79
6.81
5.83
18.02
18.42
14.58
4.08
8.68
4.49
14.21
28.42
12.55
11.69
16.56
12.46
17.27
14.59
18.34
15.75
13.07
17.82
16.06
16.51
20.22
17.33
13.80
13.99
19.27
18.61
17.71
19.94
14.40
19.00
22.46
23.24
27.53
32.26
43.17
3.90
15.23
22.66
1.41
32.25
29.92
25.57
16.51
20.74
23.72
25.20
19.44
26.12
19.56
20.29
25.26
26.98
29.05
28.32
29.46
27.71
32.00
38.74
21.61
25.34
21.76
27.05
4.82
8.04
15.03
5.17
7.88
14.27
16.15
4.81
Global
090
090
010
010
090
090
090
010
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45890
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625
23630
23650
23655
23660
23665
23670
23675
23680
23700
23800
23802
23900
23920
23921
23929
23930
23931
23935
24000
24006
24065
24066
24075
24076
24077
24100
24101
24102
24105
24110
24115
24116
24120
24125
24126
24130
24134
24136
24138
24140
24145
24147
24149
24150
24151
24152
24153
24155
24160
24164
24200
24201
24220
24300
24301
24305
24310
24320
24330
24331
24332
24340
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Treat clavicle dislocation .............................
Treat clavicle dislocation .............................
Treat clavicle dislocation .............................
Treat shoulder blade fx ...............................
Treat shoulder blade fx ...............................
Treat scapula fracture .................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat shoulder dislocation ...........................
Treat shoulder dislocation ...........................
Treat shoulder dislocation ...........................
Treat dislocation/fracture .............................
Treat dislocation/fracture .............................
Treat dislocation/fracture .............................
Treat dislocation/fracture .............................
Fixation of shoulder .....................................
Fusion of shoulder joint ...............................
Fusion of shoulder joint ...............................
Amputation of arm & girdle .........................
Amputation at shoulder joint .......................
Amputation follow-up surgery ......................
Shoulder surgery procedure ........................
Drainage of arm lesion ................................
Drainage of arm bursa ................................
Drain arm/elbow bone lesion ......................
Exploratory elbow surgery ...........................
Release elbow joint .....................................
Biopsy arm/elbow soft tissue ......................
Biopsy arm/elbow soft tissue ......................
Remove arm/elbow lesion ...........................
Remove arm/elbow lesion ...........................
Remove tumor of arm/elbow .......................
Biopsy elbow joint lining ..............................
Explore/treat elbow joint ..............................
Remove elbow joint lining ...........................
Removal of elbow bursa .............................
Remove humerus lesion .............................
Remove/graft bone lesion ...........................
Remove/graft bone lesion ...........................
Remove elbow lesion ..................................
Remove/graft bone lesion ...........................
Remove/graft bone lesion ...........................
Removal of head of radius ..........................
Removal of arm bone lesion .......................
Remove radius bone lesion ........................
Remove elbow bone lesion .........................
Partial removal of arm bone ........................
Partial removal of radius .............................
Partial removal of elbow ..............................
Radical resection of elbow ..........................
Extensive humerus surgery .........................
Extensive humerus surgery .........................
Extensive radius surgery .............................
Extensive radius surgery .............................
Removal of elbow joint ................................
Remove elbow joint implant ........................
Remove radius head implant ......................
Removal of arm foreign body ......................
Removal of arm foreign body ......................
Injection for elbow x-ray ..............................
Manipulate elbow w/anesth .........................
Muscle/tendon transfer ................................
Arm tendon lengthening ..............................
Revision of arm tendon ...............................
Repair of arm tendon ..................................
Revision of arm muscles .............................
Revision of arm muscles .............................
Tenolysis, triceps .........................................
Repair of biceps tendon ..............................
3.26
7.24
8.46
2.23
4.06
8.97
2.94
4.87
9.36
21.28
2.40
3.93
7.35
3.39
4.57
7.49
4.47
7.91
6.05
10.06
2.53
14.17
16.61
19.73
14.62
5.49
0.00
2.95
1.79
6.09
5.82
9.32
2.08
5.21
3.92
6.30
11.76
4.93
6.13
8.04
3.61
7.39
9.64
11.81
6.65
7.90
8.32
6.25
9.74
8.00
8.06
9.19
7.59
7.55
14.21
13.28
15.59
10.06
11.54
11.73
7.84
6.23
1.76
4.56
1.31
3.75
10.20
7.45
5.98
10.56
9.61
10.65
7.45
7.90
Nonfacility
PE
RVUs
4.10
NA
NA
2.92
4.75
NA
4.40
5.95
NA
NA
3.51
4.80
NA
3.68
NA
NA
5.18
NA
6.63
NA
NA
NA
NA
NA
NA
NA
0.00
5.96
5.52
NA
NA
NA
3.47
8.65
7.23
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.26
9.27
3.46
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
3.29
6.18
7.08
2.81
4.19
7.39
3.44
4.97
8.56
13.70
2.89
4.16
6.41
2.67
4.04
6.18
4.59
6.61
5.66
7.86
2.11
10.10
9.87
11.40
9.65
4.93
0.00
2.24
2.09
5.72
5.24
7.51
1.72
4.03
3.34
4.75
7.55
4.39
5.73
6.64
4.25
6.46
7.02
8.78
5.74
6.05
6.82
5.82
8.50
7.04
7.53
8.71
7.71
8.23
11.28
9.69
11.17
7.49
5.91
8.15
6.68
5.58
1.59
4.11
0.46
5.52
7.93
6.49
5.40
7.54
7.63
8.40
6.56
6.76
Malpractice
RVUs
0.35
1.25
1.46
0.36
0.59
1.54
0.48
0.84
1.62
3.69
0.40
0.67
1.27
0.30
0.69
1.29
0.71
1.36
1.01
1.75
0.44
2.35
2.70
3.18
2.46
0.78
0.00
0.43
0.28
1.05
0.97
1.50
0.17
0.80
0.56
0.95
1.72
0.85
1.03
1.33
0.61
1.28
1.67
2.05
1.10
1.06
1.16
1.04
1.64
1.38
1.34
1.51
1.25
1.30
2.34
2.32
2.59
1.48
0.74
1.92
1.30
1.03
0.20
0.72
0.08
0.65
1.66
1.15
0.96
1.73
1.60
1.77
1.23
1.36
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00128
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
7.71
NA
NA
5.52
9.40
NA
7.81
11.66
NA
NA
6.31
9.40
NA
7.36
NA
NA
10.36
NA
13.70
NA
NA
NA
NA
NA
NA
NA
0.00
9.34
7.60
NA
NA
NA
5.73
14.66
11.71
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.22
14.55
4.85
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
6.90
14.67
17.00
5.40
8.84
17.90
6.86
10.68
19.54
38.67
5.69
8.76
15.04
6.35
9.30
14.96
9.77
15.88
12.73
19.67
5.08
26.62
29.19
34.31
26.73
11.20
0.00
5.62
4.16
12.86
12.03
18.33
3.97
10.04
7.81
12.01
21.04
10.17
12.90
16.01
8.47
15.13
18.33
22.65
13.49
15.01
16.30
13.11
19.88
16.42
16.92
19.41
16.54
17.08
27.82
25.28
29.36
19.04
18.20
21.80
15.82
12.84
3.55
9.38
1.85
9.92
19.79
15.10
12.34
19.83
18.84
20.82
15.24
16.01
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
090
090
YYY
010
010
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
000
090
090
090
090
090
090
090
090
090
45891
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
24341
24342
24343
24344
24345
24346
24350
24351
24352
24354
24356
24360
24361
24362
24363
24365
24366
24400
24410
24420
24430
24435
24470
24495
24498
24500
24505
24515
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
24576
24577
24579
24582
24586
24587
24600
24605
24615
24620
24635
24640
24650
24655
24665
24666
24670
24675
24685
24800
24802
24900
24920
24925
24930
24931
24935
24940
24999
25000
25001
25020
25023
25024
25025
25028
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Repair arm tendon/muscle ..........................
Repair of ruptured tendon ...........................
Repr elbow lat ligmnt w/tiss ........................
Reconstruct elbow lat ligmnt .......................
Repr elbw med ligmnt w/tissu .....................
Reconstruct elbow med ligmnt ....................
Repair of tennis elbow ................................
Repair of tennis elbow ................................
Repair of tennis elbow ................................
Repair of tennis elbow ................................
Revision of tennis elbow .............................
Reconstruct elbow joint ...............................
Reconstruct elbow joint ...............................
Reconstruct elbow joint ...............................
Replace elbow joint .....................................
Reconstruct head of radius .........................
Reconstruct head of radius .........................
Revision of humerus ...................................
Revision of humerus ...................................
Revision of humerus ...................................
Repair of humerus .......................................
Repair humerus with graft ...........................
Revision of elbow joint ................................
Decompression of forearm ..........................
Reinforce humerus ......................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat humerus fracture ................................
Treat elbow fracture ....................................
Treat elbow fracture ....................................
Treat elbow dislocation ...............................
Treat elbow dislocation ...............................
Treat elbow dislocation ...............................
Treat elbow fracture ....................................
Treat elbow fracture ....................................
Treat elbow dislocation ...............................
Treat radius fracture ....................................
Treat radius fracture ....................................
Treat radius fracture ....................................
Treat radius fracture ....................................
Treat ulnar fracture ......................................
Treat ulnar fracture ......................................
Treat ulnar fracture ......................................
Fusion of elbow joint ...................................
Fusion/graft of elbow joint ...........................
Amputation of upper arm ............................
Amputation of upper arm ............................
Amputation follow-up surgery ......................
Amputation follow-up surgery ......................
Amputate upper arm & implant ...................
Revision of amputation ................................
Revision of upper arm .................................
Upper arm/elbow surgery ............................
Incision of tendon sheath ............................
Incise flexor carpi radialis ............................
Decompress forearm 1 space .....................
Decompress forearm 1 space .....................
Decompress forearm 2 spaces ...................
Decompress forearm 2 spaces ...................
Drainage of forearm lesion ..........................
7.91
10.62
8.66
14.01
8.66
14.01
5.25
5.91
6.43
6.48
6.68
12.34
14.09
15.00
18.50
8.40
9.14
11.06
14.83
13.45
12.82
13.18
8.75
8.13
11.92
3.22
5.17
11.65
11.65
3.50
6.87
9.44
10.46
15.70
2.81
5.56
7.80
10.66
2.87
5.79
11.60
8.56
15.22
15.17
4.23
5.42
9.43
6.98
13.20
1.20
2.16
4.40
8.15
9.50
2.55
4.72
8.81
11.20
13.70
9.61
9.55
7.07
10.25
12.73
15.57
0.00
0.00
3.38
3.38
5.92
12.97
9.51
16.55
5.25
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.99
6.69
NA
NA
5.33
7.89
NA
NA
NA
4.64
6.71
NA
NA
4.90
7.01
NA
NA
NA
NA
4.99
NA
NA
NA
NA
2.03
4.11
6.05
NA
NA
4.27
6.10
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
7.68
8.25
7.89
11.16
7.78
11.00
5.40
5.72
5.97
5.95
6.10
9.17
10.24
9.75
13.29
6.97
7.29
8.58
10.10
10.21
9.43
10.55
7.46
8.34
8.97
3.57
5.24
9.09
8.82
3.92
6.43
8.42
8.18
10.96
3.09
5.37
7.86
8.14
3.60
5.67
8.55
8.78
10.87
10.68
3.39
5.20
7.57
6.08
13.92
0.77
2.66
4.65
7.26
7.80
2.98
4.83
7.27
8.49
10.04
6.91
6.77
5.91
7.05
5.68
7.92
0.00
0.00
6.49
4.10
9.00
14.21
7.28
9.75
7.73
Malpractice
RVUs
1.36
1.85
1.43
2.36
1.44
2.33
0.87
1.02
1.10
1.07
1.11
2.05
2.18
2.60
3.01
1.41
1.52
1.92
2.57
2.17
2.21
2.27
1.48
1.18
2.06
0.50
0.89
2.02
2.02
0.57
1.18
1.64
1.82
2.73
0.44
0.93
1.30
1.86
0.46
0.95
2.02
1.48
2.64
2.52
0.50
0.89
1.60
1.07
2.28
0.12
0.35
0.70
1.41
1.62
0.41
0.81
1.52
1.63
2.37
1.53
1.61
1.14
1.67
1.89
2.13
0.00
0.00
0.55
0.55
0.93
2.03
1.36
1.82
0.81
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00129
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.71
12.75
NA
NA
9.40
15.94
NA
NA
NA
7.88
13.20
NA
NA
8.23
13.75
NA
NA
NA
NA
9.72
NA
NA
NA
NA
3.35
6.62
11.15
NA
NA
7.23
11.63
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
Facility
total
16.94
20.72
17.98
27.53
17.87
27.34
11.52
12.65
13.50
13.50
13.90
23.56
26.51
27.35
34.80
16.78
17.95
21.56
27.49
25.83
24.45
25.99
17.69
17.65
22.95
7.29
11.30
22.76
22.49
7.99
14.48
19.50
20.46
29.39
6.33
11.86
16.96
20.66
6.93
12.41
22.17
18.82
28.73
28.37
8.12
11.51
18.59
14.13
29.40
2.10
5.18
9.75
16.81
18.92
5.93
10.36
17.60
21.33
26.11
18.05
17.93
14.12
18.97
20.30
25.62
0.00
0.00
10.41
8.03
15.85
29.21
18.15
28.13
13.79
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
090
090
090
090
090
090
090
45892
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
25031
25035
25040
25065
25066
25075
25076
25077
25085
25100
25101
25105
25107
25110
25111
25112
25115
25116
25118
25119
25120
25125
25126
25130
25135
25136
25145
25150
25151
25170
25210
25215
25230
25240
25246
25248
25250
25251
25259
25260
25263
25265
25270
25272
25274
25275
25280
25290
25295
25300
25301
25310
25312
25315
25316
25320
25332
25335
25337
25350
25355
25360
25365
25370
25375
25390
25391
25392
25393
25394
25400
25405
25415
25420
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Drainage of forearm bursa ..........................
Treat forearm bone lesion ...........................
Explore/treat wrist joint ................................
Biopsy forearm soft tissues .........................
Biopsy forearm soft tissues .........................
Removal forearm lesion subcu ...................
Removal forearm lesion deep .....................
Remove tumor, forearm/wrist ......................
Incision of wrist capsule ..............................
Biopsy of wrist joint .....................................
Explore/treat wrist joint ................................
Remove wrist joint lining .............................
Remove wrist joint cartilage ........................
Remove wrist tendon lesion ........................
Remove wrist tendon lesion ........................
Reremove wrist tendon lesion .....................
Remove wrist/forearm lesion .......................
Remove wrist/forearm lesion .......................
Excise wrist tendon sheath .........................
Partial removal of ulna ................................
Removal of forearm lesion ..........................
Remove/graft forearm lesion .......................
Remove/graft forearm lesion .......................
Removal of wrist lesion ...............................
Remove & graft wrist lesion ........................
Remove & graft wrist lesion ........................
Remove forearm bone lesion ......................
Partial removal of ulna ................................
Partial removal of radius .............................
Extensive forearm surgery ..........................
Removal of wrist bone ................................
Removal of wrist bones ...............................
Partial removal of radius .............................
Partial removal of ulna ................................
Injection for wrist x-ray ................................
Remove forearm foreign body ....................
Removal of wrist prosthesis ........................
Removal of wrist prosthesis ........................
Manipulate wrist w/anesthes .......................
Repair forearm tendon/muscle ....................
Repair forearm tendon/muscle ....................
Repair forearm tendon/muscle ....................
Repair forearm tendon/muscle ....................
Repair forearm tendon/muscle ....................
Repair forearm tendon/muscle ....................
Repair forearm tendon sheath ....................
Revise wrist/forearm tendon .......................
Incise wrist/forearm tendon .........................
Release wrist/forearm tendon .....................
Fusion of tendons at wrist ...........................
Fusion of tendons at wrist ...........................
Transplant forearm tendon ..........................
Transplant forearm tendon ..........................
Revise palsy hand tendon(s) ......................
Revise palsy hand tendon(s) ......................
Repair/revise wrist joint ...............................
Revise wrist joint .........................................
Realignment of hand ...................................
Reconstruct ulna/radioulnar ........................
Revision of radius ........................................
Revision of radius ........................................
Revision of ulna ...........................................
Revise radius & ulna ...................................
Revise radius or ulna ..................................
Revise radius & ulna ...................................
Shorten radius or ulna .................................
Lengthen radius or ulna ..............................
Shorten radius & ulna .................................
Lengthen radius & ulna ...............................
Repair carpal bone, shorten ........................
Repair radius or ulna ...................................
Repair/graft radius or ulna ..........................
Repair radius & ulna ...................................
Repair/graft radius & ulna ...........................
4.14
7.36
7.18
1.99
4.13
3.74
4.92
9.77
5.50
3.90
4.69
5.85
6.43
3.92
3.39
4.53
8.83
7.11
4.37
6.04
6.10
7.48
7.56
5.26
6.89
5.97
6.37
7.09
7.39
11.09
5.95
7.90
5.23
5.17
1.45
5.14
6.60
9.58
3.75
7.81
7.83
9.89
6.00
7.04
8.76
8.51
7.22
5.29
6.55
8.81
8.41
8.15
9.58
10.20
12.33
10.77
11.41
12.89
10.17
8.79
10.17
8.44
12.40
13.37
13.05
10.40
13.66
13.96
15.88
10.40
10.92
14.39
13.36
16.34
Nonfacility
PE
RVUs
NA
NA
NA
3.49
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.36
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
7.45
12.69
7.00
1.85
6.69
5.66
8.98
11.47
6.78
5.04
5.64
6.97
7.98
6.65
4.51
5.05
13.21
12.34
5.49
7.25
11.29
12.05
12.20
6.15
7.22
6.35
11.29
7.83
11.93
14.28
6.52
8.37
5.89
6.61
0.50
8.08
5.92
7.68
5.53
12.49
12.46
13.46
11.23
11.96
12.81
7.34
11.85
13.90
11.39
8.15
7.76
12.25
13.12
13.54
15.27
11.02
8.89
11.18
10.64
13.10
13.71
12.99
14.72
15.25
15.43
13.71
15.64
15.22
16.66
7.82
14.27
16.29
15.55
17.27
Malpractice
RVUs
0.63
1.24
1.15
0.15
0.64
0.55
0.74
1.42
0.85
0.59
0.75
0.92
0.99
0.62
0.53
0.70
1.31
1.11
0.68
0.96
1.00
1.06
1.27
0.80
1.02
1.03
1.01
1.14
1.18
1.77
0.88
1.19
0.79
0.81
0.09
0.72
1.01
1.26
0.62
1.19
1.18
1.47
0.95
1.11
1.36
1.31
1.08
0.82
1.00
1.26
1.29
1.21
1.41
1.58
1.74
1.61
1.83
1.92
1.61
1.46
1.73
1.41
2.15
2.28
2.26
1.65
2.21
2.10
2.76
1.59
1.82
2.32
2.17
2.61
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00130
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
5.64
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.90
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
12.22
21.29
15.34
4.00
11.46
9.95
14.64
22.66
13.13
9.53
11.08
13.74
15.41
11.19
8.43
10.28
23.35
20.56
10.54
14.25
18.39
20.60
21.02
12.21
15.13
13.35
18.67
16.06
20.50
27.15
13.35
17.46
11.91
12.59
2.05
13.94
13.53
18.52
9.90
21.49
21.47
24.82
18.18
20.11
22.92
17.15
20.15
20.01
18.94
18.22
17.46
21.61
24.11
25.32
29.35
23.40
22.13
25.99
22.42
23.35
25.61
22.84
29.28
30.89
30.73
25.76
31.51
31.28
35.30
19.81
27.01
33.00
31.07
36.23
Global
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45893
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
25425
25426
25430
25431
25440
25441
25442
25443
25444
25445
25446
25447
25449
25450
25455
25490
25491
25492
25500
25505
25515
25520
25525
25526
25530
25535
25545
25560
25565
25574
25575
25600
25605
25611
25620
25622
25624
25628
25630
25635
25645
25650
25651
25652
25660
25670
25671
25675
25676
25680
25685
25690
25695
25800
25805
25810
25820
25825
25830
25900
25905
25907
25909
25915
25920
25922
25924
25927
25929
25931
25999
26010
26011
26020
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
Physician
work
RVUs 3
Description
Repair/graft radius or ulna ..........................
Repair/graft radius & ulna ...........................
Vasc graft into carpal bone .........................
Repair nonunion carpal bone ......................
Repair/graft wrist bone ................................
Reconstruct wrist joint .................................
Reconstruct wrist joint .................................
Reconstruct wrist joint .................................
Reconstruct wrist joint .................................
Reconstruct wrist joint .................................
Wrist replacement .......................................
Repair wrist joint(s) .....................................
Remove wrist joint implant ..........................
Revision of wrist joint ..................................
Revision of wrist joint ..................................
Reinforce radius ..........................................
Reinforce ulna .............................................
Reinforce radius and ulna ...........................
Treat fracture of radius ................................
Treat fracture of radius ................................
Treat fracture of radius ................................
Treat fracture of radius ................................
Treat fracture of radius ................................
Treat fracture of radius ................................
Treat fracture of ulna ...................................
Treat fracture of ulna ...................................
Treat fracture of ulna ...................................
Treat fracture radius & ulna ........................
Treat fracture radius & ulna ........................
Treat fracture radius & ulna ........................
Treat fracture radius/ulna ............................
Treat fracture radius/ulna ............................
Treat fracture radius/ulna ............................
Treat fracture radius/ulna ............................
Treat fracture radius/ulna ............................
Treat wrist bone fracture .............................
Treat wrist bone fracture .............................
Treat wrist bone fracture .............................
Treat wrist bone fracture .............................
Treat wrist bone fracture .............................
Treat wrist bone fracture .............................
Treat wrist bone fracture .............................
Pin ulnar styloid fracture .............................
Treat fracture ulnar styloid ..........................
Treat wrist dislocation .................................
Treat wrist dislocation .................................
Pin radioulnar dislocation ............................
Treat wrist dislocation .................................
Treat wrist dislocation .................................
Treat wrist fracture ......................................
Treat wrist fracture ......................................
Treat wrist dislocation .................................
Treat wrist dislocation .................................
Fusion of wrist joint .....................................
Fusion/graft of wrist joint .............................
Fusion/graft of wrist joint .............................
Fusion of hand bones .................................
Fuse hand bones with graft ........................
Fusion, radioulnar jnt/ulna ...........................
Amputation of forearm .................................
Amputation of forearm .................................
Amputation follow-up surgery ......................
Amputation follow-up surgery ......................
Amputation of forearm .................................
Amputate hand at wrist ...............................
Amputate hand at wrist ...............................
Amputation follow-up surgery ......................
Amputation of hand .....................................
Amputation follow-up surgery ......................
Amputation follow-up surgery ......................
Forearm or wrist surgery .............................
Drainage of finger abscess .........................
Drainage of finger abscess .........................
Drain hand tendon sheath ...........................
13.22
15.83
9.26
10.44
10.44
12.91
10.85
10.39
11.15
9.70
16.56
10.37
14.50
7.88
9.50
9.55
9.97
12.33
2.45
5.21
9.19
6.26
12.24
12.99
2.09
5.14
8.91
2.44
5.63
7.01
10.45
2.64
5.81
7.78
8.56
2.62
4.53
8.44
2.89
4.39
7.25
3.06
5.36
7.61
4.76
7.93
6.00
4.67
8.05
5.99
9.79
5.50
8.35
9.77
11.28
10.57
7.45
9.28
10.06
9.02
9.13
7.81
8.97
17.08
8.69
7.42
8.47
8.81
7.60
7.82
0.00
1.54
2.19
4.67
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.74
6.63
NA
6.94
NA
NA
3.93
6.11
NA
3.86
6.78
NA
NA
4.25
7.30
NA
NA
4.43
6.13
NA
4.34
6.05
NA
4.20
NA
NA
NA
NA
NA
5.76
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
5.21
8.22
NA
Facility
PE
RVUs
20.06
15.84
7.15
8.14
9.04
9.69
8.61
8.50
8.75
7.74
11.56
8.38
10.34
9.64
10.38
12.92
13.59
14.41
2.64
5.27
7.21
5.89
9.67
13.19
2.78
5.15
7.41
2.52
5.27
6.97
9.21
2.88
6.05
8.63
7.02
3.00
4.93
7.58
2.85
3.80
6.41
3.07
5.32
6.78
4.57
6.76
5.95
4.51
7.06
4.65
7.57
5.34
6.86
8.74
9.86
9.54
7.54
8.88
13.60
11.89
11.58
11.06
11.60
17.81
7.56
6.76
7.77
11.04
5.70
10.79
0.00
1.56
2.23
5.17
Malpractice
RVUs
2.08
2.54
1.27
1.90
1.63
2.07
1.53
1.37
1.71
1.55
2.47
1.61
2.21
1.36
0.96
1.43
1.60
2.14
0.35
0.90
1.59
1.08
2.12
2.19
0.34
0.89
1.53
0.35
0.93
1.21
1.81
0.42
1.00
1.34
1.42
0.41
0.76
1.37
0.45
0.74
1.20
0.45
0.86
1.21
0.58
1.28
1.00
0.62
1.34
0.78
1.60
0.88
1.32
1.57
1.80
1.67
1.22
1.41
1.55
1.30
1.40
1.10
1.44
2.93
1.35
1.12
1.32
1.27
1.14
1.15
0.00
0.18
0.33
0.73
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00131
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.55
12.74
NA
14.28
NA
NA
6.37
12.14
NA
6.66
13.34
NA
NA
7.31
14.11
NA
NA
7.45
11.42
NA
7.68
11.18
NA
7.71
NA
NA
NA
NA
NA
11.05
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
6.93
10.74
NA
Facility
total
35.36
34.22
17.68
20.48
21.11
24.67
21.00
20.26
21.61
18.99
30.59
20.36
27.05
18.87
20.84
23.90
25.16
28.89
5.44
11.38
17.99
13.23
24.04
28.36
5.21
11.18
17.85
5.31
11.83
15.19
21.47
5.93
12.86
17.75
17.00
6.03
10.22
17.38
6.18
8.92
14.86
6.57
11.54
15.60
9.91
15.96
12.96
9.80
16.45
11.42
18.96
11.72
16.53
20.08
22.94
21.78
16.21
19.57
25.21
22.21
22.11
19.96
22.01
37.83
17.59
15.31
17.56
21.11
14.43
19.75
0.00
3.29
4.75
10.56
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
010
010
090
45894
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
26025
26030
26034
26035
26037
26040
26045
26055
26060
26070
26075
26080
26100
26105
26110
26115
26116
26117
26121
26123
26125
26130
26135
26140
26145
26160
26170
26180
26185
26200
26205
26210
26215
26230
26235
26236
26250
26255
26260
26261
26262
26320
26340
26350
26352
26356
26357
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418
26420
26426
26428
26432
26433
26434
26437
26440
26442
26445
26449
26450
26455
26460
26471
26474
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Drainage of palm bursa ...............................
Drainage of palm bursa(s) ..........................
Treat hand bone lesion ...............................
Decompress fingers/hand ...........................
Decompress fingers/hand ...........................
Release palm contracture ...........................
Release palm contracture ...........................
Incise finger tendon sheath .........................
Incision of finger tendon ..............................
Explore/treat hand joint ...............................
Explore/treat finger joint ..............................
Explore/treat finger joint ..............................
Biopsy hand joint lining ...............................
Biopsy finger joint lining ..............................
Biopsy finger joint lining ..............................
Removal hand lesion subcut .......................
Removal hand lesion, deep ........................
Remove tumor, hand/finger .........................
Release palm contracture ...........................
Release palm contracture ...........................
Release palm contracture ...........................
Remove wrist joint lining .............................
Revise finger joint, each ..............................
Revise finger joint, each ..............................
Tendon excision, palm/finger ......................
Remove tendon sheath lesion ....................
Removal of palm tendon, each ...................
Removal of finger tendon ............................
Remove finger bone ....................................
Remove hand bone lesion ..........................
Remove/graft bone lesion ...........................
Removal of finger lesion .............................
Remove/graft finger lesion ..........................
Partial removal of hand bone ......................
Partial removal, finger bone ........................
Partial removal, finger bone ........................
Extensive hand surgery ...............................
Extensive hand surgery ...............................
Extensive finger surgery ..............................
Extensive finger surgery ..............................
Partial removal of finger ..............................
Removal of implant from hand ....................
Manipulate finger w/anesth .........................
Repair finger/hand tendon ...........................
Repair/graft hand tendon ............................
Repair finger/hand tendon ...........................
Repair finger/hand tendon ...........................
Repair/graft hand tendon ............................
Repair finger/hand tendon ...........................
Repair/graft hand tendon ............................
Repair finger/hand tendon ...........................
Revise hand/finger tendon ..........................
Repair/graft hand tendon ............................
Repair hand tendon .....................................
Repair/graft hand tendon ............................
Excision, hand/finger tendon .......................
Graft hand or finger tendon .........................
Repair finger tendon ....................................
Repair/graft finger tendon ...........................
Repair finger/hand tendon ...........................
Repair/graft finger tendon ...........................
Repair finger tendon ....................................
Repair finger tendon ....................................
Repair/graft finger tendon ...........................
Realignment of tendons ..............................
Release palm/finger tendon ........................
Release palm & finger tendon ....................
Release hand/finger tendon ........................
Release forearm/hand tendon .....................
Incision of palm tendon ...............................
Incision of finger tendon ..............................
Incise hand/finger tendon ............................
Fusion of finger tendons .............................
Fusion of finger tendons .............................
4.82
5.93
6.23
9.52
7.25
3.34
5.56
2.70
2.82
3.69
3.79
4.24
3.67
3.71
3.53
3.86
5.53
8.56
7.55
9.30
4.61
5.42
6.96
6.17
6.32
3.16
4.77
5.18
5.25
5.51
7.71
5.15
7.10
6.33
6.19
5.32
7.56
12.43
7.03
9.10
5.67
3.98
2.51
5.99
7.69
8.08
8.59
9.15
7.11
8.77
8.17
9.20
10.26
4.63
6.31
8.35
9.38
4.25
6.77
6.15
7.21
4.02
4.56
6.09
5.82
5.02
8.17
4.31
7.00
3.67
3.64
3.46
5.73
5.32
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
13.25
NA
NA
NA
NA
NA
NA
NA
12.36
NA
NA
NA
NA
NA
NA
NA
NA
NA
11.58
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
4.94
5.53
6.14
7.64
6.11
3.91
5.45
3.79
3.39
3.29
3.68
4.69
3.99
4.08
3.91
4.61
5.81
6.86
6.73
8.57
2.37
5.17
6.25
5.85
5.85
3.98
4.78
5.23
5.85
5.19
6.67
5.24
6.17
5.71
5.62
5.14
6.23
9.06
5.99
5.99
5.16
4.17
4.73
13.59
14.33
17.23
14.61
15.56
14.05
15.41
14.94
12.48
15.62
11.08
12.37
11.10
13.70
11.46
12.71
12.28
12.96
9.55
10.05
10.81
10.83
12.48
14.98
12.19
14.77
6.88
6.84
6.72
10.54
10.64
Malpractice
RVUs
0.76
0.92
1.01
1.47
1.13
0.53
0.93
0.43
0.45
0.48
0.53
0.66
0.54
0.59
0.53
0.59
0.84
1.26
1.17
1.43
0.70
0.94
1.07
0.92
0.97
0.49
0.69
0.78
0.81
0.88
1.20
0.79
0.98
1.01
0.95
0.81
1.07
1.68
1.01
1.14
0.88
0.59
0.39
0.93
1.13
1.21
1.33
1.38
1.12
1.40
1.23
1.40
1.57
0.73
0.97
0.98
0.79
0.67
1.07
0.95
1.09
0.64
0.72
0.93
0.89
0.75
1.20
0.65
1.06
0.59
0.58
0.55
0.88
0.76
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00132
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
16.38
NA
NA
NA
NA
NA
NA
NA
16.81
NA
NA
NA
NA
NA
NA
NA
NA
NA
15.23
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
10.52
12.38
13.38
18.62
14.50
7.77
11.94
6.92
6.65
7.45
7.99
9.59
8.19
8.38
7.97
9.06
12.18
16.67
15.44
19.30
7.68
11.53
14.28
12.94
13.15
7.63
10.24
11.19
11.91
11.58
15.57
11.18
14.25
13.05
12.76
11.27
14.85
23.18
14.03
16.23
11.71
8.74
7.62
20.51
23.15
26.52
24.52
26.09
22.28
25.58
24.33
23.08
27.45
16.44
19.65
20.43
23.87
16.37
20.55
19.38
21.26
14.21
15.32
17.84
17.54
18.25
24.35
17.15
22.83
11.14
11.05
10.72
17.15
16.72
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45895
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
26476
26477
26478
26479
26480
26483
26485
26489
26490
26492
26494
26496
26497
26498
26499
26500
26502
26504
26508
26510
26516
26517
26518
26520
26525
26530
26531
26535
26536
26540
26541
26542
26545
26546
26548
26550
26551
26553
26554
26555
26556
26560
26561
26562
26565
26567
26568
26580
26587
26590
26591
26593
26596
26600
26605
26607
26608
26615
26641
26645
26650
26665
26670
26675
26676
26685
26686
26700
26705
26706
26715
26720
26725
26727
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Tendon lengthening .....................................
Tendon shortening ......................................
Lengthening of hand tendon .......................
Shortening of hand tendon ..........................
Transplant hand tendon ..............................
Transplant/graft hand tendon ......................
Transplant palm tendon ..............................
Transplant/graft palm tendon ......................
Revise thumb tendon ..................................
Tendon transfer with graft ...........................
Hand tendon/muscle transfer ......................
Revise thumb tendon ..................................
Finger tendon transfer .................................
Finger tendon transfer .................................
Revision of finger ........................................
Hand tendon reconstruction ........................
Hand tendon reconstruction ........................
Hand tendon reconstruction ........................
Release thumb contracture .........................
Thumb tendon transfer ................................
Fusion of knuckle joint ................................
Fusion of knuckle joints ...............................
Fusion of knuckle joints ...............................
Release knuckle contracture .......................
Release finger contracture ..........................
Revise knuckle joint ....................................
Revise knuckle with implant ........................
Revise finger joint ........................................
Revise/implant finger joint ...........................
Repair hand joint .........................................
Repair hand joint with graft .........................
Repair hand joint with graft .........................
Reconstruct finger joint ...............................
Repair nonunion hand .................................
Reconstruct finger joint ...............................
Construct thumb replacement .....................
Great toe-hand transfer ...............................
Single transfer, toe-hand .............................
Double transfer, toe-hand ...........................
Positional change of finger ..........................
Toe joint transfer .........................................
Repair of web finger ....................................
Repair of web finger ....................................
Repair of web finger ....................................
Correct metacarpal flaw ..............................
Correct finger deformity ...............................
Lengthen metacarpal/finger .........................
Repair hand deformity .................................
Reconstruct extra finger ..............................
Repair finger deformity ................................
Repair muscles of hand ..............................
Release muscles of hand ............................
Excision constricting tissue .........................
Treat metacarpal fracture ............................
Treat metacarpal fracture ............................
Treat metacarpal fracture ............................
Treat metacarpal fracture ............................
Treat metacarpal fracture ............................
Treat thumb dislocation ...............................
Treat thumb fracture ....................................
Treat thumb fracture ....................................
Treat thumb fracture ....................................
Treat hand dislocation .................................
Treat hand dislocation .................................
Pin hand dislocation ....................................
Treat hand dislocation .................................
Treat hand dislocation .................................
Treat knuckle dislocation .............................
Treat knuckle dislocation .............................
Pin knuckle dislocation ................................
Treat knuckle dislocation .............................
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
5.18
5.15
5.80
5.74
6.69
8.30
7.71
9.56
8.42
9.63
8.48
9.60
9.58
14.01
8.99
5.96
7.14
7.47
6.01
5.43
7.15
8.84
9.03
5.30
5.33
6.69
7.92
5.24
6.37
6.43
8.63
6.78
6.92
8.93
8.04
21.25
46.60
46.29
54.98
16.64
47.28
5.38
10.92
15.01
6.74
6.82
9.09
18.19
14.06
17.97
3.26
5.31
8.96
1.96
2.86
5.36
5.36
5.33
3.94
4.41
5.72
7.61
3.69
4.64
5.52
6.98
7.95
3.69
4.19
5.12
5.74
1.66
3.34
5.23
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.79
4.70
NA
NA
NA
4.72
5.31
NA
NA
4.41
5.57
NA
NA
NA
3.68
5.43
NA
NA
2.70
4.60
NA
Facility
PE
RVUs
10.25
10.36
11.05
10.82
14.01
14.50
14.35
11.43
12.07
12.83
12.21
12.51
12.79
15.30
12.25
10.72
11.30
11.78
10.92
10.60
11.48
12.69
12.59
12.91
12.98
5.96
6.91
3.74
9.37
11.12
12.57
11.28
11.40
14.18
12.05
16.68
30.93
24.09
35.75
17.43
33.97
9.22
11.75
16.25
11.26
11.21
14.50
13.16
8.99
13.46
8.94
10.45
8.42
2.57
3.55
5.98
6.00
5.12
3.42
4.08
6.43
6.39
2.85
4.34
6.43
5.94
6.67
2.76
4.18
4.95
5.33
1.98
3.40
5.98
Malpractice
RVUs
0.79
0.81
0.90
0.92
1.02
1.26
1.15
1.26
1.21
1.40
1.28
1.45
1.41
2.10
1.35
0.90
1.13
1.24
0.98
0.79
1.10
1.41
1.35
0.80
0.81
1.04
1.17
0.71
0.96
0.99
1.28
1.02
1.05
1.44
1.20
2.45
7.96
2.41
9.41
2.48
2.57
0.85
1.45
2.23
1.00
1.04
1.49
2.28
1.53
2.77
0.48
0.78
1.43
0.30
0.49
0.87
0.88
0.86
0.39
0.67
0.94
0.90
0.39
0.77
0.91
1.09
1.24
0.35
0.66
0.81
0.91
0.24
0.53
0.84
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00133
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.05
8.05
NA
NA
NA
9.05
10.39
NA
NA
8.49
10.98
NA
NA
NA
7.71
10.28
NA
NA
4.60
8.47
NA
Facility
total
16.22
16.32
17.75
17.48
21.73
24.06
23.20
22.25
21.70
23.86
21.97
23.56
23.78
31.41
22.59
17.58
19.57
20.50
17.92
16.82
19.73
22.94
22.97
19.01
19.12
13.70
16.00
9.69
16.70
18.55
22.48
19.08
19.37
24.54
21.29
40.38
85.49
72.79
100.14
36.56
83.82
15.45
24.12
33.49
19.01
19.08
25.08
33.63
24.58
34.20
12.68
16.54
18.81
4.83
6.90
12.21
12.25
11.31
7.75
9.16
13.09
14.90
6.92
9.75
12.86
14.02
15.86
6.80
9.03
10.88
11.98
3.89
7.26
12.05
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45896
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
26820
26841
26842
26843
26844
26850
26852
26860
26861
26862
26863
26910
26951
26952
26989
26990
26991
26992
27000
27001
27003
27005
27006
27025
27030
27033
27035
27036
27040
27041
27047
27048
27049
27050
27052
27054
27060
27062
27065
27066
27067
27070
27071
27075
27076
27077
27078
27079
27080
27086
27087
27090
27091
27093
27095
27096
27097
27098
27100
27105
27110
27111
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
Treat finger fracture, each ...........................
Pin finger fracture, each ..............................
Treat finger fracture, each ...........................
Treat finger dislocation ................................
Treat finger dislocation ................................
Pin finger dislocation ...................................
Treat finger dislocation ................................
Thumb fusion with graft ...............................
Fusion of thumb ..........................................
Thumb fusion with graft ...............................
Fusion of hand joint .....................................
Fusion/graft of hand joint ............................
Fusion of knuckle ........................................
Fusion of knuckle with graft ........................
Fusion of finger joint ....................................
Fusion of finger jnt, add-on .........................
Fusion/graft of finger joint ...........................
Fuse/graft added joint .................................
Amputate metacarpal bone .........................
Amputation of finger/thumb .........................
Amputation of finger/thumb .........................
Hand/finger surgery .....................................
Drainage of pelvis lesion .............................
Drainage of pelvis bursa .............................
Drainage of bone lesion ..............................
Incision of hip tendon ..................................
Incision of hip tendon ..................................
Incision of hip tendon ..................................
Incision of hip tendon ..................................
Incision of hip tendons ................................
Incision of hip/thigh fascia ...........................
Drainage of hip joint ....................................
Exploration of hip joint .................................
Denervation of hip joint ...............................
Excision of hip joint/muscle .........................
Biopsy of soft tissues ..................................
Biopsy of soft tissues ..................................
Remove hip/pelvis lesion ............................
Remove hip/pelvis lesion ............................
Remove tumor, hip/pelvis ............................
Biopsy of sacroiliac joint ..............................
Biopsy of hip joint ........................................
Removal of hip joint lining ...........................
Removal of ischial bursa .............................
Remove femur lesion/bursa ........................
Removal of hip bone lesion ........................
Removal of hip bone lesion ........................
Remove/graft hip bone lesion .....................
Partial removal of hip bone .........................
Partial removal of hip bone .........................
Extensive hip surgery ..................................
Extensive hip surgery ..................................
Extensive hip surgery ..................................
Extensive hip surgery ..................................
Extensive hip surgery ..................................
Removal of tail bone ...................................
Remove hip foreign body ............................
Remove hip foreign body ............................
Removal of hip prosthesis ...........................
Removal of hip prosthesis ...........................
Injection for hip x-ray ...................................
Injection for hip x-ray ...................................
Inject sacroiliac joint ....................................
Revision of hip tendon ................................
Transfer tendon to pelvis ............................
Transfer of abdominal muscle .....................
Transfer of spinal muscle ............................
Transfer of iliopsoas muscle .......................
Transfer of iliopsoas muscle .......................
5.98
1.94
3.85
5.81
1.70
3.11
4.39
4.17
3.03
3.71
4.80
4.21
8.27
7.13
8.25
7.62
8.74
6.97
8.47
4.69
1.74
7.37
3.90
7.61
4.59
6.31
0.00
7.48
6.68
13.03
5.62
6.94
7.34
9.67
9.69
11.16
13.02
13.40
16.69
12.89
2.88
9.90
7.45
6.25
13.67
4.36
6.23
8.55
5.43
5.37
5.90
10.33
13.84
10.72
11.46
35.02
22.13
40.02
13.45
13.76
6.39
1.87
8.55
11.15
22.15
1.30
1.50
1.40
8.81
8.84
11.08
11.77
13.27
12.15
Nonfacility
PE
RVUs
NA
3.04
5.11
NA
2.41
4.27
NA
NA
3.34
5.29
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
10.53
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.38
NA
7.18
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.44
NA
NA
NA
4.24
5.37
4.02
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
5.37
2.63
3.78
5.37
1.94
2.91
5.49
4.24
2.32
3.69
5.76
4.37
12.42
12.37
12.54
11.60
12.56
11.44
12.16
10.46
0.90
11.62
2.05
10.59
9.50
10.91
0.00
6.97
5.30
9.96
5.11
5.89
6.33
7.57
7.73
8.32
9.33
9.61
10.89
9.70
2.05
6.60
4.71
4.72
8.24
4.30
5.71
7.11
4.27
5.02
5.29
8.19
10.34
8.80
9.74
18.71
14.10
22.00
9.64
9.29
4.72
1.80
6.51
8.50
13.56
0.49
0.52
0.32
6.21
6.82
8.39
8.87
8.88
8.85
Malpractice
RVUs
0.95
0.31
0.58
0.91
0.22
0.42
0.71
0.66
0.27
0.54
0.77
0.68
1.30
1.18
1.32
1.15
1.33
1.06
1.22
0.73
0.27
1.10
0.56
1.16
0.71
0.95
0.00
1.22
1.11
2.16
0.98
1.24
1.12
1.72
1.69
1.84
2.26
2.32
2.15
2.26
0.27
1.35
1.03
0.92
2.06
0.60
1.08
1.47
0.80
0.93
1.01
1.79
1.84
1.74
1.92
5.64
3.70
6.12
2.22
1.94
0.93
0.25
1.35
1.94
3.84
0.13
0.14
0.08
1.57
0.95
1.85
1.72
2.18
1.94
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00134
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
5.30
9.54
NA
4.33
7.80
NA
NA
6.64
9.54
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
18.32
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.53
NA
15.67
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.56
NA
NA
NA
5.67
7.01
5.50
NA
NA
NA
NA
NA
NA
Facility
total
12.30
4.88
8.21
12.09
3.86
6.44
10.59
9.07
5.62
7.94
11.33
9.26
21.99
20.69
22.11
20.37
22.63
19.48
21.85
15.88
2.92
20.09
6.50
19.36
14.80
18.17
0.00
15.67
13.09
25.15
11.71
14.08
14.79
18.95
19.11
21.33
24.61
25.33
29.73
24.85
5.20
17.85
13.19
11.89
23.97
9.26
13.02
17.13
10.50
11.32
12.20
20.31
26.02
21.26
23.12
59.37
39.94
68.14
25.31
24.99
12.05
3.92
16.41
21.59
39.56
1.92
2.17
1.81
16.58
16.61
21.33
22.37
24.32
22.95
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
ZZZ
090
090
090
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
000
000
000
090
090
090
090
090
090
45897
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
27120
27122
27125
27130
27132
27134
27137
27138
27140
27146
27147
27151
27156
27158
27161
27165
27170
27175
27176
27177
27178
27179
27181
27185
27187
27193
27194
27200
27202
27215
27216
27217
27218
27220
27222
27226
27227
27228
27230
27232
27235
27236
27238
27240
27244
27245
27246
27248
27250
27252
27253
27254
27256
27257
27258
27259
27265
27266
27275
27280
27282
27284
27286
27290
27295
27299
27301
27303
27305
27306
27307
27310
27315
27320
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Reconstruction of hip socket .......................
Reconstruction of hip socket .......................
Partial hip replacement ...............................
Total hip arthroplasty ...................................
Total hip arthroplasty ...................................
Revise hip joint replacement .......................
Revise hip joint replacement .......................
Revise hip joint replacement .......................
Transplant femur ridge ................................
Incision of hip bone .....................................
Revision of hip bone ...................................
Incision of hip bones ...................................
Revision of hip bones ..................................
Revision of pelvis ........................................
Incision of neck of femur .............................
Incision/fixation of femur .............................
Repair/graft femur head/neck ......................
Treat slipped epiphysis ...............................
Treat slipped epiphysis ...............................
Treat slipped epiphysis ...............................
Treat slipped epiphysis ...............................
Revise head/neck of femur .........................
Treat slipped epiphysis ...............................
Revision of femur epiphysis ........................
Reinforce hip bones ....................................
Treat pelvic ring fracture .............................
Treat pelvic ring fracture .............................
Treat tail bone fracture ................................
Treat tail bone fracture ................................
Treat pelvic fracture(s) ................................
Treat pelvic ring fracture .............................
Treat pelvic ring fracture .............................
Treat pelvic ring fracture .............................
Treat hip socket fracture .............................
Treat hip socket fracture .............................
Treat hip wall fracture .................................
Treat hip fracture(s) .....................................
Treat hip fracture(s) .....................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat thigh fracture ......................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Treat hip dislocation ....................................
Manipulation of hip joint ..............................
Fusion of sacroiliac joint ..............................
Fusion of pubic bones .................................
Fusion of hip joint ........................................
Fusion of hip joint ........................................
Amputation of leg at hip ..............................
Amputation of leg at hip ..............................
Pelvis/hip joint surgery ................................
Drain thigh/knee lesion ................................
Drainage of bone lesion ..............................
Incise thigh tendon & fascia ........................
Incision of thigh tendon ...............................
Incision of thigh tendons .............................
Exploration of knee joint ..............................
Partial removal, thigh nerve ........................
Partial removal, thigh nerve ........................
18.02
14.99
14.70
20.13
23.32
28.54
21.18
22.18
12.24
17.43
20.59
22.52
24.64
19.75
16.71
17.92
16.08
8.47
12.05
15.09
11.99
12.99
14.69
9.19
13.55
5.56
9.66
1.84
7.04
10.05
15.20
14.12
20.16
6.18
12.71
14.92
23.46
27.17
5.50
10.68
12.16
15.61
5.52
12.50
15.95
20.32
4.71
10.45
6.95
10.39
12.93
18.27
4.12
5.22
15.44
21.56
5.05
7.49
2.27
13.40
11.34
23.46
23.46
23.30
18.66
0.00
6.49
8.29
5.92
4.62
5.80
9.28
6.97
6.30
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.94
NA
2.16
NA
NA
NA
NA
NA
5.56
NA
NA
NA
NA
5.35
NA
NA
NA
NA
NA
NA
NA
4.33
NA
NA
NA
NA
NA
3.43
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
9.54
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
11.51
10.69
10.30
12.88
15.15
17.24
13.50
13.95
9.11
11.77
12.90
7.72
15.58
10.86
11.73
12.51
10.95
6.48
8.73
10.56
8.16
9.67
9.92
7.28
9.99
4.94
7.43
2.09
15.72
6.86
9.29
9.83
11.08
5.47
9.65
7.58
14.93
17.08
4.95
6.97
9.14
10.71
4.99
9.20
10.94
13.31
4.30
7.95
4.46
7.21
9.47
11.66
2.02
2.73
10.55
13.80
4.64
6.15
2.04
9.96
8.03
14.32
15.30
13.67
10.98
0.00
5.00
6.75
5.02
4.56
5.21
7.35
4.85
5.10
Malpractice
RVUs
3.08
2.61
2.54
3.50
4.04
4.94
3.67
3.84
2.11
2.96
3.57
3.91
4.21
3.16
2.94
3.10
2.81
1.46
2.22
2.61
2.08
2.25
1.57
2.39
2.37
0.96
1.65
0.28
1.06
1.97
2.63
2.41
3.48
1.07
2.19
2.48
4.05
4.66
0.95
1.85
2.11
2.71
0.89
2.16
2.77
3.52
0.81
1.81
0.62
1.66
2.24
3.17
0.46
0.69
2.64
3.74
0.63
1.29
0.39
2.53
1.86
3.92
3.12
3.43
2.95
0.00
1.04
1.43
1.01
0.85
1.04
1.61
1.09
1.06
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00135
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
11.47
NA
4.29
NA
NA
NA
NA
NA
12.81
NA
NA
NA
NA
11.80
NA
NA
NA
NA
NA
NA
NA
9.85
NA
NA
NA
NA
NA
8.01
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
17.08
NA
NA
NA
NA
NA
NA
NA
Facility
total
32.60
28.29
27.54
36.51
42.51
50.72
38.35
39.97
23.47
32.17
37.06
34.16
44.43
33.77
31.38
33.53
29.85
16.41
23.01
28.26
22.24
24.91
26.18
18.86
25.90
11.47
18.74
4.21
23.83
18.88
27.12
26.36
34.72
12.72
24.54
24.97
42.44
48.92
11.41
19.50
23.42
29.03
11.40
23.87
29.67
37.15
9.82
20.21
12.03
19.26
24.63
33.10
6.60
8.64
28.63
39.11
10.32
14.94
4.71
25.89
21.24
41.69
41.88
40.40
32.59
0.00
12.54
16.47
11.95
10.03
12.05
18.24
12.91
12.46
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
010
090
090
090
090
010
090
090
090
090
090
090
YYY
090
090
090
090
090
090
090
090
45898
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
27323
27324
27327
27328
27329
27330
27331
27332
27333
27334
27335
27340
27345
27347
27350
27355
27356
27357
27358
27360
27365
27370
27372
27380
27381
27385
27386
27390
27391
27392
27393
27394
27395
27396
27397
27400
27403
27405
27407
27409
27412
27415
27418
27420
27422
27424
27425
27427
27428
27429
27430
27435
27437
27438
27440
27441
27442
27443
27445
27446
27447
27448
27450
27454
27455
27457
27465
27466
27468
27470
27472
27475
27477
27479
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Biopsy, thigh soft tissues ............................
Biopsy, thigh soft tissues ............................
Removal of thigh lesion ...............................
Removal of thigh lesion ...............................
Remove tumor, thigh/knee ..........................
Biopsy, knee joint lining ..............................
Explore/treat knee joint ...............................
Removal of knee cartilage ..........................
Removal of knee cartilage ..........................
Remove knee joint lining .............................
Remove knee joint lining .............................
Removal of kneecap bursa .........................
Removal of knee cyst ..................................
Remove knee cyst .......................................
Removal of kneecap ...................................
Remove femur lesion ..................................
Remove femur lesion/graft ..........................
Remove femur lesion/graft ..........................
Remove femur lesion/fixation ......................
Partial removal, leg bone(s) ........................
Extensive leg surgery ..................................
Injection for knee x-ray ................................
Removal of foreign body .............................
Repair of kneecap tendon ...........................
Repair/graft kneecap tendon .......................
Repair of thigh muscle ................................
Repair/graft of thigh muscle ........................
Incision of thigh tendon ...............................
Incision of thigh tendons .............................
Incision of thigh tendons .............................
Lengthening of thigh tendon .......................
Lengthening of thigh tendons ......................
Lengthening of thigh tendons ......................
Transplant of thigh tendon ..........................
Transplants of thigh tendons .......................
Revise thigh muscles/tendons ....................
Repair of knee cartilage ..............................
Repair of knee ligament ..............................
Repair of knee ligament ..............................
Repair of knee ligaments ............................
Autochondrocyte implant knee ....................
Osteochondral knee allograft ......................
Repair degenerated kneecap ......................
Revision of unstable kneecap .....................
Revision of unstable kneecap .....................
Revision/removal of kneecap ......................
Lat retinacular release open .......................
Reconstruction, knee ...................................
Reconstruction, knee ...................................
Reconstruction, knee ...................................
Revision of thigh muscles ...........................
Incision of knee joint ...................................
Revise kneecap ...........................................
Revise kneecap with implant ......................
Revision of knee joint ..................................
Revision of knee joint ..................................
Revision of knee joint ..................................
Revision of knee joint ..................................
Revision of knee joint ..................................
Revision of knee joint ..................................
Total knee arthroplasty ................................
Incision of thigh ...........................................
Incision of thigh ...........................................
Realignment of thigh bone ..........................
Realignment of knee ...................................
Realignment of knee ...................................
Shortening of thigh bone .............................
Lengthening of thigh bone ..........................
Shorten/lengthen thighs ..............................
Repair of thigh .............................................
Repair/graft of thigh .....................................
Surgery to stop leg growth ..........................
Surgery to stop leg growth ..........................
Surgery to stop leg growth ..........................
2.28
4.90
4.47
5.57
14.15
4.97
5.88
8.28
7.30
8.71
10.01
4.18
5.92
5.78
8.18
7.66
9.49
10.53
4.74
10.50
16.28
0.96
5.07
7.16
10.34
7.77
10.56
5.33
7.20
9.21
6.39
8.51
11.73
7.87
11.28
9.03
8.34
8.66
10.28
12.91
23.28
18.53
10.85
9.84
9.79
9.82
5.22
9.37
14.01
15.53
9.68
9.50
8.47
11.23
10.43
10.82
11.89
10.93
17.69
15.85
21.49
11.06
13.99
17.57
12.83
13.46
13.88
16.34
18.98
16.08
17.73
8.65
9.86
12.81
Nonfacility
PE
RVUs
3.74
NA
5.95
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.56
9.52
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
1.85
4.09
3.65
4.27
8.81
4.42
5.34
6.89
6.46
7.18
7.96
4.41
5.44
5.27
7.01
6.55
7.61
8.42
2.44
9.16
11.33
0.33
4.54
6.99
8.75
7.33
9.15
4.95
6.35
7.35
5.64
6.98
9.02
6.77
8.76
7.04
6.95
7.25
8.05
9.63
14.69
12.45
8.61
7.85
7.86
7.83
5.33
7.56
10.90
12.03
7.75
8.21
7.01
8.28
5.82
6.50
8.64
8.44
11.96
10.91
14.16
8.33
10.24
12.12
9.54
9.60
9.89
11.46
12.09
11.42
12.28
6.97
7.49
9.48
Malpractice
RVUs
0.24
0.75
0.64
0.84
2.14
0.86
1.02
1.43
1.26
1.51
1.74
0.72
1.00
0.98
1.41
1.32
1.65
1.95
0.82
1.83
2.79
0.08
0.84
1.24
1.79
1.36
1.85
0.92
1.23
1.57
1.10
1.47
2.04
1.34
1.82
1.31
1.44
1.51
1.78
2.24
4.35
4.35
1.88
1.71
1.70
1.70
0.90
1.63
2.42
2.70
1.69
1.69
1.49
1.95
1.81
1.88
2.09
1.90
3.08
2.80
3.79
1.94
2.42
3.12
2.24
2.34
2.47
2.77
3.30
2.79
3.07
1.36
1.73
2.78
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00136
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
6.26
NA
11.06
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.60
15.43
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
4.37
9.74
8.76
10.68
25.09
10.25
12.24
16.60
15.02
17.39
19.71
9.31
12.37
12.03
16.60
15.53
18.75
20.90
8.00
21.49
30.40
1.38
10.45
15.40
20.88
16.45
21.56
11.20
14.78
18.13
13.13
16.96
22.79
15.97
21.87
17.37
16.72
17.42
20.11
24.78
42.32
35.33
21.34
19.40
19.35
19.35
11.45
18.55
27.33
30.27
19.12
19.40
16.96
21.46
18.06
19.20
22.62
21.27
32.73
29.57
39.44
21.33
26.65
32.81
24.61
25.40
26.24
30.58
34.37
30.29
33.07
16.98
19.08
25.07
Global
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45899
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
27485
27486
27487
27488
27495
27496
27497
27498
27499
27500
27501
27502
27503
27506
27507
27508
27509
27510
27511
27513
27514
27516
27517
27519
27520
27524
27530
27532
27535
27536
27538
27540
27550
27552
27556
27557
27558
27560
27562
27566
27570
27580
27590
27591
27592
27594
27596
27598
27599
27600
27601
27602
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27618
27619
27620
27625
27626
27630
27635
27637
27638
27640
27641
27645
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Surgery to stop leg growth ..........................
Revise/replace knee joint ............................
Revise/replace knee joint ............................
Removal of knee prosthesis ........................
Reinforce thigh ............................................
Decompression of thigh/knee ......................
Decompression of thigh/knee ......................
Decompression of thigh/knee ......................
Decompression of thigh/knee ......................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treatment of thigh fracture ..........................
Treat thigh fx growth plate ..........................
Treat thigh fx growth plate ..........................
Treat thigh fx growth plate ..........................
Treat kneecap fracture ................................
Treat kneecap fracture ................................
Treat knee fracture ......................................
Treat knee fracture ......................................
Treat knee fracture ......................................
Treat knee fracture ......................................
Treat knee fracture(s) ..................................
Treat knee fracture ......................................
Treat knee dislocation .................................
Treat knee dislocation .................................
Treat knee dislocation .................................
Treat knee dislocation .................................
Treat knee dislocation .................................
Treat kneecap dislocation ...........................
Treat kneecap dislocation ...........................
Treat kneecap dislocation ...........................
Fixation of knee joint ...................................
Fusion of knee .............................................
Amputate leg at thigh ..................................
Amputate leg at thigh ..................................
Amputate leg at thigh ..................................
Amputation follow-up surgery ......................
Amputation follow-up surgery ......................
Amputate lower leg at knee ........................
Leg surgery procedure ................................
Decompression of lower leg ........................
Decompression of lower leg ........................
Decompression of lower leg ........................
Drain lower leg lesion ..................................
Drain lower leg bursa ..................................
Incision of achilles tendon ...........................
Incision of achilles tendon ...........................
Treat lower leg bone lesion .........................
Explore/treat ankle joint ...............................
Exploration of ankle joint .............................
Biopsy lower leg soft tissue ........................
Biopsy lower leg soft tissue ........................
Remove tumor, lower leg ............................
Remove lower leg lesion .............................
Remove lower leg lesion .............................
Explore/treat ankle joint ...............................
Remove ankle joint lining ............................
Remove ankle joint lining ............................
Removal of tendon lesion ...........................
Remove lower leg bone lesion ....................
Remove/graft leg bone lesion .....................
Remove/graft leg bone lesion .....................
Partial removal of tibia ................................
Partial removal of fibula ..............................
Extensive lower leg surgery ........................
8.85
19.28
25.28
15.75
15.56
6.11
7.17
8.00
9.01
5.92
5.92
10.58
10.58
17.45
14.00
5.83
7.72
9.14
13.65
17.93
17.30
5.37
8.79
15.03
2.87
10.01
3.78
7.30
11.50
15.66
4.87
13.11
5.76
7.91
14.42
16.77
17.73
3.82
5.79
12.23
1.74
19.38
12.03
12.69
10.02
6.92
10.60
10.53
0.00
5.65
5.64
7.35
4.94
4.47
2.88
4.14
7.98
8.35
7.33
2.17
5.66
12.57
5.09
8.41
5.98
8.31
8.92
4.80
7.79
9.86
10.57
11.37
9.25
14.18
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.67
6.35
NA
NA
NA
NA
6.55
NA
NA
NA
NA
NA
6.45
NA
NA
4.69
NA
5.44
7.13
NA
NA
6.23
NA
6.12
NA
NA
NA
NA
4.97
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
7.21
5.96
7.29
NA
NA
NA
NA
3.43
7.24
NA
6.11
9.38
NA
NA
NA
7.39
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
7.16
13.08
16.04
11.34
11.05
5.42
5.28
5.79
6.64
4.85
5.23
7.88
8.05
12.39
9.53
5.32
7.64
7.12
10.77
13.38
12.88
5.36
7.24
11.17
3.34
7.97
4.30
6.27
9.71
11.25
5.04
9.21
4.78
6.75
11.21
12.63
12.57
3.08
4.62
9.03
1.72
14.25
6.53
8.40
6.02
5.04
6.65
6.85
0.00
4.37
4.68
4.97
4.07
3.87
2.26
3.25
6.02
6.79
5.95
1.77
4.34
9.08
3.92
5.82
5.31
6.30
6.73
4.27
6.54
8.03
8.04
9.90
8.03
11.57
Malpractice
RVUs
1.53
3.36
4.39
2.74
2.71
0.99
1.15
1.24
1.47
1.02
1.03
1.78
1.84
3.03
2.42
0.97
1.34
1.53
2.37
3.12
3.00
0.81
1.22
2.55
0.47
1.74
0.65
1.26
2.00
2.73
0.84
2.27
0.76
1.36
2.50
2.97
3.08
0.40
0.94
2.12
0.30
3.37
1.74
2.02
1.45
1.02
1.57
1.65
0.00
0.86
0.80
1.10
0.74
0.69
0.41
0.69
1.31
1.40
1.13
0.20
0.78
1.83
0.72
1.25
0.97
1.28
1.48
0.74
1.31
1.66
1.84
1.88
1.46
2.41
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00137
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
13.61
13.30
NA
NA
NA
NA
13.35
NA
NA
NA
NA
NA
12.63
NA
NA
8.03
NA
9.87
15.69
NA
NA
11.94
NA
12.64
NA
NA
NA
NA
9.19
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
12.89
11.12
10.58
NA
NA
NA
NA
5.81
13.69
NA
11.92
19.03
NA
NA
NA
12.93
NA
NA
NA
NA
NA
NA
Facility
total
17.53
35.71
45.71
29.83
29.32
12.52
13.61
15.03
17.11
11.79
12.18
20.24
20.47
32.87
25.95
12.12
16.69
17.79
26.79
34.43
33.19
11.54
17.25
28.75
6.67
19.72
8.72
14.83
23.21
29.64
10.75
24.59
11.30
16.01
28.13
32.38
33.38
7.29
11.36
23.38
3.77
37.00
20.30
23.11
17.49
12.99
18.82
19.03
0.00
10.88
11.13
13.43
9.75
9.03
5.55
8.07
15.30
16.54
14.42
4.14
10.78
23.48
9.73
15.48
12.26
15.89
17.12
9.81
15.63
19.55
20.45
23.15
18.74
28.16
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
YYY
090
090
090
090
090
010
010
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45900
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
27646
27647
27648
27650
27652
27654
27656
27658
27659
27664
27665
27675
27676
27680
27681
27685
27686
27687
27690
27691
27692
27695
27696
27698
27700
27702
27703
27704
27705
27707
27709
27712
27715
27720
27722
27724
27725
27727
27730
27732
27734
27740
27742
27745
27750
27752
27756
27758
27759
27760
27762
27766
27780
27781
27784
27786
27788
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Extensive lower leg surgery ........................
Extensive ankle/heel surgery ......................
Injection for ankle x-ray ...............................
Repair achilles tendon .................................
Repair/graft achilles tendon ........................
Repair of achilles tendon ............................
Repair leg fascia defect ..............................
Repair of leg tendon, each ..........................
Repair of leg tendon, each ..........................
Repair of leg tendon, each ..........................
Repair of leg tendon, each ..........................
Repair lower leg tendons ............................
Repair lower leg tendons ............................
Release of lower leg tendon .......................
Release of lower leg tendons .....................
Revision of lower leg tendon .......................
Revise lower leg tendons ............................
Revision of calf tendon ................................
Revise lower leg tendon ..............................
Revise lower leg tendon ..............................
Revise additional leg tendon .......................
Repair of ankle ligament .............................
Repair of ankle ligaments ...........................
Repair of ankle ligament .............................
Revision of ankle joint .................................
Reconstruct ankle joint ................................
Reconstruction, ankle joint ..........................
Removal of ankle implant ............................
Incision of tibia ............................................
Incision of fibula ..........................................
Incision of tibia & fibula ...............................
Realignment of lower leg ............................
Revision of lower leg ...................................
Repair of tibia ..............................................
Repair/graft of tibia ......................................
Repair/graft of tibia ......................................
Repair of lower leg ......................................
Repair of lower leg ......................................
Repair of tibia epiphysis ..............................
Repair of fibula epiphysis ............................
Repair lower leg epiphyses .........................
Repair of leg epiphyses ..............................
Repair of leg epiphyses ..............................
Reinforce tibia .............................................
Treatment of tibia fracture ...........................
Treatment of tibia fracture ...........................
Treatment of tibia fracture ...........................
Treatment of tibia fracture ...........................
Treatment of tibia fracture ...........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of fibula fracture .........................
Treatment of fibula fracture .........................
Treatment of fibula fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treat lower leg fracture ...............................
Treat lower leg fracture ...............................
Treat lower leg fracture ...............................
Treat lower leg fracture ...............................
Treat lower leg fracture ...............................
Treat lower leg joint .....................................
Treat lower leg dislocation ..........................
Treat lower leg dislocation ..........................
Treat lower leg dislocation ..........................
12.67
12.24
0.96
9.70
10.33
10.02
4.57
4.98
6.81
4.59
5.40
7.18
8.43
5.74
6.82
6.50
7.46
6.24
8.72
9.97
1.87
6.51
8.28
9.37
9.30
13.68
15.88
7.63
10.38
4.37
9.96
14.26
14.40
11.79
11.82
18.21
15.60
14.02
7.41
5.32
8.49
9.31
10.30
10.07
3.20
5.84
6.78
11.67
13.77
3.02
5.25
8.37
2.66
4.40
7.11
2.85
4.45
7.67
2.84
5.13
10.68
2.90
5.50
11.00
13.01
2.90
6.19
8.55
14.07
16.24
5.49
3.79
4.56
6.49
Nonfacility
PE
RVUs
NA
NA
3.39
NA
NA
NA
8.20
NA
NA
NA
NA
NA
NA
NA
NA
7.38
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.90
6.74
NA
NA
NA
4.83
6.43
NA
4.05
5.61
NA
4.61
5.76
NA
4.94
6.35
NA
4.54
6.47
NA
NA
4.22
6.69
NA
NA
NA
NA
4.54
NA
NA
Facility
PE
RVUs
10.60
7.48
0.34
7.30
7.81
6.97
3.70
4.45
5.50
4.42
4.84
5.59
6.57
4.96
5.74
5.35
6.30
5.18
6.22
7.54
0.90
5.71
6.28
6.77
5.63
10.12
10.91
5.42
7.92
4.78
7.87
10.43
10.43
9.10
8.84
11.98
11.56
10.02
6.21
4.80
6.11
7.72
5.76
7.91
3.74
5.51
6.25
8.89
9.99
3.48
5.12
6.99
3.12
4.51
6.26
3.23
4.52
6.74
3.59
5.00
8.29
3.31
5.02
13.08
13.87
3.47
5.23
11.29
15.09
16.21
8.63
3.74
4.32
5.97
Malpractice
RVUs
2.05
1.75
0.08
1.59
1.71
1.58
0.69
0.79
1.09
0.76
0.89
1.11
1.37
0.93
1.15
0.97
1.24
1.00
1.33
1.64
0.32
1.05
1.28
1.47
1.30
2.37
2.76
1.27
1.80
0.76
1.73
2.47
2.49
2.04
2.05
3.16
2.71
2.43
1.72
0.77
1.35
1.62
1.79
1.75
0.55
1.01
1.17
2.03
2.38
0.48
0.85
1.44
0.41
0.73
1.23
0.46
0.74
1.32
0.46
0.82
1.85
0.43
0.82
1.91
2.25
0.45
1.02
1.47
2.43
2.81
0.95
0.54
0.73
1.03
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00138
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
4.43
NA
NA
NA
13.46
NA
NA
NA
NA
NA
NA
NA
NA
14.86
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.65
13.59
NA
NA
NA
8.32
12.53
NA
7.12
10.74
NA
7.92
10.95
NA
8.24
12.30
NA
7.86
12.79
NA
NA
7.56
13.91
NA
NA
NA
NA
8.87
NA
NA
Facility
total
25.32
21.47
1.38
18.59
19.85
18.57
8.96
10.22
13.40
9.77
11.14
13.89
16.36
11.63
13.72
12.82
15.00
12.43
16.27
19.15
3.10
13.27
15.83
17.61
16.23
26.17
29.56
14.31
20.10
9.91
19.56
27.15
27.32
22.93
22.72
33.34
29.87
26.47
15.35
10.90
15.95
18.65
17.85
19.73
7.49
12.36
14.20
22.59
26.13
6.98
11.22
16.80
6.18
9.64
14.60
6.54
9.71
15.72
6.89
10.96
20.82
6.63
11.34
25.99
29.12
6.81
12.44
21.31
31.58
35.26
15.08
8.07
9.61
13.49
Global
090
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45901
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
27840
27842
27846
27848
27860
27870
27871
27880
27881
27882
27884
27886
27888
27889
27892
27893
27894
27899
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28030
28035
28043
28045
28046
28050
28052
28054
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Treat ankle dislocation ................................
Treat ankle dislocation ................................
Treat ankle dislocation ................................
Treat ankle dislocation ................................
Fixation of ankle joint ..................................
Fusion of ankle joint, open ..........................
Fusion of tibiofibular joint ............................
Amputation of lower leg ..............................
Amputation of lower leg ..............................
Amputation of lower leg ..............................
Amputation follow-up surgery ......................
Amputation follow-up surgery ......................
Amputation of foot at ankle .........................
Amputation of foot at ankle .........................
Decompression of leg .................................
Decompression of leg .................................
Decompression of leg .................................
Leg/ankle surgery procedure ......................
Drainage of bursa of foot ............................
Treatment of foot infection ..........................
Treatment of foot infection ..........................
Treat foot bone lesion .................................
Incision of foot fascia ..................................
Incision of toe tendon ..................................
Incision of toe tendons ................................
Exploration of foot joint ...............................
Exploration of foot joint ...............................
Exploration of toe joint ................................
Removal of foot nerve .................................
Decompression of tibia nerve .....................
Excision of foot lesion .................................
Excision of foot lesion .................................
Resection of tumor, foot ..............................
Biopsy of foot joint lining .............................
Biopsy of foot joint lining .............................
Biopsy of toe joint lining ..............................
Partial removal, foot fascia ..........................
Removal of foot fascia ................................
Removal of foot joint lining ..........................
Removal of foot joint lining ..........................
Removal of foot lesion ................................
Excise foot tendon sheath ...........................
Excise foot tendon sheath ...........................
Removal of foot lesion ................................
Removal of toe lesions ................................
Removal of ankle/heel lesion ......................
Remove/graft foot lesion .............................
Remove/graft foot lesion .............................
Removal of foot lesion ................................
Remove/graft foot lesion .............................
Remove/graft foot lesion .............................
Removal of toe lesions ................................
Part removal of metatarsal ..........................
Part removal of metatarsal ..........................
Part removal of metatarsal ..........................
Part removal of metatarsal ..........................
Removal of metatarsal heads .....................
Revision of foot ...........................................
Removal of heel bone .................................
Removal of heel spur ..................................
Part removal of ankle/heel ..........................
Partial removal of foot bone ........................
Partial removal of toe ..................................
Partial removal of toe ..................................
Removal of ankle bone ...............................
Removal of metatarsal ................................
Removal of toe ............................................
Partial removal of toe ..................................
Partial removal of toe ..................................
Extensive foot surgery .................................
Extensive foot surgery .................................
Extensive foot surgery .................................
Removal of foot foreign body ......................
Removal of foot foreign body ......................
4.58
6.21
9.80
11.20
2.34
13.92
9.18
11.85
12.34
8.95
8.22
9.33
9.68
9.99
7.39
7.35
10.49
0.00
2.74
4.62
8.42
8.69
4.45
2.85
4.14
5.01
4.67
4.38
6.15
5.09
3.54
4.72
10.18
4.25
3.94
3.45
5.23
6.52
5.10
4.58
3.58
4.78
3.86
4.41
3.64
5.66
7.74
6.50
5.12
7.16
5.56
4.16
4.08
5.01
4.49
4.79
9.80
7.76
5.96
5.39
5.40
7.29
4.81
3.52
8.12
6.91
4.09
3.66
3.74
9.61
8.81
6.05
1.96
4.64
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
3.15
5.17
6.42
NA
4.77
2.45
0.00
6.09
5.39
5.38
NA
6.00
3.94
5.58
8.90
5.11
5.08
4.89
5.69
6.70
5.45
5.68
5.41
7.81
5.80
5.34
5.34
7.86
NA
NA
5.69
NA
6.67
4.85
5.43
6.36
5.96
6.33
11.63
7.08
6.41
5.67
7.28
7.04
5.27
4.46
NA
7.29
5.05
4.58
4.80
NA
7.79
5.93
3.47
5.62
Facility
PE
RVUs
3.63
4.96
7.68
11.46
1.93
10.21
7.35
6.96
8.58
6.29
5.60
6.34
7.28
6.30
5.44
5.32
7.57
0.00
1.93
3.71
5.15
5.96
3.20
2.42
3.28
4.06
3.80
3.85
3.67
4.03
3.14
3.58
6.37
3.55
3.38
3.18
3.86
4.03
3.78
4.20
3.72
4.55
3.79
3.44
3.47
4.61
5.81
4.57
3.88
4.44
4.17
3.25
3.22
3.62
3.54
4.34
8.27
5.17
4.30
3.73
4.34
5.23
3.67
2.98
6.57
4.70
3.27
2.73
3.31
5.43
5.16
3.73
1.44
3.60
Malpractice
RVUs
0.46
1.00
1.70
1.94
0.39
2.36
1.59
1.75
1.98
1.29
1.22
1.40
1.51
1.46
1.10
1.10
1.65
0.00
0.33
0.61
1.12
1.16
0.57
0.36
0.59
0.72
0.62
0.58
0.74
0.70
0.46
0.63
1.36
0.60
0.53
0.46
0.70
0.83
0.73
0.68
0.47
0.76
0.61
0.59
0.49
0.82
1.14
0.91
0.70
0.97
0.74
0.53
0.54
0.67
0.61
0.63
1.42
1.03
0.84
0.70
0.77
0.98
0.60
0.45
1.26
0.92
0.53
0.47
0.49
1.33
1.12
0.73
0.22
0.61
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00139
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
6.21
10.39
15.96
NA
9.79
5.66
4.73
11.82
10.68
10.34
NA
11.79
7.94
10.93
20.44
9.96
9.55
8.80
11.62
14.05
11.28
10.94
9.45
13.35
10.26
10.34
9.47
14.34
NA
NA
11.51
NA
12.97
9.54
10.05
12.04
11.06
11.75
22.85
15.87
13.21
11.76
13.45
15.31
10.68
8.43
NA
15.12
9.67
8.70
9.03
NA
17.71
12.71
5.65
10.87
Facility
total
8.67
12.17
19.18
24.61
4.67
26.49
18.12
20.56
22.90
16.53
15.04
17.06
18.47
17.75
13.93
13.78
19.71
0.00
5.00
8.94
14.69
15.81
8.22
5.62
8.01
9.79
9.09
8.81
10.56
9.82
7.13
8.93
17.91
8.40
7.85
7.09
9.79
11.38
9.61
9.46
7.77
10.09
8.26
8.44
7.59
11.09
14.68
11.98
9.70
12.58
10.47
7.94
7.84
9.30
8.64
9.76
19.49
13.96
11.11
9.83
10.51
13.50
9.08
6.95
15.94
12.53
7.89
6.86
7.53
16.37
15.08
10.51
3.62
8.85
Global
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
YYY
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
90
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
45902
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260
28261
28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of foot foreign body ......................
Repair of foot tendon ..................................
Repair/graft of foot tendon ..........................
Repair of foot tendon ..................................
Repair/graft of foot tendon ..........................
Release of foot tendon ................................
Release of foot tendons ..............................
Release of foot tendon ................................
Release of foot tendons ..............................
Incision of foot tendon(s) .............................
Incision of toe tendon ..................................
Incision of foot tendon .................................
Revision of foot tendon ...............................
Release of big toe .......................................
Revision of foot fascia .................................
Release of midfoot joint ..............................
Revision of foot tendon ...............................
Revision of foot and ankle ..........................
Release of midfoot joint ..............................
Release of foot contracture .........................
Release of toe joint, each ...........................
Fusion of toes ..............................................
Repair of hammertoe ..................................
Repair of hammertoe ..................................
Partial removal of foot bone ........................
Repair hallux rigidus ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Correction of bunion ....................................
Incision of heel bone ...................................
Incision of ankle bone .................................
Incision of midfoot bones ............................
Incise/graft midfoot bones ...........................
Incision of metatarsal ..................................
Incision of metatarsal ..................................
Incision of metatarsal ..................................
Incision of metatarsals ................................
Revision of big toe ......................................
Revision of toe ............................................
Repair deformity of toe ................................
Removal of sesamoid bone ........................
Repair of foot bones ....................................
Repair of metatarsals ..................................
Resect enlarged toe tissue .........................
Resect enlarged toe ....................................
Repair extra toe(s) ......................................
Repair webbed toe(s) ..................................
Reconstruct cleft foot ..................................
Treatment of heel fracture ...........................
Treatment of heel fracture ...........................
Treatment of heel fracture ...........................
Treat heel fracture .......................................
Treat/graft heel fracture ...............................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treatment of ankle fracture .........................
Treat ankle fracture .....................................
Treat midfoot fracture, each ........................
Treat midfoot fracture, each ........................
Treat midfoot fracture ..................................
Treat midfoot fracture, each ........................
Treat metatarsal fracture .............................
Treat metatarsal fracture .............................
Treat metatarsal fracture .............................
Treat metatarsal fracture .............................
Treat big toe fracture ...................................
Treat big toe fracture ...................................
Treat big toe fracture ...................................
Treat big toe fracture ...................................
5.73
4.60
6.84
4.37
6.35
4.53
5.62
3.66
4.53
4.24
3.39
3.37
7.74
4.36
5.92
7.97
11.73
15.84
10.35
4.76
3.80
5.19
4.59
4.56
4.74
7.04
5.66
7.04
9.16
8.57
9.19
9.19
7.95
10.58
9.55
9.56
9.17
10.50
5.86
6.33
5.29
12.79
5.43
4.55
5.01
4.86
9.19
8.35
6.98
8.42
4.26
5.92
13.35
2.16
4.57
6.31
15.98
16.65
2.09
3.40
4.71
15.63
1.90
3.10
2.69
7.01
1.99
2.98
3.38
5.71
1.09
1.58
2.33
3.81
Nonfacility
PE
RVUs
5.84
5.32
7.31
5.05
6.38
4.93
5.50
4.53
5.06
4.90
4.71
4.87
7.39
4.87
5.82
6.56
8.87
13.37
7.94
5.16
4.44
6.34
5.12
5.06
6.20
8.06
6.44
7.80
11.26
7.68
8.36
9.04
7.47
8.99
NA
NA
8.16
NA
6.96
10.64
6.01
NA
5.98
5.67
5.47
5.15
NA
9.10
6.67
7.22
5.88
6.38
NA
3.82
5.00
NA
NA
NA
3.58
4.07
NA
NA
3.31
3.64
NA
NA
3.31
3.53
NA
NA
2.00
2.21
7.96
9.34
Facility
PE
RVUs
3.91
3.53
4.47
3.30
4.03
3.41
4.08
2.90
3.70
3.61
3.26
3.33
4.89
3.45
4.10
4.95
7.22
10.63
7.12
3.72
2.87
4.39
3.44
3.27
4.83
5.68
4.63
5.60
6.22
4.72
5.39
6.14
4.98
6.05
6.86
6.72
5.67
6.72
4.14
5.16
3.71
7.83
3.56
3.60
4.69
3.35
6.56
6.19
4.24
4.82
3.60
4.61
10.20
2.96
4.50
6.54
15.56
15.18
2.48
3.64
5.69
10.73
2.40
3.37
4.03
7.98
2.36
3.12
4.82
7.53
1.59
2.01
3.12
5.68
Malpractice
RVUs
0.73
0.61
0.91
0.58
0.81
0.57
0.69
0.46
0.58
0.55
0.44
0.44
1.06
0.58
0.82
1.14
1.57
2.59
1.54
0.62
0.46
0.73
0.59
0.57
0.65
1.02
0.82
0.91
1.13
1.09
1.19
1.32
1.05
1.37
1.54
1.42
1.27
1.27
0.84
0.90
0.70
2.04
0.70
0.63
0.73
0.63
1.43
1.27
0.84
1.01
0.51
0.80
2.28
0.35
0.73
1.11
2.66
2.80
0.31
0.55
0.81
2.58
0.28
0.44
0.44
1.10
0.30
0.44
0.54
0.83
0.14
0.20
0.36
0.56
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00140
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
12.30
10.53
15.06
10.00
13.55
10.03
11.81
8.64
10.16
9.69
8.54
8.68
16.19
9.81
12.57
15.67
22.17
31.81
19.83
10.54
8.70
12.26
10.30
10.19
11.59
16.12
12.92
15.75
21.55
17.34
18.74
19.55
16.47
20.94
NA
NA
18.60
NA
13.66
17.87
12.00
NA
12.12
10.85
11.21
10.63
NA
18.72
14.49
16.64
10.65
13.10
NA
6.33
10.30
NA
NA
NA
5.98
8.02
NA
NA
5.50
7.18
NA
NA
5.60
6.94
NA
NA
3.23
3.99
10.66
13.71
Facility
total
10.37
8.74
12.23
8.25
11.20
8.51
10.39
7.02
8.81
8.40
7.08
7.14
13.69
8.39
10.84
14.06
20.53
29.06
19.01
9.10
7.12
10.31
8.62
8.40
10.22
13.74
11.11
13.55
16.51
14.38
15.77
16.65
13.98
18.00
17.95
17.70
16.11
18.49
10.84
12.39
9.71
22.65
9.70
8.78
10.43
8.84
17.18
15.81
12.07
14.25
8.37
11.33
25.83
5.48
9.80
13.97
34.20
34.63
4.88
7.59
11.21
28.94
4.58
6.91
7.15
16.10
4.66
6.54
8.74
14.07
2.82
3.79
5.82
10.05
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45903
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28899
29000
29010
29015
29020
29025
29035
29040
29044
29046
29049
29055
29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29220
29240
29260
29280
29305
29325
29345
29355
29358
29365
29405
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Treatment of toe fracture ............................
Treatment of toe fracture ............................
Treat toe fracture .........................................
Treat sesamoid bone fracture .....................
Treat sesamoid bone fracture .....................
Treat foot dislocation ...................................
Treat foot dislocation ...................................
Treat foot dislocation ...................................
Repair foot dislocation .................................
Treat foot dislocation ...................................
Treat foot dislocation ...................................
Treat foot dislocation ...................................
Repair foot dislocation .................................
Treat foot dislocation ...................................
Treat foot dislocation ...................................
Treat foot dislocation ...................................
Repair foot dislocation .................................
Treat toe dislocation ....................................
Treat toe dislocation ....................................
Treat toe dislocation ....................................
Repair toe dislocation ..................................
Treat toe dislocation ....................................
Treat toe dislocation ....................................
Treat toe dislocation ....................................
Repair of toe dislocation .............................
Fusion of foot bones ...................................
Fusion of foot bones ...................................
Fusion of foot bones ...................................
Fusion of foot bones ...................................
Fusion of foot bones ...................................
Revision of foot bones ................................
Fusion of foot bones ...................................
Fusion of big toe joint ..................................
Fusion of big toe joint ..................................
Fusion of big toe joint ..................................
Amputation of midfoot .................................
Amputation thru metatarsal .........................
Amputation toe & metatarsal .......................
Amputation of toe ........................................
Partial amputation of toe .............................
Foot/toes surgery procedure .......................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of body cast ..............................
Application of figure eight ............................
Application of shoulder cast ........................
Application of shoulder cast ........................
Application of long arm cast ........................
Application of forearm cast .........................
Apply hand/wrist cast ..................................
Apply finger cast ..........................................
Apply long arm splint ...................................
Apply forearm splint ....................................
Apply forearm splint ....................................
Application of finger splint ...........................
Application of finger splint ...........................
Strapping of chest .......................................
Strapping of low back ..................................
Strapping of shoulder ..................................
Strapping of elbow or wrist .........................
Strapping of hand or finger .........................
Application of hip cast .................................
Application of hip casts ...............................
Application of long leg cast .........................
Application of long leg cast .........................
Apply long leg cast brace ............................
Application of long leg cast .........................
Apply short leg cast .....................................
1.09
1.46
3.33
1.06
2.35
2.04
2.45
3.21
6.30
1.66
3.32
4.17
8.00
1.89
2.72
4.90
7.78
1.70
1.91
2.78
4.22
1.23
1.92
2.67
2.93
18.81
13.11
11.61
10.76
10.85
9.65
8.03
7.30
4.74
7.76
8.22
8.40
6.21
4.41
3.59
0.00
2.25
2.06
2.41
2.11
2.40
1.77
2.22
2.12
2.41
0.89
1.78
1.31
0.87
0.77
0.87
0.62
0.87
0.59
0.77
0.50
0.55
0.65
0.64
0.71
0.55
0.51
2.03
2.32
1.40
1.53
1.43
1.18
0.86
Nonfacility
PE
RVUs
1.54
1.93
8.76
1.67
7.40
2.65
2.60
6.89
11.09
2.65
3.92
NA
8.69
3.03
3.35
NA
NA
1.61
2.21
3.87
5.95
1.48
0.00
NA
7.92
NA
NA
NA
NA
NA
NA
10.65
11.53
6.22
8.16
NA
NA
NA
7.47
6.95
0.00
3.98
4.62
4.23
4.69
4.38
5.06
3.53
5.87
4.95
2.01
4.12
2.28
2.25
2.08
1.98
0.95
1.76
1.51
1.49
0.46
0.74
0.76
0.74
0.86
0.78
0.82
4.78
4.95
2.53
2.59
2.76
2.64
2.14
Facility
PE
RVUs
1.49
1.85
5.19
1.41
3.45
2.41
2.48
4.25
7.52
2.27
3.70
4.11
7.47
2.61
3.16
4.64
9.80
0.96
1.51
2.55
4.24
0.76
1.42
2.48
4.53
12.10
9.48
8.02
8.29
7.65
6.70
6.34
6.49
3.72
5.48
5.67
5.52
4.39
3.72
3.42
0.00
1.70
1.73
1.57
1.39
1.82
1.54
1.49
1.85
2.04
0.51
1.44
0.70
0.73
0.66
0.62
0.48
0.49
0.38
0.45
0.17
0.23
0.33
0.39
0.35
0.31
0.31
1.72
1.90
1.03
1.09
1.06
0.92
0.69
Malpractice
RVUs
0.14
0.18
0.49
0.14
0.34
0.26
0.37
0.52
1.04
0.23
0.56
0.69
1.25
0.27
0.40
0.82
1.30
0.20
0.26
0.43
0.57
0.13
0.26
0.43
0.45
3.08
2.16
1.86
1.70
1.68
1.47
1.22
1.13
0.65
1.05
1.15
1.18
0.86
0.61
0.50
0.00
0.41
0.45
0.28
0.28
0.44
0.28
0.36
0.35
0.42
0.13
0.30
0.17
0.15
0.13
0.14
0.07
0.12
0.07
0.07
0.06
0.03
0.04
0.04
0.06
0.05
0.03
0.35
0.40
0.24
0.26
0.25
0.20
0.14
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00141
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
2.77
3.58
12.58
2.87
10.09
4.95
5.42
10.62
18.43
4.54
7.79
NA
17.94
5.20
6.46
NA
NA
3.51
4.38
7.08
10.74
2.84
2.18
NA
11.29
NA
NA
NA
NA
NA
NA
19.89
19.97
11.61
16.96
NA
NA
NA
12.49
11.03
0.00
6.64
7.14
6.92
7.08
7.23
7.11
6.12
8.35
7.79
3.03
6.21
3.76
3.28
2.98
3.00
1.65
2.76
2.17
2.33
1.02
1.32
1.45
1.42
1.64
1.38
1.36
7.17
7.67
4.17
4.38
4.44
4.02
3.14
Facility
total
2.72
3.50
9.01
2.61
6.14
4.72
5.30
7.97
14.86
4.17
7.58
8.97
16.71
4.77
6.28
10.36
18.87
2.87
3.68
5.75
9.03
2.13
3.60
5.58
7.91
33.99
24.75
21.49
20.75
20.18
17.82
15.58
14.93
9.11
14.28
15.04
15.10
11.46
8.74
7.50
0.00
4.37
4.25
4.27
3.79
4.66
3.60
4.08
4.33
4.87
1.54
3.52
2.19
1.75
1.57
1.63
1.17
1.49
1.04
1.29
0.73
0.81
1.02
1.07
1.12
0.91
0.85
4.10
4.63
2.67
2.89
2.74
2.31
1.70
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
010
010
090
010
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
45904
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29590
29700
29705
29710
29715
29720
29730
29740
29750
29799
29800
29804
29805
29806
29807
29819
29820
29821
29822
29823
29824
29825
29826
29827
29830
29834
29835
29836
29837
29838
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29863
29866
29867
29868
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Apply short leg cast .....................................
Apply short leg cast .....................................
Addition of walker to cast ............................
Apply rigid leg cast ......................................
Application of leg cast .................................
Application, long leg splint ..........................
Application lower leg splint ..........................
Strapping of hip ...........................................
Strapping of knee ........................................
Strapping of ankle and/or ft .........................
Strapping of toes .........................................
Application of paste boot .............................
Application of foot splint ..............................
Removal/revision of cast .............................
Removal/revision of cast .............................
Removal/revision of cast .............................
Removal/revision of cast .............................
Repair of body cast .....................................
Windowing of cast .......................................
Wedging of cast ..........................................
Wedging of clubfoot cast .............................
Casting/strapping procedure .......................
Jaw arthroscopy/surgery .............................
Jaw arthroscopy/surgery .............................
Shoulder arthroscopy, dx ............................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Shoulder arthroscopy/surgery .....................
Arthroscop rotator cuff repr .........................
Elbow arthroscopy .......................................
Elbow arthroscopy/surgery ..........................
Elbow arthroscopy/surgery ..........................
Elbow arthroscopy/surgery ..........................
Elbow arthroscopy/surgery ..........................
Elbow arthroscopy/surgery ..........................
Wrist arthroscopy ........................................
Wrist arthroscopy/surgery ...........................
Wrist arthroscopy/surgery ...........................
Wrist arthroscopy/surgery ...........................
Wrist arthroscopy/surgery ...........................
Wrist arthroscopy/surgery ...........................
Wrist endoscopy/surgery .............................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Tibial arthroscopy/surgery ...........................
Tibial arthroscopy/surgery ...........................
Hip arthroscopy, dx .....................................
Hip arthroscopy/surgery ..............................
Hip arthroscopy/surgery ..............................
Hip arthroscopy/surgery ..............................
Autgrft implnt, knee w/scope .......................
Allgrft implnt, knee w/scope ........................
Meniscal trnspl, knee w/scpe ......................
Knee arthroscopy, dx ..................................
Knee arthroscopy/drainage .........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
1.01
1.18
0.57
1.78
2.08
0.69
0.73
0.54
0.57
0.51
0.47
0.57
0.76
0.57
0.76
1.34
0.94
0.68
0.75
1.12
1.26
0.00
6.43
8.15
5.89
14.38
13.91
7.63
7.07
7.73
7.43
8.18
8.26
7.63
9.00
15.37
5.76
6.28
6.48
7.56
6.87
7.72
5.54
6.01
6.37
7.53
6.75
7.08
5.44
8.20
13.11
10.62
14.15
8.06
9.16
9.91
9.91
13.91
17.03
23.64
5.07
6.55
6.00
7.05
6.31
7.93
7.35
8.05
8.51
7.77
8.66
11.05
7.33
9.10
Nonfacility
PE
RVUs
2.20
2.22
1.06
2.49
1.97
1.50
1.16
0.88
0.83
0.48
0.46
0.76
0.53
0.89
0.80
1.49
1.82
1.53
0.79
1.38
1.27
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
0.73
0.90
0.27
0.95
1.07
0.44
0.45
0.46
0.32
0.31
0.29
0.35
0.28
0.27
0.37
0.68
0.39
0.38
0.34
0.48
0.57
0.00
6.72
7.64
5.48
10.80
10.64
6.56
6.01
6.57
6.46
6.98
7.29
6.54
7.28
11.16
5.18
5.64
5.69
6.56
5.92
6.66
5.15
5.44
5.63
6.29
5.86
5.99
5.43
5.02
9.49
8.48
10.34
6.73
7.11
8.29
8.25
10.98
12.80
16.26
4.72
5.68
6.35
5.88
5.65
6.80
6.52
6.89
7.12
6.73
7.01
8.77
6.48
7.71
Malpractice
RVUs
0.15
0.20
0.08
0.27
0.27
0.08
0.09
0.03
0.05
0.06
0.06
0.07
0.09
0.08
0.13
0.20
0.09
0.12
0.12
0.18
0.21
0.00
0.99
1.38
1.02
2.49
2.41
1.32
1.22
1.33
1.28
1.41
1.42
1.32
1.55
2.66
0.99
1.08
1.13
1.22
1.19
1.30
0.84
0.92
1.04
0.99
1.07
1.08
0.86
1.25
2.34
1.84
2.39
1.36
1.59
1.62
1.42
2.39
2.78
4.35
0.85
1.14
1.04
1.11
1.09
1.37
1.28
1.39
1.47
1.34
1.50
1.92
1.27
1.58
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00142
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
3.36
3.60
1.71
4.54
4.32
2.27
1.98
1.45
1.45
1.05
0.99
1.40
1.38
1.54
1.69
3.03
2.85
2.33
1.67
2.68
2.74
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
1.89
2.29
0.92
3.00
3.43
1.21
1.27
1.03
0.94
0.88
0.82
0.99
1.13
0.92
1.26
2.22
1.42
1.18
1.21
1.78
2.04
0.00
14.14
17.16
12.39
27.67
26.96
15.51
14.31
15.63
15.18
16.57
16.96
15.48
17.83
29.19
11.93
13.00
13.30
15.33
13.99
15.67
11.53
12.37
13.04
14.81
13.68
14.16
11.73
14.47
24.93
20.95
26.87
16.15
17.86
19.82
19.58
27.28
32.61
44.25
10.64
13.38
13.39
14.04
13.06
16.09
15.16
16.32
17.10
15.84
17.16
21.74
15.09
18.39
Global
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45905
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
29886
29887
29888
29889
29891
29892
29893
29894
29895
29897
29898
29899
29900
29901
29902
29999
30000
30020
30100
30110
30115
30117
30118
30120
30124
30125
30130
30140
30150
30160
30200
30210
30220
30300
30310
30320
30400
30410
30420
30430
30435
30450
30460
30462
30465
30520
30540
30545
30560
30580
30600
30620
30630
30801
30802
30901
30903
30905
30906
30915
30920
30930
30999
31000
31002
31020
31030
31032
31040
31050
31051
31070
31075
31080
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Knee arthroscopy/surgery ...........................
Ankle arthroscopy/surgery ...........................
Ankle arthroscopy/surgery ...........................
Scope, plantar fasciotomy ...........................
Ankle arthroscopy/surgery ...........................
Ankle arthroscopy/surgery ...........................
Ankle arthroscopy/surgery ...........................
Ankle arthroscopy/surgery ...........................
Ankle arthroscopy/surgery ...........................
Mcp joint arthroscopy, dx ............................
Mcp joint arthroscopy, surg .........................
Mcp joint arthroscopy, surg .........................
Arthroscopy of joint .....................................
Drainage of nose lesion ..............................
Drainage of nose lesion ..............................
Intranasal biopsy .........................................
Removal of nose polyp(s) ...........................
Removal of nose polyp(s) ...........................
Removal of intranasal lesion .......................
Removal of intranasal lesion .......................
Revision of nose ..........................................
Removal of nose lesion ...............................
Removal of nose lesion ...............................
Removal of turbinate bones ........................
Removal of turbinate bones ........................
Partial removal of nose ...............................
Removal of nose .........................................
Injection treatment of nose ..........................
Nasal sinus therapy .....................................
Insert nasal septal button ............................
Remove nasal foreign body ........................
Remove nasal foreign body ........................
Remove nasal foreign body ........................
Reconstruction of nose ...............................
Reconstruction of nose ...............................
Reconstruction of nose ...............................
Revision of nose ..........................................
Revision of nose ..........................................
Revision of nose ..........................................
Revision of nose ..........................................
Revision of nose ..........................................
Repair nasal stenosis ..................................
Repair of nasal septum ...............................
Repair nasal defect .....................................
Repair nasal defect .....................................
Release of nasal adhesions ........................
Repair upper jaw fistula ..............................
Repair mouth/nose fistula ...........................
Intranasal reconstruction .............................
Repair nasal septum defect ........................
Cauterization, inner nose ............................
Cauterization, inner nose ............................
Control of nosebleed ...................................
Control of nosebleed ...................................
Control of nosebleed ...................................
Repeat control of nosebleed .......................
Ligation, nasal sinus artery .........................
Ligation, upper jaw artery ............................
Therapy, fracture of nose ............................
Nasal surgery procedure .............................
Irrigation, maxillary sinus .............................
Irrigation, sphenoid sinus ............................
Exploration, maxillary sinus .........................
Exploration, maxillary sinus .........................
Explore sinus, remove polyps .....................
Exploration behind upper jaw ......................
Exploration, sphenoid sinus ........................
Sphenoid sinus surgery ...............................
Exploration of frontal sinus ..........................
Exploration of frontal sinus ..........................
Removal of frontal sinus .............................
7.55
9.05
13.91
16.01
8.41
9.01
5.22
7.21
6.99
7.18
8.33
13.92
5.42
6.13
6.70
0.00
1.43
1.43
0.94
1.63
4.35
3.17
9.70
5.27
3.11
7.16
3.38
3.43
9.15
9.59
0.78
1.08
1.54
1.04
1.96
4.52
9.84
12.99
15.89
7.21
11.71
18.66
9.97
19.58
11.64
5.70
7.76
11.38
1.26
6.69
6.02
5.97
7.12
1.09
2.03
1.21
1.54
1.97
2.45
7.20
9.84
1.26
0.00
1.15
1.91
2.95
5.92
6.57
9.43
5.28
7.11
4.28
9.17
11.42
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
6.64
NA
NA
NA
NA
NA
NA
NA
NA
0.00
3.99
3.41
2.03
3.28
NA
13.54
NA
6.80
NA
NA
NA
NA
NA
NA
1.64
2.12
4.36
4.50
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.73
7.88
7.54
NA
NA
4.06
4.58
1.34
2.74
3.51
3.89
NA
NA
NA
0.00
2.85
NA
8.41
11.21
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
6.63
7.67
9.87
12.04
7.29
7.52
4.09
5.34
5.34
5.71
6.05
10.23
5.67
6.05
6.33
0.00
1.37
1.45
0.80
1.54
5.73
4.61
9.03
5.78
3.63
8.11
5.52
6.22
10.64
9.92
0.73
1.29
1.51
1.84
3.04
6.84
15.01
17.64
17.44
15.31
18.43
21.03
9.57
19.21
11.57
6.65
9.00
11.78
2.09
5.69
4.90
8.69
7.85
1.92
2.36
0.31
0.48
0.73
1.15
6.62
8.89
1.61
0.00
1.38
3.13
5.16
6.59
7.16
9.43
6.29
8.19
5.90
9.59
13.18
Malpractice
RVUs
1.30
1.57
2.41
2.78
1.39
1.41
0.63
1.15
1.11
1.17
1.28
2.40
0.94
1.06
1.12
0.00
0.12
0.12
0.07
0.14
0.41
0.26
0.78
0.52
0.25
0.63
0.31
0.35
0.93
0.88
0.06
0.09
0.12
0.08
0.16
0.39
1.04
1.42
1.46
0.77
1.22
1.96
1.03
2.53
1.06
0.46
0.67
1.70
0.10
0.89
0.70
0.57
0.61
0.09
0.16
0.11
0.13
0.17
0.20
0.58
0.80
0.12
0.00
0.09
0.15
0.29
0.60
0.59
0.87
0.49
0.62
0.38
0.75
1.23
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00143
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
12.49
NA
NA
NA
NA
NA
NA
NA
NA
0.00
5.54
4.97
3.04
5.05
NA
16.97
NA
12.59
NA
NA
NA
NA
NA
NA
2.48
3.30
6.02
5.62
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.09
15.46
14.26
NA
NA
5.25
6.78
2.67
4.42
5.65
6.55
NA
NA
NA
0.00
4.09
NA
11.65
17.73
NA
NA
NA
NA
NA
NA
NA
Facility
total
15.47
18.29
26.19
30.83
17.09
17.94
9.94
13.71
13.44
14.06
15.66
26.54
12.03
13.25
14.15
0.00
2.92
3.00
1.82
3.31
10.49
8.04
19.50
11.57
6.98
15.90
9.21
10.00
20.72
20.39
1.57
2.46
3.18
2.96
5.16
11.75
25.89
32.05
34.80
23.30
31.36
41.65
20.57
41.32
24.28
12.81
17.43
24.86
3.45
13.27
11.63
15.23
15.58
3.10
4.56
1.63
2.16
2.88
3.81
14.40
19.52
2.99
0.00
2.63
5.19
8.40
13.11
14.32
19.73
12.06
15.92
10.56
19.51
25.83
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
010
010
000
010
090
090
090
090
090
090
090
090
090
090
000
010
010
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
090
010
010
000
000
000
000
090
090
010
YYY
010
010
090
090
090
090
090
090
090
090
090
45906
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
31081
31084
31085
31086
31087
31090
31200
31201
31205
31225
31230
31231
31233
31235
31237
31238
31239
31240
31254
31255
31256
31267
31276
31287
31288
31290
31291
31292
31293
31294
31299
31300
31320
31360
31365
31367
31368
31370
31375
31380
31382
31390
31395
31400
31420
31500
31502
31505
31510
31511
31512
31513
31515
31520
31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31545
31546
31560
31561
31570
31571
31575
31576
31577
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of frontal sinus .............................
Removal of frontal sinus .............................
Removal of frontal sinus .............................
Removal of frontal sinus .............................
Removal of frontal sinus .............................
Exploration of sinuses .................................
Removal of ethmoid sinus ...........................
Removal of ethmoid sinus ...........................
Removal of ethmoid sinus ...........................
Removal of upper jaw .................................
Removal of upper jaw .................................
Nasal endoscopy, dx ...................................
Nasal/sinus endoscopy, dx .........................
Nasal/sinus endoscopy, dx .........................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Revision of ethmoid sinus ...........................
Removal of ethmoid sinus ...........................
Exploration maxillary sinus ..........................
Endoscopy, maxillary sinus .........................
Sinus endoscopy, surgical ..........................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Nasal/sinus endoscopy, surg ......................
Sinus surgery procedure .............................
Removal of larynx lesion .............................
Diagnostic incision, larynx ...........................
Removal of larynx .......................................
Removal of larynx .......................................
Partial removal of larynx .............................
Partial removal of larynx .............................
Partial removal of larynx .............................
Partial removal of larynx .............................
Partial removal of larynx .............................
Partial removal of larynx .............................
Removal of larynx & pharynx ......................
Reconstruct larynx & pharynx .....................
Revision of larynx ........................................
Removal of epiglottis ...................................
Insert emergency airway .............................
Change of windpipe airway .........................
Diagnostic laryngoscopy .............................
Laryngoscopy with biopsy ...........................
Remove foreign body, larynx ......................
Removal of larynx lesion .............................
Injection into vocal cord ..............................
Laryngoscopy for aspiration ........................
Diagnostic laryngoscopy .............................
Diagnostic laryngoscopy .............................
Diagnostic laryngoscopy .............................
Laryngoscopy for treatment ........................
Laryngoscopy and dilation ..........................
Laryngoscopy and dilation ..........................
Operative laryngoscopy ...............................
Operative laryngoscopy ...............................
Operative laryngoscopy ...............................
Operative laryngoscopy ...............................
Operative laryngoscopy ...............................
Operative laryngoscopy ...............................
Remove vc lesion w/scope .........................
Remove vc lesion scope/graft .....................
Operative laryngoscopy ...............................
Operative laryngoscopy ...............................
Laryngoscopy with injection ........................
Laryngoscopy with injection ........................
Diagnostic laryngoscopy .............................
Laryngoscopy with biopsy ...........................
Remove foreign body, larynx ......................
12.76
13.52
14.21
12.87
13.11
9.54
4.97
8.38
10.24
19.24
21.95
1.10
2.18
2.65
2.99
3.27
8.71
2.62
4.65
6.96
3.30
5.46
8.86
3.92
4.58
17.24
18.20
14.77
16.22
19.07
0.00
14.30
5.26
17.08
24.17
21.87
27.10
21.39
20.22
20.22
20.53
27.54
31.10
10.31
10.22
2.33
0.65
0.61
1.92
2.16
2.07
2.10
1.80
2.57
2.64
2.58
3.28
2.37
2.69
3.39
3.59
3.17
3.56
4.13
4.53
6.31
9.75
5.46
6.00
3.87
4.27
1.10
1.97
2.47
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.34
4.23
4.82
5.08
5.11
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.43
3.23
3.06
3.15
NA
3.44
NA
3.59
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.43
NA
1.86
3.62
3.67
Facility
PE
RVUs
13.68
13.27
13.72
13.07
12.29
12.48
8.87
9.09
11.45
17.49
18.89
0.86
1.44
1.67
1.82
2.02
7.73
1.68
2.75
3.96
2.04
3.17
4.93
2.37
2.71
11.64
12.08
10.26
11.00
12.43
0.00
14.71
10.05
16.42
19.92
21.49
25.03
21.85
20.05
20.20
21.26
23.90
27.81
13.38
9.33
0.54
0.28
0.60
1.22
1.03
1.32
1.42
1.04
1.52
1.61
1.67
1.82
1.43
1.66
1.89
2.20
1.93
2.18
2.45
2.69
3.38
4.88
3.04
3.25
2.30
2.51
0.87
1.26
1.49
Malpractice
RVUs
2.46
1.19
1.72
1.07
1.44
0.94
0.29
0.82
0.67
1.59
1.77
0.09
0.20
0.26
0.28
0.27
0.62
0.24
0.45
0.73
0.33
0.55
0.92
0.39
0.46
1.40
1.68
1.21
1.28
1.53
0.00
1.17
0.46
1.38
1.97
1.78
2.20
1.74
1.63
1.70
1.67
2.23
2.48
0.83
0.83
0.17
0.05
0.05
0.16
0.19
0.18
0.17
0.14
0.20
0.21
0.21
0.26
0.19
0.22
0.29
0.29
0.26
0.29
0.33
0.37
0.37
0.78
0.43
0.49
0.31
0.35
0.09
0.14
0.21
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00144
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.54
6.62
7.72
8.35
8.65
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.09
5.31
5.41
5.40
NA
5.38
NA
6.43
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.61
NA
3.05
5.73
6.36
Facility
total
28.90
27.98
29.65
27.00
26.83
22.96
14.13
18.28
22.36
38.32
42.62
2.05
3.82
4.57
5.09
5.56
17.05
4.53
7.85
11.65
5.67
9.18
14.71
6.68
7.75
30.29
31.95
26.24
28.50
33.03
0.00
30.18
15.77
34.88
46.06
45.14
54.33
44.98
41.90
42.12
43.46
53.67
61.39
24.52
20.38
3.04
0.98
1.26
3.30
3.38
3.58
3.69
2.98
4.28
4.46
4.45
5.36
3.99
4.56
5.57
6.07
5.36
6.02
6.91
7.58
10.07
15.41
8.93
9.74
6.48
7.13
2.06
3.37
4.17
Global
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
010
000
000
000
000
000
000
000
000
010
010
010
010
010
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
45907
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
31578
31579
31580
31582
31584
31585
31586
31587
31588
31590
31595
31599
31600
31601
31603
31605
31610
31611
31612
31613
31614
31615
31620
31622
31623
31624
31625
31628
31629
31630
31631
31632
31633
31635
31636
31637
31638
31640
31641
31643
31645
31646
31656
31700
31708
31710
31715
31717
31720
31725
31730
31750
31755
31760
31766
31770
31775
31780
31781
31785
31786
31800
31805
31820
31825
31830
31899
32000
32002
32005
32019
32020
32035
32036
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of larynx lesion .............................
Diagnostic laryngoscopy .............................
Revision of larynx ........................................
Revision of larynx ........................................
Treat larynx fracture ....................................
Treat larynx fracture ....................................
Treat larynx fracture ....................................
Revision of larynx ........................................
Revision of larynx ........................................
Reinnervate larynx ......................................
Larynx nerve surgery ..................................
Larynx surgery procedure ...........................
Incision of windpipe .....................................
Incision of windpipe .....................................
Incision of windpipe .....................................
Incision of windpipe .....................................
Incision of windpipe .....................................
Surgery/speech prosthesis ..........................
Puncture/clear windpipe ..............................
Repair windpipe opening .............................
Repair windpipe opening .............................
Visualization of windpipe .............................
Endobronchial us add-on ............................
Dx bronchoscope/wash ...............................
Dx bronchoscope/brush ..............................
Dx bronchoscope/lavage .............................
Bronchoscopy w/biopsy(s) ..........................
Bronchoscopy/lung bx, each .......................
Bronchoscopy/needle bx, each ...................
Bronchoscopy dilate/fx repr .........................
Bronchoscopy, dilate w/stent ......................
Bronchoscopy/lung bx, add’l .......................
Bronchoscopy/needle bx add’l ....................
Bronchoscopy w/fb removal ........................
Bronchoscopy, bronch stents ......................
Bronchoscopy, stent add-on .......................
Bronchoscopy, revise stent .........................
Bronchoscopy w/tumor excise ....................
Bronchoscopy, treat blockage .....................
Diag bronchoscope/catheter .......................
Bronchoscopy, clear airways ......................
Bronchoscopy, reclear airway .....................
Bronchoscopy, inj for x-ray .........................
Insertion of airway catheter .........................
Instill airway contrast dye ............................
Insertion of airway catheter .........................
Injection for bronchus x-ray .........................
Bronchial brush biopsy ................................
Clearance of airways ...................................
Clearance of airways ...................................
Intro, windpipe wire/tube .............................
Repair of windpipe ......................................
Repair of windpipe ......................................
Repair of windpipe ......................................
Reconstruction of windpipe .........................
Repair/graft of bronchus ..............................
Reconstruct bronchus .................................
Reconstruct windpipe ..................................
Reconstruct windpipe ..................................
Remove windpipe lesion .............................
Remove windpipe lesion .............................
Repair of windpipe injury .............................
Repair of windpipe injury .............................
Closure of windpipe lesion ..........................
Repair of windpipe defect ...........................
Revise windpipe scar ..................................
Airways surgical procedure .........................
Drainage of chest ........................................
Treatment of collapsed lung ........................
Treat lung lining chemically .........................
Insert pleural catheter .................................
Insertion of chest tube .................................
Exploration of chest .....................................
Exploration of chest .....................................
2.85
2.26
12.38
21.63
19.65
4.64
8.04
11.99
13.12
6.97
8.35
0.00
7.18
4.45
4.15
3.58
8.77
5.64
0.91
4.59
7.12
2.09
1.40
2.79
2.89
2.89
3.37
3.81
4.10
3.82
4.37
1.03
1.32
3.68
4.31
1.58
4.89
4.94
5.03
3.50
3.17
2.73
2.17
1.34
1.41
1.30
1.11
2.12
1.06
1.96
2.86
13.03
15.94
22.36
30.44
22.52
23.55
17.73
23.54
17.23
23.99
7.43
13.14
4.49
6.81
4.50
0.00
1.54
2.19
2.19
4.18
3.98
8.68
9.69
Nonfacility
PE
RVUs
4.19
3.64
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
1.10
NA
NA
2.55
5.59
5.46
6.17
5.56
5.61
6.81
13.48
NA
NA
0.80
0.91
5.90
NA
NA
NA
NA
NA
NA
4.95
4.68
6.94
2.16
NA
NA
NA
7.76
NA
NA
7.21
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.62
7.56
5.72
0.00
2.92
3.14
6.09
18.66
NA
NA
NA
Facility
PE
RVUs
1.48
1.44
15.50
25.01
17.74
6.55
10.59
9.04
13.31
14.97
10.28
0.00
3.09
2.32
1.65
1.15
8.10
6.98
0.34
5.91
8.67
1.17
0.54
1.04
1.03
1.03
1.18
1.28
1.37
1.66
1.72
0.30
0.39
1.39
1.72
0.55
1.92
2.01
1.83
1.20
1.10
0.98
0.83
0.67
0.48
0.42
0.34
0.78
0.32
0.57
0.97
17.23
24.11
10.59
13.49
10.00
11.47
10.66
11.70
9.85
12.72
8.95
7.04
3.57
5.24
3.90
0.00
0.48
1.08
0.68
1.62
1.32
5.73
6.26
Malpractice
RVUs
0.23
0.18
1.00
1.75
1.71
0.38
0.67
0.97
1.06
0.84
0.68
0.00
0.80
0.40
0.44
0.40
0.79
0.46
0.08
0.42
0.58
0.16
0.11
0.18
0.13
0.13
0.18
0.18
0.16
0.32
0.34
0.18
0.16
0.24
0.31
0.13
0.22
0.46
0.35
0.20
0.16
0.14
0.15
0.08
0.07
0.12
0.07
0.14
0.07
0.14
0.21
1.05
1.29
2.94
4.52
2.83
3.01
1.65
2.24
1.59
3.29
0.79
1.82
0.38
0.53
0.44
0.00
0.08
0.12
0.23
0.42
0.43
1.26
1.43
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00145
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
7.27
6.09
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
2.09
NA
NA
4.80
7.10
8.42
9.19
8.57
9.16
10.80
17.74
NA
NA
2.01
2.39
9.81
NA
NA
NA
NA
NA
NA
8.28
7.54
9.27
3.58
NA
NA
NA
10.02
NA
NA
10.27
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
10.49
14.90
10.66
0.00
4.54
5.45
8.51
23.26
NA
NA
NA
Facility
total
4.55
3.88
28.89
48.40
39.10
11.57
19.29
22.00
27.48
22.79
19.31
0.00
11.08
7.17
6.24
5.13
17.66
13.08
1.33
10.92
16.38
3.43
2.05
4.00
4.05
4.05
4.73
5.26
5.63
5.80
6.43
1.52
1.87
5.31
6.34
2.26
7.03
7.41
7.21
4.90
4.43
3.85
3.16
2.10
1.97
1.84
1.53
3.05
1.46
2.67
4.03
31.30
41.34
35.89
48.45
35.35
38.02
30.03
37.48
28.67
40.00
17.17
22.00
8.44
12.58
8.83
0.00
2.10
3.39
3.11
6.22
5.73
15.67
17.38
Global
000
000
090
090
090
090
090
090
090
090
090
YYY
000
000
000
000
090
090
000
090
090
000
ZZZ
000
000
000
000
000
000
000
000
ZZZ
ZZZ
000
000
ZZZ
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
000
000
000
000
000
090
090
45908
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
32095
32100
32110
32120
32124
32140
32141
32150
32151
32160
32200
32201
32215
32220
32225
32310
32320
32400
32402
32405
32420
32440
32442
32445
32480
32482
32484
32486
32488
32491
32500
32501
32520
32522
32525
32540
32601
32602
32603
32604
32605
32606
32650
32651
32652
32653
32654
32655
32656
32657
32658
32659
32660
32661
32662
32663
32664
32665
32800
32810
32815
32820
32851
32852
32853
32854
32855
32856
32900
32905
32906
32940
32960
32997
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Biopsy through chest wall ...........................
Exploration/biopsy of chest .........................
Explore/repair chest ....................................
Re-exploration of chest ...............................
Explore chest free adhesions ......................
Removal of lung lesion(s) ...........................
Remove/treat lung lesions ...........................
Removal of lung lesion(s) ...........................
Remove lung foreign body ..........................
Open chest heart massage .........................
Drain, open, lung lesion ..............................
Drain, percut, lung lesion ............................
Treat chest lining .........................................
Release of lung ...........................................
Partial release of lung .................................
Removal of chest lining ...............................
Free/remove chest lining .............................
Needle biopsy chest lining ..........................
Open biopsy chest lining .............................
Biopsy, lung or mediastinum .......................
Puncture/clear lung .....................................
Removal of lung ..........................................
Sleeve pneumonectomy ..............................
Removal of lung ..........................................
Partial removal of lung ................................
Bilobectomy .................................................
Segmentectomy ...........................................
Sleeve lobectomy ........................................
Completion pneumonectomy .......................
Lung volume reduction ................................
Partial removal of lung ................................
Repair bronchus add-on ..............................
Remove lung & revise chest .......................
Remove lung & revise chest .......................
Remove lung & revise chest .......................
Removal of lung lesion ................................
Thoracoscopy, diagnostic ............................
Thoracoscopy, diagnostic ............................
Thoracoscopy, diagnostic ............................
Thoracoscopy, diagnostic ............................
Thoracoscopy, diagnostic ............................
Thoracoscopy, diagnostic ............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Thoracoscopy, surgical ...............................
Repair lung hernia .......................................
Close chest after drainage ..........................
Close bronchial fistula .................................
Reconstruct injured chest ............................
Lung transplant, single ................................
Lung transplant with bypass .......................
Lung transplant, double ...............................
Lung transplant with bypass .......................
Prepare donor lung, single ..........................
Prepare donor lung, double ........................
Removal of rib(s) .........................................
Revise & repair chest wall ..........................
Revise & repair chest wall ..........................
Revision of lung ...........................................
Therapeutic pneumothorax .........................
Total lung lavage .........................................
8.37
15.25
23.02
11.54
12.73
13.94
14.01
14.16
14.22
9.31
15.30
4.00
11.33
24.01
13.97
13.45
24.01
1.76
7.57
1.93
2.18
25.01
26.25
25.10
23.76
25.01
20.70
23.93
25.72
21.26
22.01
4.69
21.69
24.21
26.51
14.65
5.46
5.96
7.82
8.79
6.93
8.41
10.75
12.92
18.67
12.88
12.44
13.11
12.92
13.66
11.63
11.59
17.43
13.26
16.45
18.48
14.21
15.55
13.70
13.06
23.17
21.49
38.65
41.82
47.84
51.00
0.00
0.00
20.28
20.76
26.78
19.44
1.84
6.00
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
21.42
NA
NA
NA
NA
NA
2.16
NA
0.69
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
1.72
NA
Facility
PE
RVUs
5.25
7.65
10.50
6.89
7.08
7.53
7.39
7.47
7.93
5.19
8.72
1.37
6.72
12.63
7.49
7.24
11.91
0.56
4.98
0.66
0.69
12.36
14.11
13.42
11.57
12.42
10.89
12.60
13.17
11.97
11.78
1.51
10.81
11.65
12.30
9.15
2.30
2.47
2.97
3.39
2.84
3.27
6.45
6.95
9.69
6.67
7.15
6.96
7.54
7.35
6.95
7.08
8.99
7.43
8.45
10.24
7.35
7.88
7.28
7.37
10.69
11.99
25.98
30.94
29.88
32.72
0.00
0.00
9.73
9.90
11.79
9.22
0.55
1.86
Malpractice
RVUs
1.22
2.23
3.21
1.63
1.89
1.96
2.00
2.00
2.03
1.31
2.13
0.24
1.68
3.56
2.06
1.99
3.51
0.10
1.07
0.11
0.12
3.68
3.84
3.71
3.49
3.66
3.03
3.51
3.80
2.98
3.25
0.65
3.20
3.32
3.87
2.07
0.80
0.87
1.14
1.25
1.00
1.22
1.58
1.86
2.72
1.88
1.63
1.89
1.89
1.99
1.69
1.62
2.08
1.92
2.17
2.72
2.32
2.15
1.98
1.93
3.27
2.52
5.56
6.00
7.05
7.20
0.00
0.00
2.93
3.15
3.97
2.88
0.16
0.55
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00146
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
25.66
NA
NA
NA
NA
NA
4.03
NA
2.74
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
3.72
NA
Facility
total
14.83
25.13
36.72
20.06
21.69
23.43
23.40
23.63
24.18
15.81
26.16
5.60
19.73
40.20
23.52
22.67
39.42
2.42
13.62
2.71
2.99
41.05
44.21
42.23
38.82
41.09
34.62
40.04
42.69
36.21
37.04
6.85
35.70
39.18
42.68
25.87
8.57
9.30
11.92
13.43
10.78
12.89
18.78
21.73
31.08
21.42
21.22
21.96
22.34
22.99
20.27
20.29
28.50
22.61
27.07
31.44
23.88
25.58
22.96
22.36
37.12
36.00
70.19
78.76
84.77
90.92
0.00
0.00
32.94
33.81
42.54
31.54
2.55
8.41
Global
090
090
090
090
090
090
090
090
090
090
090
000
090
090
090
090
090
000
090
000
000
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
000
000
000
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
XXX
XXX
090
090
090
090
000
000
45909
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
32999
33010
33011
33015
33020
33025
33030
33031
33050
33120
33130
33140
33141
33200
33201
33206
33207
33208
33210
33211
33212
33213
33214
33215
33216
33217
33218
33220
33222
33223
33224
33225
33226
33233
33234
33235
33236
33237
33238
33240
33241
33243
33244
33245
33246
33249
33250
33251
33253
33261
33282
33284
33300
33305
33310
33315
33320
33321
33322
33330
33332
33335
33400
33401
33403
33404
33405
33406
33410
33411
33412
33413
33414
33415
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Chest surgery procedure .............................
Drainage of heart sac ..................................
Repeat drainage of heart sac .....................
Incision of heart sac ....................................
Incision of heart sac ....................................
Incision of heart sac ....................................
Partial removal of heart sac ........................
Partial removal of heart sac ........................
Removal of heart sac lesion .......................
Removal of heart lesion ..............................
Removal of heart lesion ..............................
Heart revascularize (tmr) .............................
Heart tmr w/other procedure .......................
Insertion of heart pacemaker ......................
Insertion of heart pacemaker ......................
Insertion of heart pacemaker ......................
Insertion of heart pacemaker ......................
Insertion of heart pacemaker ......................
Insertion of heart electrode .........................
Insertion of heart electrode .........................
Insertion of pulse generator ........................
Insertion of pulse generator ........................
Upgrade of pacemaker system ...................
Reposition pacing-defib lead .......................
Insert lead pace-defib, one .........................
Insert lead pace-defib, dual .........................
Repair lead pace-defib, one ........................
Repair lead pace-defib, dual .......................
Revise pocket, pacemaker ..........................
Revise pocket, pacing-defib ........................
Insert pacing lead & connect ......................
L ventric pacing lead add-on .......................
Reposition l ventric lead ..............................
Removal of pacemaker system ...................
Removal of pacemaker system ...................
Removal pacemaker electrode ...................
Remove electrode/thoracotomy ..................
Remove electrode/thoracotomy ..................
Remove electrode/thoracotomy ..................
Insert pulse generator .................................
Remove pulse generator .............................
Remove eltrd/thoracotomy ..........................
Remove eltrd, transven ...............................
Insert epic eltrd pace-defib ..........................
Insert epic eltrd/generator ...........................
Eltrd/insert pace-defib .................................
Ablate heart dysrhythm focus .....................
Ablate heart dysrhythm focus .....................
Reconstruct atria .........................................
Ablate heart dysrhythm focus .....................
Implant pat-active ht record ........................
Remove pat-active ht record .......................
Repair of heart wound .................................
Repair of heart wound .................................
Exploratory heart surgery ............................
Exploratory heart surgery ............................
Repair major blood vessel(s) ......................
Repair major vessel ....................................
Repair major blood vessel(s) ......................
Insert major vessel graft ..............................
Insert major vessel graft ..............................
Insert major vessel graft ..............................
Repair of aortic valve ..................................
Valvuloplasty, open .....................................
Valvuloplasty, w/cp bypass .........................
Prepare heart-aorta conduit ........................
Replacement of aortic valve ........................
Replacement of aortic valve ........................
Replacement of aortic valve ........................
Replacement of aortic valve ........................
Replacement of aortic valve ........................
Replacement of aortic valve ........................
Repair of aortic valve ..................................
Revision, subvalvular tissue ........................
0.00
2.24
2.24
6.80
12.62
12.09
18.72
21.80
14.37
24.57
21.40
20.01
4.84
12.48
10.18
6.67
8.05
8.14
3.31
3.40
5.52
6.37
7.76
4.76
5.78
5.75
5.44
5.52
4.96
6.46
9.06
8.35
8.70
3.30
7.83
9.41
12.61
13.72
15.23
7.61
3.25
22.66
13.77
14.31
20.72
14.24
21.86
24.89
31.07
24.89
4.17
2.51
17.93
21.45
18.52
22.38
16.79
20.21
20.63
21.44
23.97
30.02
28.52
23.92
24.90
28.56
35.02
37.51
32.47
36.27
42.02
43.52
30.36
27.16
Nonfacility
PE
RVUs
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
0.00
0.80
0.84
4.87
6.63
6.19
9.25
9.77
7.68
11.29
9.93
10.59
1.55
6.92
6.49
4.59
4.83
4.98
1.30
1.37
3.44
3.86
5.09
3.38
4.39
4.45
4.46
4.46
4.42
4.77
4.21
3.40
3.97
3.42
5.06
7.06
7.35
7.78
8.15
4.72
3.09
11.36
9.12
8.05
10.36
8.82
11.92
11.44
13.48
11.47
4.20
3.56
9.18
10.32
9.32
10.57
8.23
9.56
10.16
10.06
10.31
12.98
14.97
13.45
13.75
13.97
17.44
18.22
15.85
17.89
19.54
19.98
13.80
11.72
Malpractice
RVUs
0.00
0.14
0.15
0.65
1.79
1.80
2.83
3.13
2.14
3.69
3.00
2.85
0.69
1.70
1.36
0.52
0.59
0.56
0.18
0.21
0.43
0.45
0.58
0.37
0.36
0.39
0.37
0.37
0.42
0.45
0.54
0.45
0.59
0.22
0.56
0.73
1.68
1.59
2.02
0.41
0.18
2.09
0.99
2.01
2.63
0.77
3.18
3.59
4.52
3.45
0.23
0.14
2.65
3.12
2.58
3.27
2.07
2.90
2.85
2.81
3.02
4.27
4.10
3.56
3.54
4.32
5.31
5.43
4.68
5.46
6.37
6.51
4.56
4.13
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00147
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
0.00
3.19
3.23
12.33
21.03
20.09
30.80
34.71
24.18
39.54
34.34
33.45
7.08
21.11
18.03
11.79
13.46
13.67
4.78
4.97
9.39
10.68
13.43
8.51
10.54
10.59
10.27
10.35
9.80
11.68
13.80
12.20
13.25
6.94
13.45
17.20
21.64
23.08
25.40
12.74
6.52
36.11
23.88
24.37
33.71
23.83
36.96
39.92
49.08
39.81
8.60
6.20
29.76
34.90
30.42
36.22
27.09
32.67
33.64
34.31
37.30
47.27
47.59
40.93
42.19
46.84
57.77
61.16
53.00
59.63
67.93
70.00
48.72
43.02
Global
YYY
000
000
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
000
000
090
090
090
090
090
090
090
090
090
090
000
ZZZ
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45910
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
33416
33417
33420
33422
33425
33426
33427
33430
33460
33463
33464
33465
33468
33470
33471
33472
33474
33475
33476
33478
33496
33500
33501
33502
33503
33504
33505
33506
33508
33510
33511
33512
33513
33514
33516
33517
33518
33519
33521
33522
33523
33530
33533
33534
33535
33536
33542
33545
33572
33600
33602
33606
33608
33610
33611
33612
33615
33617
33619
33641
33645
33647
33660
33665
33670
33681
33684
33688
33690
33692
33694
33697
33702
33710
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Revise ventricle muscle ..............................
Repair of aortic valve ..................................
Revision of mitral valve ...............................
Revision of mitral valve ...............................
Repair of mitral valve ..................................
Repair of mitral valve ..................................
Repair of mitral valve ..................................
Replacement of mitral valve ........................
Revision of tricuspid valve ..........................
Valvuloplasty, tricuspid ................................
Valvuloplasty, tricuspid ................................
Replace tricuspid valve ...............................
Revision of tricuspid valve ..........................
Revision of pulmonary valve .......................
Valvotomy, pulmonary valve .......................
Revision of pulmonary valve .......................
Revision of pulmonary valve .......................
Replacement, pulmonary valve ...................
Revision of heart chamber ..........................
Revision of heart chamber ..........................
Repair, prosth valve clot .............................
Repair heart vessel fistula ...........................
Repair heart vessel fistula ...........................
Coronary artery correction ..........................
Coronary artery graft ...................................
Coronary artery graft ...................................
Repair artery w/tunnel .................................
Repair artery, translocation .........................
Endoscopic vein harvest .............................
CABG, vein, single ......................................
CABG, vein, two ..........................................
CABG, vein, three .......................................
CABG, vein, four .........................................
CABG, vein, five ..........................................
Cabg, vein, six or more ...............................
CABG, artery-vein, single ............................
CABG, artery-vein, two ...............................
CABG, artery-vein, three .............................
CABG, artery-vein, four ...............................
CABG, artery-vein, five ...............................
Cabg, art-vein, six or more .........................
Coronary artery, bypass/reop ......................
CABG, arterial, single ..................................
CABG, arterial, two .....................................
CABG, arterial, three ...................................
Cabg, arterial, four or more .........................
Removal of heart lesion ..............................
Repair of heart damage ..............................
Open coronary endarterectomy ..................
Closure of valve ..........................................
Closure of valve ..........................................
Anastomosis/artery-aorta ............................
Repair anomaly w/conduit ...........................
Repair by enlargement ................................
Repair double ventricle ...............................
Repair double ventricle ...............................
Repair, modified fontan ...............................
Repair single ventricle .................................
Repair single ventricle .................................
Repair heart septum defect .........................
Revision of heart veins ................................
Repair heart septum defects .......................
Repair of heart defects ................................
Repair of heart defects ................................
Repair of heart chambers ...........................
Repair heart septum defect .........................
Repair heart septum defect .........................
Repair heart septum defect .........................
Reinforce pulmonary artery .........................
Repair of heart defects ................................
Repair of heart defects ................................
Repair of heart defects ................................
Repair of heart defects ................................
Repair of heart defects ................................
30.36
28.55
22.72
25.95
27.01
33.02
40.02
33.52
23.61
25.63
27.34
28.81
30.13
20.82
22.26
22.26
23.06
33.02
25.78
26.75
27.26
25.56
17.79
21.05
21.79
24.67
26.85
35.52
0.31
29.02
30.02
31.81
32.01
32.77
35.02
2.58
4.85
7.12
9.41
11.67
13.96
5.86
30.02
32.21
34.52
37.51
28.87
36.79
4.45
29.53
28.56
30.75
31.10
30.62
34.02
35.02
34.02
37.01
45.02
21.40
24.83
28.75
30.02
28.62
35.02
30.62
29.67
30.63
19.56
30.76
34.02
36.02
26.55
29.73
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
13.13
13.26
9.43
12.99
12.48
16.35
18.50
16.51
10.97
12.58
13.16
12.64
13.24
10.71
9.77
11.93
10.74
15.10
12.17
12.66
12.45
11.23
8.19
10.82
9.79
11.64
12.68
14.19
0.10
15.53
16.23
16.76
16.93
17.19
17.95
0.82
1.55
2.28
3.01
3.74
4.44
1.87
15.67
16.85
17.30
17.58
12.67
15.37
1.42
12.38
12.52
13.32
13.68
13.44
13.78
14.82
12.93
15.54
20.23
9.33
11.50
13.50
13.24
13.32
13.52
14.26
13.27
10.17
9.86
13.32
13.87
14.41
12.26
13.76
Malpractice
RVUs
4.56
4.09
1.81
3.93
4.06
5.01
6.07
5.08
3.44
3.86
4.14
4.38
4.06
1.03
3.38
3.54
3.21
4.92
2.41
3.88
4.12
3.86
1.90
2.99
1.77
3.35
2.18
4.65
0.04
4.40
4.55
4.66
4.87
4.76
5.11
0.39
0.73
1.04
1.37
1.77
2.12
0.88
4.55
4.69
5.01
5.42
4.37
5.19
0.65
4.41
3.81
4.40
4.73
4.55
4.36
5.28
4.31
5.64
6.44
3.22
3.78
3.31
4.48
3.99
4.64
4.44
3.38
4.72
1.96
4.57
5.26
4.08
3.67
4.42
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00148
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
48.05
45.90
33.95
42.87
43.56
54.37
64.59
55.10
38.02
42.07
44.65
45.82
47.43
32.56
35.41
37.73
37.00
53.04
40.36
43.29
43.83
40.65
27.87
34.86
33.36
39.66
41.72
54.36
0.45
48.95
50.80
53.24
53.81
54.72
58.08
3.79
7.13
10.44
13.79
17.18
20.52
8.61
50.24
53.75
56.83
60.52
45.91
57.35
6.52
46.32
44.88
48.47
49.51
48.61
52.16
55.12
51.26
58.19
71.69
33.95
40.11
45.56
47.74
45.93
53.18
49.32
46.32
45.52
31.38
48.66
53.15
54.51
42.48
47.91
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45911
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
33720
33722
33730
33732
33735
33736
33737
33750
33755
33762
33764
33766
33767
33770
33771
33774
33775
33776
33777
33778
33779
33780
33781
33786
33788
33800
33802
33803
33813
33814
33820
33822
33824
33840
33845
33851
33852
33853
33860
33861
33863
33870
33875
33877
33910
33915
33916
33917
33918
33919
33920
33922
33924
33933
33935
33944
33945
33960
33961
33967
33968
33970
33971
33973
33974
33975
33976
33977
33978
33979
33980
33999
34001
34051
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
R
C
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
Physician
work
RVUs 3
Description
Repair of heart defect .................................
Repair of heart defect .................................
Repair heart-vein defect(s) ..........................
Repair heart-vein defect ..............................
Revision of heart chamber ..........................
Revision of heart chamber ..........................
Revision of heart chamber ..........................
Major vessel shunt ......................................
Major vessel shunt ......................................
Major vessel shunt ......................................
Major vessel shunt & graft ..........................
Major vessel shunt ......................................
Major vessel shunt ......................................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair great vessels defect ........................
Repair arterial trunk .....................................
Revision of pulmonary artery ......................
Aortic suspension ........................................
Repair vessel defect ....................................
Repair vessel defect ....................................
Repair septal defect ....................................
Repair septal defect ....................................
Revise major vessel ....................................
Revise major vessel ....................................
Revise major vessel ....................................
Remove aorta constriction ..........................
Remove aorta constriction ..........................
Remove aorta constriction ..........................
Repair septal defect ....................................
Repair septal defect ....................................
Ascending aortic graft .................................
Ascending aortic graft .................................
Ascending aortic graft .................................
Transverse aortic arch graft ........................
Thoracic aortic graft ....................................
Thoracoabdominal graft ..............................
Remove lung artery emboli .........................
Remove lung artery emboli .........................
Surgery of great vessel ...............................
Repair pulmonary artery ..............................
Repair pulmonary atresia ............................
Repair pulmonary atresia ............................
Repair pulmonary atresia ............................
Transect pulmonary artery ..........................
Remove pulmonary shunt ...........................
Prepare donor heart/lung ............................
Transplantation, heart/lung ..........................
Prepare donor heart ....................................
Transplantation of heart ..............................
External circulation assist ............................
External circulation assist ............................
Insert ia percut device .................................
Remove aortic assist device .......................
Aortic circulation assist ................................
Aortic circulation assist ................................
Insert balloon device ...................................
Remove intra-aortic balloon ........................
Implant ventricular device ...........................
Implant ventricular device ...........................
Remove ventricular device ..........................
Remove ventricular device ..........................
Insert intracorporeal device .........................
Remove intracorporeal device ....................
Cardiac surgery procedure ..........................
Removal of artery clot .................................
Removal of artery clot .................................
26.57
28.43
34.27
28.18
21.40
23.53
21.77
21.42
21.80
21.80
21.80
22.78
24.51
37.01
34.67
30.99
32.21
34.06
33.48
40.02
36.23
41.77
36.47
39.02
26.63
16.25
17.67
19.61
20.66
25.78
16.30
17.32
19.53
20.64
22.13
21.28
23.72
31.73
38.02
42.02
45.02
44.02
33.08
42.63
24.60
21.03
25.84
24.51
26.46
40.02
31.96
23.53
5.50
0.00
60.99
0.00
42.12
19.37
10.93
4.85
0.64
6.75
9.70
9.77
14.42
21.01
23.02
19.30
21.74
46.02
56.28
0.00
12.92
15.22
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
Facility
PE
RVUs
11.98
13.09
14.33
13.51
9.04
11.97
11.26
10.37
8.58
10.24
10.24
11.07
11.37
14.36
12.11
14.46
14.39
15.27
14.86
16.36
15.87
18.55
13.19
15.99
11.48
7.95
9.00
9.30
10.52
12.31
8.10
8.59
9.68
9.97
10.97
10.39
11.20
14.43
16.03
17.31
18.24
17.91
13.78
16.01
11.12
9.71
11.10
11.84
11.61
17.47
13.44
10.87
1.79
0.00
27.47
0.00
20.34
4.83
3.52
1.91
0.23
2.27
6.06
3.29
7.94
6.15
7.41
10.77
11.54
14.63
24.71
0.00
6.54
7.62
Malpractice
RVUs
3.83
1.30
5.01
3.67
1.91
3.08
3.24
1.16
3.25
3.13
3.00
3.69
3.81
5.72
5.66
4.80
4.98
5.07
5.47
6.18
2.91
3.67
5.95
5.69
4.02
2.45
2.26
3.19
3.12
3.84
2.34
2.67
2.88
2.15
3.21
3.17
2.15
4.47
5.74
6.35
6.57
6.60
4.88
5.92
3.69
1.44
3.66
3.69
4.14
5.95
4.37
3.09
0.82
0.00
9.03
0.00
6.24
2.66
0.88
0.35
0.07
0.82
1.25
1.26
1.73
3.06
3.25
2.80
3.30
6.95
8.56
0.00
1.84
2.20
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00149
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
Facility
total
42.38
42.82
53.61
45.36
32.35
38.57
36.27
32.95
33.64
35.18
35.04
37.53
39.69
57.09
52.44
50.25
51.58
54.40
53.81
62.56
55.01
64.00
55.61
60.69
42.13
26.65
28.93
32.10
34.30
41.93
26.74
28.59
32.09
32.76
36.31
34.84
37.07
50.63
59.79
65.68
69.83
68.53
51.73
64.56
39.41
32.18
40.60
40.04
42.21
63.44
49.77
37.48
8.11
0.00
97.50
0.00
68.70
26.86
15.33
7.11
0.94
9.84
17.01
14.32
24.09
30.22
33.68
32.87
36.58
67.60
89.55
0.00
21.29
25.04
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
XXX
090
XXX
090
000
ZZZ
000
000
000
090
000
090
XXX
XXX
090
090
XXX
090
YYY
090
090
45912
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
34101
34111
34151
34201
34203
34401
34421
34451
34471
34490
34501
34502
34510
34520
34530
34800
34802
34803
34804
34805
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
34900
35001
35002
35005
35011
35013
35021
35022
35045
35081
35082
35091
35092
35102
35103
35111
35112
35121
35122
35131
35132
35141
35142
35151
35152
35180
35182
35184
35188
35189
35190
35201
35206
35207
35211
35216
35221
35226
35231
35236
35241
35246
35251
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of artery clot .................................
Removal of arm artery clot ..........................
Removal of artery clot .................................
Removal of artery clot .................................
Removal of leg artery clot ...........................
Removal of vein clot ....................................
Removal of vein clot ....................................
Removal of vein clot ....................................
Removal of vein clot ....................................
Removal of vein clot ....................................
Repair valve, femoral vein ..........................
Reconstruct vena cava ................................
Transposition of vein valve .........................
Cross-over vein graft ...................................
Leg vein fusion ............................................
Endovas aaa repr w/sm tube ......................
Endovas aaa repr w/2-p part ......................
Endovas aaa repr w/3-p part ......................
Endovas aaa repr w/1-p part ......................
Endovas aaa repr w/long tube ....................
Endovas iliac a device add-on ....................
Xpose for endoprosth, femorl ......................
Femoral endovas graft add-on ....................
Xpose for endoprosth, iliac .........................
Endovasc extend prosth, init .......................
Endovasc exten prosth, add’l ......................
Open aortic tube prosth repr .......................
Open aortoiliac prosth repr .........................
Open aortofemor prosth repr ......................
Xpose for endoprosth, iliac .........................
Xpose, endoprosth, brachial .......................
Endovasc iliac repr w/graft ..........................
Repair defect of artery ................................
Repair artery rupture, neck .........................
Repair defect of artery ................................
Repair defect of artery ................................
Repair artery rupture, arm ...........................
Repair defect of artery ................................
Repair artery rupture, chest ........................
Repair defect of arm artery .........................
Repair defect of artery ................................
Repair artery rupture, aorta .........................
Repair defect of artery ................................
Repair artery rupture, aorta .........................
Repair defect of artery ................................
Repair artery rupture, groin .........................
Repair defect of artery ................................
Repair artery rupture,spleen .......................
Repair defect of artery ................................
Repair artery rupture, belly .........................
Repair defect of artery ................................
Repair artery rupture, groin .........................
Repair defect of artery ................................
Repair artery rupture, thigh .........................
Repair defect of artery ................................
Repair artery rupture, knee .........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
10.01
10.01
25.01
10.03
16.51
25.01
12.00
27.01
10.18
9.87
16.01
26.96
18.96
17.96
16.65
20.76
23.02
24.05
23.02
21.89
4.13
6.75
4.80
9.76
12.00
4.13
32.61
35.36
35.36
12.00
5.35
16.39
19.65
21.01
18.13
18.01
22.01
19.66
23.20
17.58
28.03
38.52
35.42
45.02
30.77
40.52
25.01
30.02
30.02
35.02
25.01
30.02
20.01
23.32
22.66
25.63
13.63
30.02
18.01
14.29
28.02
12.76
16.15
13.26
10.15
22.13
18.76
24.40
14.51
20.01
17.11
23.14
26.46
30.21
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
5.21
5.24
10.17
5.25
7.83
10.75
6.19
11.17
5.27
5.32
8.30
12.14
9.10
8.32
8.38
9.00
9.69
10.04
9.71
9.29
1.36
2.18
1.54
3.16
6.06
1.36
13.30
11.49
14.18
4.44
2.20
7.46
9.25
9.62
8.98
7.76
9.41
9.21
9.69
7.31
11.15
14.91
13.20
17.18
12.04
15.45
10.22
11.74
12.04
13.53
10.45
12.07
8.64
10.07
9.70
11.02
6.76
12.67
8.08
7.41
11.63
6.29
7.72
6.37
7.14
10.31
8.81
9.73
7.48
9.46
7.66
10.80
11.26
11.57
Malpractice
RVUs
1.41
1.40
3.55
1.45
2.35
3.09
1.55
3.83
1.18
1.41
2.34
3.62
2.32
2.28
1.73
2.45
2.32
2.00
2.29
2.00
0.59
1.18
0.67
1.50
1.28
0.44
4.54
4.88
4.84
1.69
0.76
1.99
2.80
2.99
1.76
2.54
3.09
2.86
3.16
2.44
4.00
5.42
5.12
6.38
4.47
5.74
3.46
4.07
4.29
4.74
3.79
4.29
2.89
3.35
3.23
3.60
1.00
4.35
2.52
2.15
4.00
1.79
2.33
1.86
1.48
3.19
2.64
3.36
2.01
2.88
2.42
3.52
3.85
4.12
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00150
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
16.63
16.65
38.73
16.73
26.70
38.85
19.75
42.02
16.63
16.60
26.66
42.72
30.37
28.56
26.77
32.21
35.03
36.08
35.02
33.18
6.08
10.12
7.01
14.42
19.35
5.93
50.45
51.73
54.38
18.14
8.31
25.84
31.70
33.62
28.87
28.31
34.52
31.73
36.05
27.33
43.18
58.85
53.74
68.58
47.28
61.71
38.69
45.83
46.35
53.29
39.25
46.38
31.54
36.73
35.59
40.25
21.39
47.04
28.60
23.85
43.65
20.83
26.20
21.48
18.77
35.63
30.21
37.49
24.00
32.35
27.19
37.46
41.58
45.90
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
000
ZZZ
000
090
ZZZ
090
090
090
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45913
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
35256
35261
35266
35271
35276
35281
35286
35301
35311
35321
35331
35341
35351
35355
35361
35363
35371
35372
35381
35390
35400
35450
35452
35454
35456
35458
35459
35460
35470
35471
35472
35473
35474
35475
35476
35480
35481
35482
35483
35484
35485
35490
35491
35492
35493
35494
35495
35500
35501
35506
35507
35508
35509
35510
35511
35512
35515
35516
35518
35521
35522
35525
35526
35531
35533
35536
35541
35546
35548
35549
35551
35556
35558
35560
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Repair blood vessel lesion ..........................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Rechanneling of artery ................................
Reoperation, carotid add-on ........................
Angioscopy ..................................................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair venous blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair venous blockage ..............................
Atherectomy, open ......................................
Atherectomy, open ......................................
Atherectomy, open ......................................
Atherectomy, open ......................................
Atherectomy, open ......................................
Atherectomy, open ......................................
Atherectomy, percutaneous ........................
Atherectomy, percutaneous ........................
Atherectomy, percutaneous ........................
Atherectomy, percutaneous ........................
Atherectomy, percutaneous ........................
Atherectomy, percutaneous ........................
Harvest vein for bypass ..............................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
18.37
17.81
14.92
22.13
24.26
28.02
16.17
18.71
27.01
16.01
26.21
25.12
23.02
18.51
28.22
30.21
14.73
18.01
15.82
3.20
3.01
10.07
6.91
6.04
7.35
9.50
8.64
6.04
8.64
10.07
6.91
6.04
7.36
9.50
6.04
11.08
7.62
6.65
8.11
10.44
9.50
11.08
7.62
6.65
8.11
10.44
9.50
6.45
19.20
19.68
19.68
18.66
18.08
23.02
21.21
22.51
18.66
16.33
21.21
22.21
21.77
20.64
29.97
36.22
28.02
31.71
25.81
25.55
21.58
23.36
26.68
21.77
21.21
32.01
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
87.06
97.32
63.69
59.64
85.82
57.78
45.66
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
8.09
7.90
6.83
10.20
10.98
11.44
7.82
8.19
11.26
7.16
10.90
10.55
9.34
7.87
11.40
12.24
6.75
7.81
7.58
1.04
1.08
3.53
2.54
2.26
2.70
3.38
3.10
2.22
3.50
4.16
2.86
2.53
3.03
3.73
2.47
4.00
2.83
2.54
2.98
3.69
3.49
4.92
3.37
3.29
3.99
4.70
4.63
1.97
8.16
9.16
9.10
9.26
8.46
10.15
9.12
9.96
9.19
6.58
8.73
9.54
9.61
9.13
12.27
14.08
11.43
12.60
10.90
10.58
9.19
10.07
11.14
9.44
9.28
12.93
Malpractice
RVUs
2.62
2.60
2.09
3.15
3.48
3.96
2.34
2.67
3.41
2.24
3.82
3.77
3.34
2.66
4.14
4.32
2.13
2.62
2.25
0.46
0.43
1.25
0.94
0.87
1.04
1.26
1.21
0.83
0.69
0.67
0.58
0.51
0.57
0.62
0.34
1.28
1.13
0.89
1.15
1.27
1.35
0.71
0.74
0.43
0.56
0.59
0.69
0.93
2.80
2.86
2.84
2.77
2.61
2.11
2.90
2.11
2.77
2.33
3.02
3.12
2.11
2.11
3.62
5.16
3.84
4.61
3.70
3.69
2.97
3.29
3.74
3.09
2.99
4.74
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00151
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
96.39
108.06
71.19
66.20
93.76
67.90
52.04
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
29.08
28.31
23.84
35.48
38.72
43.42
26.34
29.56
41.69
25.41
40.93
39.44
35.69
29.04
43.75
46.77
23.61
28.44
25.65
4.69
4.52
14.85
10.40
9.17
11.10
14.14
12.95
9.09
12.82
14.90
10.36
9.08
10.96
13.85
8.85
16.36
11.58
10.08
12.24
15.40
14.34
16.72
11.72
10.37
12.66
15.73
14.82
9.35
30.16
31.70
31.62
30.68
29.14
35.27
33.23
34.58
30.61
25.25
32.97
34.88
33.50
31.88
45.86
55.47
43.28
48.93
40.41
39.82
33.74
36.72
41.57
34.30
33.48
49.68
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
ZZZ
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45914
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
35563
35565
35566
35571
35572
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35636
35641
35642
35645
35646
35647
35650
35651
35654
35656
35661
35663
35665
35666
35671
35681
35682
35683
35685
35686
35691
35693
35694
35695
35697
35700
35701
35721
35741
35761
35800
35820
35840
35860
35870
35875
35876
35879
35881
35901
35903
35905
35907
36000
36002
36005
36010
36011
36012
36013
36014
36015
36100
36120
36140
36145
36160
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Harvest femoropopliteal vein .......................
Vein bypass graft ........................................
Vein bypass graft ........................................
Vein bypass graft ........................................
Harvest artery for cabg ...............................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Bypass graft, not vein .................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Artery bypass graft ......................................
Composite bypass graft ..............................
Composite bypass graft ..............................
Composite bypass graft ..............................
Bypass graft patency/patch .........................
Bypass graft/av fist patency ........................
Arterial transposition ....................................
Arterial transposition ....................................
Arterial transposition ....................................
Arterial transposition ....................................
Reimplant artery each .................................
Reoperation, bypass graft ...........................
Exploration, carotid artery ...........................
Exploration, femoral artery ..........................
Exploration popliteal artery ..........................
Exploration of artery/vein ............................
Explore neck vessels ..................................
Explore chest vessels .................................
Explore abdominal vessels .........................
Explore limb vessels ...................................
Repair vessel graft defect ...........................
Removal of clot in graft ...............................
Removal of clot in graft ...............................
Revise graft w/vein ......................................
Revise graft w/vein ......................................
Excision, graft, neck ....................................
Excision, graft, extremity .............................
Excision, graft, thorax ..................................
Excision, graft, abdomen .............................
Place needle in vein ....................................
Pseudoaneurysm injection trt ......................
Injection ext venography .............................
Place catheter in vein ..................................
Place catheter in vein ..................................
Place catheter in vein ..................................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Establish access to artery ...........................
Establish access to artery ...........................
Establish access to artery ...........................
Artery to vein shunt .....................................
Establish access to aorta ............................
24.21
23.22
26.93
24.07
6.82
22.38
28.41
24.76
4.95
17.50
18.72
15.77
15.71
20.01
24.01
27.77
34.02
29.52
24.58
17.99
17.47
31.01
28.02
19.01
25.05
25.01
19.54
19.01
22.01
21.01
22.20
19.34
1.60
7.20
8.51
4.05
3.35
18.06
15.37
19.17
19.17
3.01
3.09
8.51
7.18
8.01
5.37
7.02
12.89
9.78
5.55
22.18
10.13
17.00
16.01
18.01
8.20
9.40
31.26
35.02
0.18
1.96
0.95
2.43
3.15
3.52
2.53
3.03
3.52
3.03
2.01
2.01
2.01
2.53
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.56
2.77
8.00
18.12
27.36
20.90
20.81
20.65
23.90
12.20
10.97
12.60
12.69
13.15
Facility
PE
RVUs
10.24
9.85
11.05
10.52
2.20
9.86
11.88
11.12
1.59
8.32
8.71
7.64
7.81
8.42
10.18
11.71
13.43
12.07
10.71
8.74
8.09
12.72
11.42
8.12
10.43
10.36
8.36
8.66
9.68
9.17
10.32
9.08
0.52
2.32
2.75
1.34
1.12
8.16
7.60
8.36
8.30
1.00
1.00
5.00
4.28
4.53
3.89
4.49
7.01
5.16
3.90
9.48
5.10
7.33
7.48
8.43
5.13
5.97
12.78
13.79
0.05
1.00
0.33
0.80
1.09
1.26
0.69
1.09
1.26
1.14
0.67
0.66
0.69
0.85
Malpractice
RVUs
3.51
3.29
3.82
3.42
0.99
3.16
4.01
3.51
0.73
2.49
2.69
2.08
2.19
2.91
3.45
4.07
4.95
4.09
3.53
2.27
2.49
4.43
3.98
2.71
3.35
3.52
2.79
2.71
3.10
3.00
3.15
2.77
0.23
1.03
1.20
0.58
0.47
2.58
2.21
2.69
2.73
0.41
0.44
1.12
1.03
1.12
0.75
0.95
1.94
1.34
0.78
3.00
1.41
2.39
2.27
2.55
1.15
1.30
4.43
4.91
0.01
0.17
0.05
0.20
0.27
0.23
0.25
0.19
0.21
0.26
0.14
0.16
0.11
0.26
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00152
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.75
4.90
9.00
20.76
30.78
24.64
23.58
23.86
27.63
15.49
13.13
14.77
14.81
15.93
Facility
total
37.95
36.36
41.81
38.01
10.02
35.41
44.30
39.39
7.27
28.31
30.12
25.49
25.71
31.34
37.63
43.54
52.40
45.68
38.82
28.99
28.06
48.16
43.42
29.84
38.83
38.89
30.69
30.38
34.80
33.18
35.67
31.19
2.35
10.56
12.46
5.96
4.94
28.79
25.18
30.22
30.20
4.42
4.52
14.63
12.49
13.65
10.01
12.47
21.84
16.28
10.23
34.67
16.64
26.72
25.76
28.99
14.48
16.67
48.47
53.71
0.24
3.13
1.33
3.44
4.51
5.00
3.46
4.31
4.98
4.43
2.83
2.83
2.82
3.63
Global
090
090
090
090
ZZZ
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
090
090
090
090
ZZZ
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
XXX
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45915
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
36200
36215
36216
36217
36218
36245
36246
36247
36248
36260
36261
36262
36299
36400
36405
36406
36410
36416
36420
36425
36430
36440
36450
36455
36460
36468
36469
36470
36471
36475
36476
36478
36479
36481
36500
36510
36511
36512
36513
36514
36515
36516
36522
36540
36550
36555
36556
36557
36558
36560
36561
36563
36565
36566
36568
36569
36570
36571
36575
36576
36578
36580
36581
36582
36583
36584
36585
36589
36590
36595
36596
36597
36600
36620
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
B
A
A
A
A
A
A
A
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Place catheter in aorta ................................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Place catheter in artery ...............................
Insertion of infusion pump ...........................
Revision of infusion pump ...........................
Removal of infusion pump ..........................
Vessel injection procedure ..........................
Bl draw < 3 yrs fem/jugular .........................
Bl draw < 3 yrs scalp vein ...........................
Bl draw < 3 yrs other vein ...........................
Non-routine bl draw > 3 yrs ........................
Capillary blood draw ....................................
Vein access cutdown < 1 yr ........................
Vein access cutdown > 1 yr ........................
Blood transfusion service ............................
Bl push transfuse, 2 yr or < ........................
Bl exchange/transfuse, nb ...........................
Bl exchange/transfuse non-nb ....................
Transfusion service, fetal ............................
Injection(s), spider veins .............................
Injection(s), spider veins .............................
Injection therapy of vein ..............................
Injection therapy of veins ............................
Endovenous rf, 1st vein ..............................
Endovenous rf, vein add-on ........................
Endovenous laser, 1st vein .........................
Endovenous laser vein add-on ...................
Insertion of catheter, vein ............................
Insertion of catheter, vein ............................
Insertion of catheter, vein ............................
Apheresis wbc .............................................
Apheresis rbc ..............................................
Apheresis platelets ......................................
Apheresis plasma ........................................
Apheresis, adsorp/reinfuse ..........................
Apheresis, selective ....................................
Photopheresis ..............................................
Collect blood venous device .......................
Declot vascular device ................................
Insert non-tunnel cv cath .............................
Insert non-tunnel cv cath .............................
Insert tunneled cv cath ................................
Insert tunneled cv cath ................................
Insert tunneled cv cath ................................
Insert tunneled cv cath ................................
Insert tunneled cv cath ................................
Insert tunneled cv cath ................................
Insert tunneled cv cath ................................
Insert picc cath ............................................
Insert picc cath ............................................
Insert picvad cath ........................................
Insert picvad cath ........................................
Repair tunneled cv cath ..............................
Repair tunneled cv cath ..............................
Replace tunneled cv cath ............................
Replace cvad cath .......................................
Replace tunneled cv cath ............................
Replace tunneled cv cath ............................
Replace tunneled cv cath ............................
Replace picc cath ........................................
Replace picvad cath ....................................
Removal tunneled cv cath ...........................
Removal tunneled cv cath ...........................
Mech remov tunneled cv cath .....................
Mech remov tunneled cv cath .....................
Reposition venous catheter .........................
Withdrawal of arterial blood ........................
Insertion catheter, artery .............................
3.03
4.68
5.28
6.30
1.01
4.68
5.28
6.30
1.01
9.72
5.45
4.02
0.00
0.38
0.31
0.18
0.18
0.00
1.01
0.76
0.00
1.03
2.23
2.43
6.59
0.00
0.00
1.09
1.57
6.73
3.39
6.73
3.39
6.99
3.52
1.09
1.74
1.74
1.74
1.74
1.74
1.22
1.67
0.00
0.00
2.69
2.51
5.10
4.80
6.25
6.00
6.20
6.00
6.50
1.92
1.82
5.32
5.30
0.67
3.20
3.50
1.31
3.44
5.20
5.25
1.20
4.80
2.27
3.31
3.60
0.75
1.21
0.32
1.15
Nonfacility
PE
RVUs
16.72
27.47
29.85
55.46
5.04
32.95
30.80
50.01
4.05
NA
NA
NA
0.00
0.29
0.26
0.28
0.30
0.00
NA
NA
0.96
NA
NA
NA
NA
0.00
0.00
2.62
2.99
48.94
7.59
44.54
7.69
NA
NA
3.44
NA
NA
NA
15.88
62.05
76.84
32.02
0.00
0.38
5.43
5.21
20.41
20.32
28.86
28.25
24.94
24.32
24.65
7.06
7.26
31.95
31.47
4.06
6.61
11.13
6.63
19.51
26.90
26.86
6.64
28.57
2.16
3.35
16.43
3.62
2.44
0.48
NA
Facility
PE
RVUs
1.06
1.69
1.88
2.28
0.36
1.76
1.91
2.25
0.36
4.82
3.59
2.71
0.00
0.09
0.08
0.05
0.05
0.00
0.27
0.22
NA
0.28
0.69
0.98
2.18
0.00
0.00
0.76
0.95
2.56
1.16
2.56
1.16
2.68
1.39
0.56
0.71
0.72
0.71
0.69
0.65
0.47
1.04
0.00
NA
0.79
0.72
2.67
2.61
3.04
2.93
2.90
2.91
3.04
0.60
0.62
2.74
2.71
0.27
1.84
2.34
0.43
1.98
2.91
2.99
0.61
2.80
1.41
1.72
1.51
0.52
0.46
0.09
0.23
Malpractice
RVUs
0.24
0.27
0.31
0.44
0.07
0.31
0.38
0.47
0.07
1.29
0.70
0.54
0.00
0.03
0.03
0.01
0.01
0.00
0.07
0.06
0.06
0.10
0.21
0.15
0.79
0.00
0.00
0.12
0.19
0.37
0.18
0.37
0.18
0.55
0.20
0.10
0.08
0.08
0.17
0.08
0.08
0.08
0.13
0.00
0.37
0.11
0.19
0.57
0.57
0.57
0.57
0.84
0.57
0.57
0.11
0.19
0.57
0.57
0.20
0.19
0.19
0.19
0.19
0.19
0.19
0.19
0.19
0.24
0.44
0.21
0.05
0.07
0.02
0.07
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00153
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
19.99
32.42
35.44
62.20
6.12
37.94
36.46
56.79
5.13
NA
NA
NA
0.00
0.70
0.60
0.47
0.49
0.00
NA
NA
1.02
NA
NA
NA
NA
0.00
0.00
3.83
4.75
56.05
11.15
51.64
11.26
NA
NA
4.63
NA
NA
NA
17.70
63.87
78.15
33.83
0.00
0.75
8.22
7.91
26.08
25.69
35.68
34.82
31.99
30.89
31.72
9.10
9.27
37.84
37.34
4.93
10.00
14.82
8.13
23.13
32.29
32.30
8.04
33.56
4.68
7.10
20.23
4.43
3.72
0.82
NA
Facility
total
4.33
6.64
7.47
9.02
1.44
6.75
7.57
9.02
1.44
15.83
9.75
7.27
0.00
0.50
0.42
0.24
0.24
0.00
1.35
1.04
NA
1.42
3.14
3.57
9.57
0.00
0.00
1.97
2.71
9.67
4.72
9.67
4.72
10.22
5.11
1.75
2.53
2.54
2.62
2.52
2.47
1.77
2.85
0.00
NA
3.58
3.42
8.34
7.97
9.87
9.50
9.95
9.48
10.12
2.64
2.63
8.63
8.58
1.14
5.23
6.03
1.93
5.61
8.30
8.43
2.00
7.79
3.92
5.46
5.32
1.32
1.74
0.43
1.45
Global
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
XXX
ZZZ
090
090
090
YYY
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
010
010
000
ZZZ
000
ZZZ
000
000
000
000
000
000
000
000
000
000
XXX
XXX
000
000
010
010
010
010
010
010
010
000
000
010
010
000
010
010
000
010
010
010
000
010
010
010
000
000
000
XXX
000
45916
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
36625
36640
36660
36680
36800
36810
36815
36818
36819
36820
36821
36822
36823
36825
36830
36831
36832
36833
36834
36835
36838
36860
36861
36870
37140
37145
37160
37180
37181
37182
37183
37195
37200
37201
37202
37203
37204
37205
37206
37207
37208
37209
37215
37216
37250
37251
37500
37501
37565
37600
37605
37606
37607
37609
37615
37616
37617
37618
37620
37650
37660
37700
37720
37730
37735
37760
37765
37766
37780
37785
37788
37790
37799
38100
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
R
R
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
Physician
work
RVUs 3
Description
Insertion catheter, artery .............................
Insertion catheter, artery .............................
Insertion catheter, artery .............................
Insert needle, bone cavity ...........................
Insertion of cannula .....................................
Insertion of cannula .....................................
Insertion of cannula .....................................
Av fuse, uppr arm, cephalic ........................
Av fuse, uppr arm, basilic ...........................
Av fusion/forearm vein ................................
Av fusion direct any site ..............................
Insertion of cannula(s) .................................
Insertion of cannula(s) .................................
Artery-vein autograft ....................................
Artery-vein nonautograft ..............................
Open thrombect av fistula ...........................
Av fistula revision, open ..............................
Av fistula revision ........................................
Repair A-V aneurysm ..................................
Artery to vein shunt .....................................
Dist revas ligation, hemo .............................
External cannula declotting .........................
Cannula declotting .......................................
Percut thrombect av fistula .........................
Revision of circulation .................................
Revision of circulation .................................
Revision of circulation .................................
Revision of circulation .................................
Splice spleen/kidney veins ..........................
Insert hepatic shunt (tips) ............................
Remove hepatic shunt (tips) .......................
Thrombolytic therapy, stroke .......................
Transcatheter biopsy ...................................
Transcatheter therapy infuse ......................
Transcatheter therapy infuse ......................
Transcatheter retrieval ................................
Transcatheter occlusion ..............................
Transcath iv stent, percut ............................
Transcath iv stent/perc addl ........................
Transcath iv stent, open ..............................
Transcath iv stent/open addl .......................
Exchange arterial catheter ..........................
Transcath stent, cca w/eps .........................
Transcath stent, cca w/o eps ......................
Iv us first vessel add-on ..............................
Iv us each add vessel add-on .....................
Endoscopy ligate perf veins ........................
Vascular endoscopy procedure ...................
Ligation of neck vein ...................................
Ligation of neck artery .................................
Ligation of neck artery .................................
Ligation of neck artery .................................
Ligation of a-v fistula ...................................
Temporal artery procedure ..........................
Ligation of neck artery .................................
Ligation of chest artery ................................
Ligation of abdomen artery .........................
Ligation of extremity artery ..........................
Revision of major vein .................................
Revision of major vein .................................
Revision of major vein .................................
Revise leg vein ............................................
Removal of leg vein ....................................
Removal of leg veins ...................................
Removal of leg veins/lesion ........................
Ligation, leg veins, open .............................
Phleb veins - extrem - to 20 .......................
Phleb veins - extrem 20+ ............................
Revision of leg vein .....................................
Ligate/divide/excise vein .............................
Revascularization, penis .............................
Penile venous occlusion ..............................
Vascular surgery procedure ........................
Removal of spleen, total .............................
2.11
2.10
1.40
1.20
2.43
3.97
2.63
11.54
14.01
14.01
8.94
5.42
21.01
9.85
12.00
8.01
10.50
11.95
9.94
7.15
20.64
2.01
2.53
5.16
23.61
24.62
21.61
24.62
26.69
17.00
8.01
0.00
4.56
5.00
5.68
5.03
18.15
8.29
4.13
8.29
4.13
2.27
18.75
18.02
2.10
1.60
11.00
0.00
10.88
11.25
13.12
6.28
6.16
3.01
5.73
16.50
22.07
4.84
10.56
7.81
21.01
3.73
5.66
7.33
10.53
10.47
7.35
9.31
3.84
3.84
22.02
8.35
0.00
14.51
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.26
NA
52.60
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
33.96
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
4.38
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.13
NA
NA
0.00
NA
Facility
PE
RVUs
0.52
1.02
0.43
0.49
1.76
1.67
1.14
6.06
6.20
6.21
4.55
4.32
9.19
4.92
5.10
3.88
4.62
5.08
4.67
4.23
9.21
0.70
1.54
3.30
10.93
10.73
9.10
10.06
10.89
6.37
3.16
0.00
1.58
2.67
3.25
2.14
6.22
3.95
1.50
3.10
1.36
0.78
9.55
9.26
0.76
0.55
6.76
0.00
5.51
6.44
6.74
4.46
3.48
1.93
4.00
7.92
9.00
3.50
5.83
4.55
8.86
2.73
3.62
4.20
5.36
5.22
4.46
5.18
2.79
2.67
10.13
4.76
0.00
6.10
Malpractice
RVUs
0.26
0.21
0.14
0.11
0.25
0.45
0.35
1.89
1.95
1.94
1.23
0.79
2.88
1.35
1.66
1.09
1.44
1.65
1.37
0.98
3.01
0.11
0.27
0.29
2.01
3.25
2.81
3.34
3.40
1.00
0.47
0.00
0.27
0.33
0.43
0.29
1.48
0.60
0.31
1.17
0.59
0.15
1.09
1.04
0.21
0.19
1.54
0.00
1.33
1.41
1.98
1.23
0.85
0.36
0.68
2.32
2.97
0.67
0.91
1.01
2.48
0.53
0.80
1.04
1.48
1.44
0.48
0.48
0.53
0.54
2.25
0.59
0.00
1.91
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00154
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.38
NA
58.05
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
39.28
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
7.75
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.51
NA
NA
0.00
NA
Facility
total
2.89
3.34
1.97
1.81
4.44
6.09
4.12
19.49
22.16
22.16
14.71
10.53
33.09
16.12
18.77
12.98
16.56
18.68
15.98
12.37
32.86
2.82
4.33
8.75
36.54
38.60
33.52
38.02
40.98
24.37
11.63
0.00
6.41
8.00
9.36
7.46
25.84
12.84
5.94
12.56
6.08
3.21
29.39
28.31
3.08
2.35
19.30
0.00
17.72
19.11
21.84
11.97
10.49
5.29
10.41
26.74
34.05
9.01
17.30
13.36
32.35
6.99
10.08
12.57
17.37
17.13
12.30
14.97
7.15
7.05
34.40
13.70
0.00
22.52
Global
000
000
000
000
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
090
090
090
090
090
090
000
000
XXX
000
000
000
000
000
000
ZZZ
000
ZZZ
000
090
090
ZZZ
ZZZ
090
YYY
090
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
090
45917
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
38101
38102
38115
38120
38129
38200
38204
38205
38206
38207
38208
38209
38210
38211
38212
38213
38214
38215
38220
38221
38230
38240
38241
38242
38300
38305
38308
38380
38381
38382
38500
38505
38510
38520
38525
38530
38542
38550
38555
38562
38564
38570
38571
38572
38589
38700
38720
38724
38740
38745
38746
38747
38760
38765
38770
38780
38790
38792
38794
38999
39000
39010
39200
39220
39400
39499
39501
39502
39503
39520
39530
39531
39540
39541
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
C
A
B
R
R
I
I
I
I
I
I
I
I
I
A
A
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
C
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of spleen, partial ..........................
Removal of spleen, total .............................
Repair of ruptured spleen ...........................
Laparoscopy, splenectomy ..........................
Laparoscope proc, spleen ...........................
Injection for spleen x-ray .............................
Bl donor search management .....................
Harvest allogenic stem cells .......................
Harvest auto stem cells ...............................
Cryopreserve stem cells ..............................
Thaw preserved stem cells .........................
Wash harvest stem cells .............................
T-cell depletion of harvest ...........................
Tumor cell deplete of harvst .......................
Rbc depletion of harvest .............................
Platelet deplete of harvest ..........................
Volume deplete of harvest ..........................
Harvest stem cell concentrte .......................
Bone marrow aspiration ..............................
Bone marrow biopsy ...................................
Bone marrow collection ...............................
Bone marrow/stem transplant .....................
Bone marrow/stem transplant .....................
Lymphocyte infuse transplant .....................
Drainage, lymph node lesion ......................
Drainage, lymph node lesion ......................
Incision of lymph channels ..........................
Thoracic duct procedure .............................
Thoracic duct procedure .............................
Thoracic duct procedure .............................
Biopsy/removal, lymph nodes .....................
Needle biopsy, lymph nodes .......................
Biopsy/removal, lymph nodes .....................
Biopsy/removal, lymph nodes .....................
Biopsy/removal, lymph nodes .....................
Biopsy/removal, lymph nodes .....................
Explore deep node(s), neck ........................
Removal, neck/armpit lesion .......................
Removal, neck/armpit lesion .......................
Removal, pelvic lymph nodes .....................
Removal, abdomen lymph nodes ...............
Laparoscopy, lymph node biop ...................
Laparoscopy, lymphadenectomy .................
Laparoscopy, lymphadenectomy .................
Laparoscope proc, lymphatic ......................
Removal of lymph nodes, neck ...................
Removal of lymph nodes, neck ...................
Removal of lymph nodes, neck ...................
Remove armpit lymph nodes ......................
Remove armpit lymph nodes ......................
Remove thoracic lymph nodes ....................
Remove abdominal lymph nodes ................
Remove groin lymph nodes ........................
Remove groin lymph nodes ........................
Remove pelvis lymph nodes .......................
Remove abdomen lymph nodes .................
Inject for lymphatic x-ray .............................
Identify sentinel node ..................................
Access thoracic lymph duct ........................
Blood/lymph system procedure ...................
Exploration of chest .....................................
Exploration of chest .....................................
Removal chest lesion ..................................
Removal chest lesion ..................................
Visualization of chest ..................................
Chest procedure ..........................................
Repair diaphragm laceration .......................
Repair paraesophageal hernia ....................
Repair of diaphragm hernia ........................
Repair of diaphragm hernia ........................
Repair of diaphragm hernia ........................
Repair of diaphragm hernia ........................
Repair of diaphragm hernia ........................
Repair of diaphragm hernia ........................
15.32
4.80
15.83
17.00
0.00
2.65
0.00
1.50
1.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.08
1.37
4.54
2.24
2.24
1.71
1.99
6.00
6.45
7.46
12.89
10.08
3.75
1.14
6.43
6.67
6.07
7.99
5.91
6.92
14.15
10.49
10.83
9.26
14.69
16.60
0.00
8.25
13.62
14.55
10.03
13.11
4.89
4.89
12.96
19.99
13.24
16.60
1.29
0.52
4.45
0.00
6.10
11.79
13.63
17.42
5.61
0.00
13.20
16.34
95.05
16.11
15.42
16.43
13.33
14.42
Nonfacility
PE
RVUs
NA
NA
NA
NA
0.00
NA
0.00
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3.52
3.73
NA
NA
NA
NA
4.20
NA
NA
NA
NA
NA
3.64
2.05
5.44
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
6.48
1.61
6.57
7.30
0.00
0.93
0.00
0.65
0.65
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.51
0.63
3.13
1.00
1.01
0.76
2.04
4.41
3.68
5.54
6.70
5.67
2.06
0.80
3.41
3.96
3.27
4.30
4.39
3.86
8.26
5.88
5.25
3.99
6.36
7.09
0.00
6.11
9.11
9.57
4.90
6.02
1.57
1.63
6.08
8.92
6.35
8.20
0.78
0.46
3.68
0.00
4.54
7.16
7.22
8.95
4.56
0.00
6.33
7.04
32.58
7.79
6.96
7.20
6.11
6.45
Malpractice
RVUs
2.04
0.63
2.08
2.24
0.00
0.14
0.00
0.07
0.07
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.05
0.07
0.48
0.11
0.11
0.08
0.25
0.88
0.85
0.74
1.84
1.37
0.49
0.09
0.72
0.84
0.80
1.12
0.60
0.88
1.75
1.20
1.32
1.13
1.15
1.90
0.00
0.72
1.20
1.28
1.32
1.73
0.72
0.64
1.71
2.47
1.40
1.88
0.13
0.06
0.32
0.00
0.89
1.75
2.02
2.45
0.82
0.00
1.77
2.16
10.95
2.23
2.10
2.21
1.79
1.92
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00155
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
0.00
NA
0.00
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4.66
5.17
NA
NA
NA
NA
6.45
NA
NA
NA
NA
NA
7.88
3.28
12.59
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
23.84
7.04
24.48
26.55
0.00
3.72
0.00
2.22
2.22
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.64
2.07
8.15
3.35
3.36
2.55
4.28
11.29
10.99
13.75
21.43
17.12
6.30
2.03
10.56
11.47
10.15
13.40
10.90
11.66
24.16
17.57
17.40
14.38
22.20
25.60
0.00
15.08
23.92
25.40
16.25
20.85
7.18
7.16
20.75
31.38
20.99
26.69
2.20
1.04
8.45
0.00
11.53
20.70
22.86
28.83
10.99
0.00
21.29
25.54
138.58
26.14
24.48
25.84
21.23
22.79
Global
090
ZZZ
090
090
YYY
000
XXX
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
010
XXX
XXX
000
010
090
090
090
090
090
010
000
010
090
090
090
090
090
090
090
090
010
010
010
YYY
090
090
090
090
090
ZZZ
ZZZ
090
090
090
090
000
000
090
YYY
090
090
090
090
010
YYY
090
090
090
090
090
090
090
090
45918
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
39545
39560
39561
39599
4000F
4001F
4002F
4006F
4009F
4011F
40490
40500
40510
40520
40525
40527
40530
40650
40652
40654
40700
40701
40702
40720
40761
40799
40800
40801
40804
40805
40806
40808
40810
40812
40814
40816
40818
40819
40820
40830
40831
40840
40842
40843
40844
40845
40899
41000
41005
41006
41007
41008
41009
41010
41015
41016
41017
41018
41100
41105
41108
41110
41112
41113
41114
41115
41116
41120
41130
41135
41140
41145
41150
41153
..........
..........
..........
..........
.........
.........
.........
.........
.........
.........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
C
I
I
I
I
I
I
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
R
R
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Revision of diaphragm ................................
Resect diaphragm, simple ...........................
Resect diaphragm, complex ........................
Diaphragm surgery procedure ....................
Tobacco use txmnt counseling ...................
Tobacco use txmnt, pharmacol ...................
Statin therapy, rx .........................................
Beta-blocker therapy, rx ..............................
Ace inhibitor therapy, rx ..............................
Oral antiplatelet tx, rx ..................................
Biopsy of lip .................................................
Partial excision of lip ...................................
Partial excision of lip ...................................
Partial excision of lip ...................................
Reconstruct lip with flap ..............................
Reconstruct lip with flap ..............................
Partial removal of lip ...................................
Repair lip .....................................................
Repair lip .....................................................
Repair lip .....................................................
Repair cleft lip/nasal ....................................
Repair cleft lip/nasal ....................................
Repair cleft lip/nasal ....................................
Repair cleft lip/nasal ....................................
Repair cleft lip/nasal ....................................
Lip surgery procedure .................................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Removal, foreign body, mouth ....................
Removal, foreign body, mouth ....................
Incision of lip fold ........................................
Biopsy of mouth lesion ................................
Excision of mouth lesion .............................
Excise/repair mouth lesion ..........................
Excise/repair mouth lesion ..........................
Excision of mouth lesion .............................
Excise oral mucosa for graft .......................
Excise lip or cheek fold ...............................
Treatment of mouth lesion ..........................
Repair mouth laceration ..............................
Repair mouth laceration ..............................
Reconstruction of mouth .............................
Reconstruction of mouth .............................
Reconstruction of mouth .............................
Reconstruction of mouth .............................
Reconstruction of mouth .............................
Mouth surgery procedure ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Incision of tongue fold .................................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Drainage of mouth lesion ............................
Biopsy of tongue .........................................
Biopsy of tongue .........................................
Biopsy of floor of mouth ..............................
Excision of tongue lesion ............................
Excision of tongue lesion ............................
Excision of tongue lesion ............................
Excision of tongue lesion ............................
Excision of tongue fold ................................
Excision of mouth lesion .............................
Partial removal of tongue ............................
Partial removal of tongue ............................
Tongue and neck surgery ...........................
Removal of tongue ......................................
Tongue removal, neck surgery ...................
Tongue, mouth, jaw surgery .......................
Tongue, mouth, neck surgery .....................
13.38
12.00
17.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.22
4.28
4.70
4.67
7.56
9.14
5.40
3.64
4.26
5.31
12.80
15.86
13.05
13.56
14.73
0.00
1.17
2.54
1.24
2.70
0.31
0.96
1.31
2.31
3.42
3.67
2.41
2.41
1.28
1.76
2.46
8.74
8.74
12.10
16.02
18.59
0.00
1.30
1.26
3.25
3.11
3.37
3.59
1.06
3.96
4.07
4.07
5.10
1.63
1.42
1.05
1.51
2.74
3.20
8.48
1.74
2.44
9.78
11.15
23.11
25.51
30.07
23.06
23.78
Nonfacility
PE
RVUs
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.72
7.24
6.69
7.48
NA
NA
7.88
6.63
7.65
8.62
NA
NA
NA
NA
NA
0.00
3.06
4.13
3.40
4.51
1.86
2.75
2.97
3.83
5.05
5.28
5.21
4.19
4.09
3.71
4.69
9.82
10.09
12.11
15.74
17.02
0.00
2.32
3.42
4.87
5.08
4.79
5.09
3.43
5.52
5.70
5.72
6.20
2.45
2.34
2.11
3.04
4.56
4.84
NA
3.40
4.49
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
7.43
6.12
9.27
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.62
4.29
3.93
4.01
6.14
7.15
4.49
3.19
4.15
4.82
8.83
10.99
8.06
9.60
9.96
0.00
1.77
2.73
1.80
2.77
0.50
1.48
1.65
2.37
3.85
3.95
3.88
3.09
2.45
2.00
2.96
6.80
6.62
7.61
11.32
12.90
0.00
1.40
1.71
3.13
2.98
3.16
3.53
1.65
4.14
4.22
4.29
4.53
1.40
1.30
1.11
1.63
3.19
3.44
7.11
1.83
2.78
15.03
15.86
22.62
25.94
29.85
24.08
24.40
Malpractice
RVUs
1.83
1.59
2.44
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.05
0.38
0.49
0.52
0.85
0.97
0.55
0.38
0.52
0.60
0.95
1.65
1.23
1.79
1.93
0.00
0.13
0.31
0.11
0.32
0.04
0.10
0.13
0.28
0.41
0.40
0.21
0.29
0.11
0.19
0.30
1.08
1.08
1.39
1.99
2.00
0.00
0.12
0.12
0.35
0.31
0.42
0.47
0.07
0.46
0.53
0.53
0.68
0.15
0.13
0.10
0.13
0.28
0.34
0.83
0.18
0.23
0.79
0.93
1.88
2.26
2.54
1.94
2.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00156
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3.00
11.90
11.88
12.67
NA
NA
13.83
10.65
12.43
14.53
NA
NA
NA
NA
NA
0.00
4.36
6.98
4.75
7.52
2.21
3.81
4.41
6.42
8.88
9.35
7.84
6.90
5.48
5.66
7.45
19.64
19.91
25.60
33.76
37.61
0.00
3.74
4.80
8.47
8.50
8.58
9.15
4.56
9.93
10.30
10.32
11.98
4.24
3.89
3.26
4.68
7.57
8.38
NA
5.33
7.16
NA
NA
NA
NA
NA
NA
NA
Facility
total
22.64
19.72
29.21
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.89
8.95
9.12
9.20
14.55
17.26
10.44
7.21
8.93
10.73
22.57
28.51
22.34
24.95
26.62
0.00
3.07
5.57
3.15
5.79
0.85
2.54
3.09
4.96
7.67
8.02
6.50
5.79
3.84
3.96
5.73
16.62
16.44
21.11
29.33
33.48
0.00
2.82
3.09
6.73
6.40
6.95
7.59
2.78
8.56
8.82
8.89
10.31
3.18
2.85
2.27
3.27
6.21
6.97
16.41
3.75
5.45
25.60
27.94
47.60
53.71
62.46
49.08
50.17
Global
090
090
090
YYY
XXX
XXX
XXX
XXX
XXX
XXX
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
010
010
010
010
000
010
010
010
090
090
090
090
010
010
010
090
090
090
090
090
YYY
010
010
090
090
090
090
010
090
090
090
090
010
010
010
010
090
090
090
010
090
090
090
090
090
090
090
090
45919
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
41155
41250
41251
41252
41500
41510
41520
41599
41800
41805
41806
41820
41821
41822
41823
41825
41826
41827
41828
41830
41850
41870
41872
41874
41899
42000
42100
42104
42106
42107
42120
42140
42145
42160
42180
42182
42200
42205
42210
42215
42220
42225
42226
42227
42235
42260
42280
42281
42299
42300
42305
42310
42320
42325
42326
42330
42335
42340
42400
42405
42408
42409
42410
42415
42420
42425
42426
42440
42450
42500
42505
42507
42508
42509
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
C
A
A
A
R
R
R
R
A
A
A
R
R
R
R
R
R
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Tongue, jaw, & neck surgery ......................
Repair tongue laceration .............................
Repair tongue laceration .............................
Repair tongue laceration .............................
Fixation of tongue ........................................
Tongue to lip surgery ..................................
Reconstruction, tongue fold ........................
Tongue and mouth surgery .........................
Drainage of gum lesion ...............................
Removal foreign body, gum ........................
Removal foreign body,jawbone ...................
Excision, gum, each quadrant .....................
Excision of gum flap ....................................
Excision of gum lesion ................................
Excision of gum lesion ................................
Excision of gum lesion ................................
Excision of gum lesion ................................
Excision of gum lesion ................................
Excision of gum lesion ................................
Removal of gum tissue ...............................
Treatment of gum lesion .............................
Gum graft ....................................................
Repair gum ..................................................
Repair tooth socket .....................................
Dental surgery procedure ............................
Drainage mouth roof lesion .........................
Biopsy roof of mouth ...................................
Excision lesion, mouth roof .........................
Excision lesion, mouth roof .........................
Excision lesion, mouth roof .........................
Remove palate/lesion ..................................
Excision of uvula .........................................
Repair palate, pharynx/uvula ......................
Treatment mouth roof lesion .......................
Repair palate ...............................................
Repair palate ...............................................
Reconstruct cleft palate ...............................
Reconstruct cleft palate ...............................
Reconstruct cleft palate ...............................
Reconstruct cleft palate ...............................
Reconstruct cleft palate ...............................
Reconstruct cleft palate ...............................
Lengthening of palate ..................................
Lengthening of palate ..................................
Repair palate ...............................................
Repair nose to lip fistula .............................
Preparation, palate mold .............................
Insertion, palate prosthesis .........................
Palate/uvula surgery ....................................
Drainage of salivary gland ..........................
Drainage of salivary gland ..........................
Drainage of salivary gland ..........................
Drainage of salivary gland ..........................
Create salivary cyst drain ............................
Create salivary cyst drain ............................
Removal of salivary stone ...........................
Removal of salivary stone ...........................
Removal of salivary stone ...........................
Biopsy of salivary gland ..............................
Biopsy of salivary gland ..............................
Excision of salivary cyst ..............................
Drainage of salivary cyst .............................
Excise parotid gland/lesion .........................
Excise parotid gland/lesion .........................
Excise parotid gland/lesion .........................
Excise parotid gland/lesion .........................
Excise parotid gland/lesion .........................
Excise submaxillary gland ...........................
Excise sublingual gland ...............................
Repair salivary duct .....................................
Repair salivary duct .....................................
Parotid duct diversion ..................................
Parotid duct diversion ..................................
Parotid duct diversion ..................................
27.74
1.91
2.27
2.98
3.71
3.42
2.74
0.00
1.17
1.24
2.70
0.00
0.00
2.31
3.31
1.31
2.31
3.42
3.10
3.35
0.00
0.00
2.60
3.10
0.00
1.23
1.31
1.64
2.10
4.44
6.17
1.62
8.06
1.80
2.51
3.83
12.00
13.30
14.51
8.83
7.02
9.55
10.01
9.53
7.88
9.81
1.54
1.93
0.00
1.93
6.07
1.56
2.35
2.76
3.78
2.21
3.32
4.60
0.78
3.30
4.54
2.82
9.35
16.89
19.60
13.03
21.27
6.97
4.62
4.30
6.18
6.11
9.11
11.54
Nonfacility
PE
RVUs
NA
2.94
3.33
3.98
NA
NA
4.77
0.00
2.92
3.00
3.96
0.00
0.00
3.99
5.68
3.12
2.95
5.67
3.86
5.14
0.00
0.00
5.14
4.96
0.00
2.52
2.09
2.69
3.41
5.85
NA
3.76
NA
4.16
3.11
3.90
NA
NA
NA
NA
NA
NA
NA
NA
NA
10.14
1.98
2.69
0.00
2.83
NA
2.33
3.31
4.68
6.24
3.15
4.98
6.10
1.68
3.98
5.96
4.58
NA
NA
NA
NA
NA
NA
5.96
5.74
7.14
NA
NA
NA
Facility
PE
RVUs
26.14
1.24
1.61
2.22
7.33
7.57
3.55
0.00
1.40
2.30
3.09
0.00
0.00
1.90
3.99
2.11
2.19
3.61
2.82
3.57
0.00
0.00
3.43
3.14
0.00
1.25
1.34
1.56
2.38
3.92
11.56
2.07
7.39
2.20
2.06
2.95
9.92
9.82
11.21
8.74
6.92
16.15
14.14
14.78
11.93
6.90
1.11
1.84
0.00
1.80
4.62
1.52
2.06
2.36
3.09
1.81
3.10
3.86
0.72
2.40
3.55
2.72
6.08
10.54
11.99
8.37
12.61
4.67
4.22
4.11
5.27
6.45
8.25
9.97
Malpractice
RVUs
2.33
0.18
0.22
0.29
0.30
0.20
0.27
0.00
0.12
0.13
0.37
0.00
0.00
0.31
0.47
0.15
0.30
0.35
0.44
0.44
0.00
0.00
0.30
0.45
0.00
0.12
0.13
0.16
0.25
0.44
0.52
0.13
0.65
0.17
0.21
0.40
1.27
1.58
2.16
1.31
0.73
0.86
1.01
0.98
0.72
1.26
0.19
0.17
0.00
0.16
0.51
0.13
0.21
0.27
0.29
0.19
0.29
0.42
0.06
0.28
0.45
0.27
0.91
1.43
1.65
1.05
1.80
0.59
0.42
0.41
0.55
0.49
1.04
0.93
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00157
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
5.03
5.83
7.25
NA
NA
7.78
0.00
4.21
4.37
7.03
0.00
0.00
6.62
9.46
4.59
5.56
9.44
7.40
8.93
0.00
0.00
8.03
8.51
0.00
3.87
3.53
4.49
5.76
10.73
NA
5.52
NA
6.13
5.82
8.13
NA
NA
NA
NA
NA
NA
NA
NA
NA
21.21
3.71
4.79
0.00
4.92
NA
4.02
5.88
7.71
10.31
5.56
8.59
11.12
2.52
7.56
10.95
7.67
NA
NA
NA
NA
NA
NA
11.00
10.45
13.87
NA
NA
NA
Facility
total
56.21
3.33
4.10
5.49
11.34
11.18
6.56
0.00
2.69
3.68
6.16
0.00
0.00
4.53
7.77
3.57
4.81
7.38
6.35
7.35
0.00
0.00
6.33
6.69
0.00
2.60
2.78
3.37
4.73
8.80
18.25
3.82
16.10
4.17
4.78
7.18
23.20
24.70
27.88
18.88
14.67
26.56
25.16
25.29
20.52
17.97
2.85
3.94
0.00
3.89
11.21
3.21
4.62
5.38
7.16
4.21
6.71
8.88
1.56
5.98
8.54
5.80
16.34
28.87
33.24
22.45
35.68
12.23
9.26
8.82
12.00
13.05
18.40
22.44
Global
090
010
010
010
090
090
090
YYY
010
010
010
000
000
010
090
010
010
090
010
010
000
000
090
090
YYY
010
010
010
010
090
090
090
090
010
010
010
090
090
090
090
090
090
090
090
090
090
010
010
YYY
010
090
010
010
090
090
010
090
090
000
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45920
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
42510
42550
42600
42650
42660
42665
42699
42700
42720
42725
42800
42802
42804
42806
42808
42809
42810
42815
42820
42821
42825
42826
42830
42831
42835
42836
42842
42844
42845
42860
42870
42890
42892
42894
42900
42950
42953
42955
42960
42961
42962
42970
42971
42972
42999
43020
43030
43045
43100
43101
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
43130
43135
43200
43201
43202
43204
43205
43215
43216
43217
43219
43220
43226
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Parotid duct diversion ..................................
Injection for salivary x-ray ...........................
Closure of salivary fistula ............................
Dilation of salivary duct ...............................
Dilation of salivary duct ...............................
Ligation of salivary duct ..............................
Salivary surgery procedure .........................
Drainage of tonsil abscess ..........................
Drainage of throat abscess .........................
Drainage of throat abscess .........................
Biopsy of throat ...........................................
Biopsy of throat ...........................................
Biopsy of upper nose/throat ........................
Biopsy of upper nose/throat ........................
Excise pharynx lesion .................................
Remove pharynx foreign body ....................
Excision of neck cyst ...................................
Excision of neck cyst ...................................
Remove tonsils and adenoids .....................
Remove tonsils and adenoids .....................
Removal of tonsils .......................................
Removal of tonsils .......................................
Removal of adenoids ..................................
Removal of adenoids ..................................
Removal of adenoids ..................................
Removal of adenoids ..................................
Extensive surgery of throat .........................
Extensive surgery of throat .........................
Extensive surgery of throat .........................
Excision of tonsil tags .................................
Excision of lingual tonsil ..............................
Partial removal of pharynx ..........................
Revision of pharyngeal walls ......................
Revision of pharyngeal walls ......................
Repair throat wound ....................................
Reconstruction of throat ..............................
Repair throat, esophagus ............................
Surgical opening of throat ...........................
Control throat bleeding ................................
Control throat bleeding ................................
Control throat bleeding ................................
Control nose/throat bleeding .......................
Control nose/throat bleeding .......................
Control nose/throat bleeding .......................
Throat surgery procedure ............................
Incision of esophagus .................................
Throat muscle surgery ................................
Incision of esophagus .................................
Excision of esophagus lesion ......................
Excision of esophagus lesion ......................
Removal of esophagus ...............................
Removal of esophagus ...............................
Removal of esophagus ...............................
Removal of esophagus ...............................
Partial removal of esophagus .....................
Partial removal of esophagus .....................
Partial removal of esophagus .....................
Partial removal of esophagus .....................
Partial removal of esophagus .....................
Partial removal of esophagus .....................
Removal of esophagus ...............................
Removal of esophagus pouch ....................
Removal of esophagus pouch ....................
Esophagus endoscopy ................................
Esoph scope w/submucous inj ....................
Esophagus endoscopy, biopsy ...................
Esoph scope w/sclerosis inj ........................
Esophagus endoscopy/ligation ....................
Esophagus endoscopy ................................
Esophagus endoscopy/lesion ......................
Esophagus endoscopy ................................
Esophagus endoscopy ................................
Esoph endoscopy, dilation ..........................
Esoph endoscopy, dilation ..........................
8.16
1.25
4.82
0.77
1.13
2.54
0.00
1.62
5.42
10.72
1.39
1.54
1.24
1.58
2.30
1.81
3.26
7.07
3.91
4.29
3.42
3.38
2.58
2.72
2.30
3.19
8.77
14.32
24.30
2.22
5.40
12.95
15.84
22.90
5.25
8.11
8.97
7.39
2.33
5.59
7.14
5.43
6.21
7.20
0.00
8.10
7.70
20.13
9.20
16.25
40.02
34.21
43.52
35.29
31.23
40.02
33.22
29.21
40.02
33.22
27.33
11.75
16.11
1.59
2.09
1.89
3.77
3.79
2.61
2.40
2.91
2.81
2.10
2.34
Nonfacility
PE
RVUs
NA
3.10
6.55
1.11
1.37
4.27
0.00
2.65
4.79
NA
2.19
4.59
3.65
3.97
3.08
2.30
5.63
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.08
4.71
5.75
NA
NA
NA
0.00
7.19
NA
NA
NA
Facility
PE
RVUs
7.61
0.43
4.03
0.71
0.88
2.55
0.00
1.68
3.69
8.03
1.38
1.99
1.68
1.87
1.88
1.30
3.51
6.34
3.22
3.43
3.12
2.97
2.52
2.80
2.42
2.91
10.81
15.91
22.66
2.37
8.48
13.90
16.83
21.54
3.57
11.60
16.55
10.46
1.93
4.89
5.80
4.09
5.02
5.58
0.00
5.31
5.34
10.51
6.06
7.77
17.70
13.87
18.73
14.88
16.17
16.75
13.41
13.19
16.93
13.85
12.85
7.35
7.95
1.08
1.14
0.98
1.66
1.66
1.25
1.13
1.27
1.45
1.04
1.13
Malpractice
RVUs
0.66
0.07
0.43
0.07
0.09
0.23
0.00
0.13
0.44
0.91
0.11
0.12
0.10
0.13
0.19
0.16
0.29
0.61
0.31
0.35
0.25
0.27
0.20
0.22
0.21
0.26
0.71
1.16
1.98
0.18
0.44
1.05
1.28
1.86
0.50
0.72
0.88
0.80
0.19
0.45
0.58
0.39
0.51
0.62
0.00
0.87
0.70
2.58
0.93
2.31
5.22
4.07
5.79
4.42
3.05
5.17
4.10
3.90
5.40
4.15
3.73
1.16
2.33
0.13
0.15
0.15
0.30
0.28
0.22
0.20
0.26
0.24
0.17
0.19
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00158
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
4.43
11.80
1.96
2.60
7.03
0.00
4.40
10.65
NA
3.69
6.26
4.99
5.68
5.58
4.27
9.18
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.80
6.95
7.79
NA
NA
NA
2.60
10.35
NA
NA
NA
Facility
total
16.43
1.75
9.28
1.55
2.10
5.31
0.00
3.43
9.55
19.66
2.88
3.65
3.02
3.58
4.38
3.27
7.06
14.02
7.44
8.07
6.78
6.62
5.30
5.73
4.93
6.35
20.29
31.39
48.94
4.78
14.32
27.90
33.95
46.30
9.32
20.42
26.40
18.66
4.46
10.93
13.52
9.91
11.74
13.41
0.00
14.27
13.74
33.22
16.19
26.33
62.94
52.14
68.04
54.59
50.45
61.94
50.73
46.30
62.35
51.22
43.92
20.27
26.39
2.80
3.39
3.03
5.73
5.73
4.08
3.73
4.43
4.50
3.32
3.66
Global
090
000
090
000
000
090
YYY
010
010
090
010
010
010
010
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
090
090
010
090
090
090
090
090
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
000
000
000
000
45921
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
43227
43228
43231
43232
43234
43235
43236
43237
43238
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
43250
43251
43255
43256
43257
43258
43259
43260
43261
43262
43263
43264
43265
43267
43268
43269
43271
43272
43280
43289
43300
43305
43310
43312
43313
43314
43320
43324
43325
43326
43330
43331
43340
43341
43350
43351
43352
43360
43361
43400
43401
43405
43410
43415
43420
43425
43450
43453
43456
43458
43460
43496
43499
43500
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
Physician
work
RVUs 3
Description
Esoph endoscopy, repair ............................
Esoph endoscopy, ablation .........................
Esoph endoscopy w/us exam .....................
Esoph endoscopy w/us fn bx ......................
Upper GI endoscopy, exam ........................
Uppr gi endoscopy, diagnosis .....................
Uppr gi scope w/submuc inj ........................
Endoscopic us exam, esoph .......................
Uppr gi endoscopy w/us fn bx ....................
Upper GI endoscopy, biopsy .......................
Esoph endoscope w/drain cyst ...................
Upper GI endoscopy with tube ...................
Uppr gi endoscopy w/us fn bx ....................
Upper gi endoscopy & inject .......................
Upper GI endoscopy/ligation .......................
Uppr gi scope dilate strictr ..........................
Place gastrostomy tube ...............................
Operative upper GI endoscopy ...................
Uppr gi endoscopy/guide wire .....................
Esoph endoscopy, dilation ..........................
Upper GI endoscopy/tumor .........................
Operative upper GI endoscopy ...................
Operative upper GI endoscopy ...................
Uppr gi endoscopy w/stent ..........................
Uppr gi scope w/thrml txmnt .......................
Operative upper GI endoscopy ...................
Endoscopic ultrasound exam ......................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Endo cholangiopancreatograph ..................
Laparoscopy, fundoplasty ...........................
Laparoscope proc, esoph ............................
Repair of esophagus ...................................
Repair esophagus and fistula .....................
Repair of esophagus ...................................
Repair esophagus and fistula .....................
Esophagoplasty congenital .........................
Tracheo-esophagoplasty cong ....................
Fuse esophagus & stomach .......................
Revise esophagus & stomach ....................
Revise esophagus & stomach ....................
Revise esophagus & stomach ....................
Repair of esophagus ...................................
Repair of esophagus ...................................
Fuse esophagus & intestine ........................
Fuse esophagus & intestine ........................
Surgical opening, esophagus ......................
Surgical opening, esophagus ......................
Surgical opening, esophagus ......................
Gastrointestinal repair .................................
Gastrointestinal repair .................................
Ligate esophagus veins ..............................
Esophagus surgery for veins ......................
Ligate/staple esophagus .............................
Repair esophagus wound ...........................
Repair esophagus wound ...........................
Repair esophagus opening .........................
Repair esophagus opening .........................
Dilate esophagus .........................................
Dilate esophagus .........................................
Dilate esophagus .........................................
Dilate esophagus .........................................
Pressure treatment esophagus ...................
Free jejunum flap, microvasc ......................
Esophagus surgery procedure ....................
Surgical opening of stomach .......................
3.60
3.77
3.20
4.48
2.01
2.39
2.93
3.99
5.03
2.88
6.86
2.60
7.31
4.57
5.05
3.19
4.33
3.39
3.16
2.91
3.21
3.70
4.82
4.35
5.51
4.55
5.20
5.96
6.27
7.39
7.29
8.91
10.02
7.39
7.39
8.22
7.39
7.39
17.25
0.00
9.15
17.39
25.40
28.44
45.30
50.29
19.94
20.58
20.07
19.75
19.78
20.14
19.62
20.86
15.79
18.36
15.27
35.72
40.52
21.21
22.10
20.02
13.48
25.01
14.36
21.04
1.38
1.51
2.58
3.07
3.80
0.00
0.00
11.05
Nonfacility
PE
RVUs
NA
NA
NA
NA
5.49
5.55
6.89
NA
NA
6.18
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.83
6.53
14.11
7.20
NA
0.00
0.00
NA
Facility
PE
RVUs
1.57
1.64
1.42
1.92
0.92
1.11
1.34
1.75
2.14
1.30
2.83
1.19
2.93
1.95
2.14
1.40
1.81
1.49
1.45
1.33
1.42
1.61
2.05
1.85
2.27
1.93
2.15
2.48
2.60
3.02
3.02
3.59
4.00
3.00
3.15
3.33
3.01
3.01
7.17
0.00
6.22
10.37
10.89
11.55
18.40
18.88
9.05
8.62
8.66
9.17
8.46
9.83
8.81
10.35
8.31
9.70
8.27
14.98
16.63
10.06
9.26
9.60
7.54
11.61
7.24
9.84
0.77
0.82
1.21
1.40
1.57
0.00
0.00
4.93
Malpractice
RVUs
0.28
0.34
0.23
0.34
0.17
0.19
0.21
0.43
0.43
0.22
0.56
0.21
0.53
0.33
0.37
0.26
0.34
0.27
0.23
0.22
0.26
0.29
0.35
0.32
0.36
0.33
0.35
0.43
0.46
0.54
0.54
0.65
0.73
0.54
0.54
0.60
0.54
0.54
2.27
0.00
1.12
1.54
3.60
4.00
5.45
6.63
2.73
2.75
2.59
2.84
2.62
2.93
2.45
2.91
1.42
2.46
2.05
4.96
4.49
1.95
3.04
2.83
1.71
3.52
1.43
3.02
0.11
0.11
0.20
0.24
0.31
0.00
0.00
1.45
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00159
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
7.67
8.13
10.02
NA
NA
9.28
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.32
8.15
16.89
10.51
NA
0.00
0.00
NA
Facility
total
5.45
5.75
4.85
6.74
3.11
3.70
4.48
6.17
7.60
4.39
10.25
4.00
10.78
6.85
7.56
4.85
6.48
5.14
4.83
4.46
4.89
5.59
7.22
6.52
8.14
6.81
7.70
8.87
9.33
10.96
10.85
13.15
14.75
10.94
11.08
12.15
10.94
10.94
26.69
0.00
16.49
29.30
39.89
43.99
69.15
75.80
31.72
31.95
31.32
31.76
30.86
32.90
30.87
34.12
25.52
30.51
25.59
55.66
61.64
33.22
34.40
32.45
22.72
40.14
23.03
33.90
2.26
2.44
3.99
4.70
5.68
0.00
0.00
17.43
Global
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
090
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
090
YYY
090
45922
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
43501
43502
43510
43520
43600
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43635
43638
43639
43640
43641
43644
43645
43651
43652
43653
43659
43750
43752
43760
43761
43800
43810
43820
43825
43830
43831
43832
43840
43842
43843
43845
43846
43847
43848
43850
43855
43860
43865
43870
43880
43999
44005
44010
44015
44020
44021
44025
44050
44055
44100
44110
44111
44120
44121
44125
44126
44127
44128
44130
44132
44133
44135
44136
44137
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
R
C
Physician
work
RVUs 3
Description
Surgical repair of stomach ..........................
Surgical repair of stomach ..........................
Surgical opening of stomach .......................
Incision of pyloric muscle ............................
Biopsy of stomach .......................................
Biopsy of stomach .......................................
Excision of stomach lesion ..........................
Excision of stomach lesion ..........................
Removal of stomach ...................................
Removal of stomach ...................................
Removal of stomach ...................................
Removal of stomach, partial .......................
Removal of stomach, partial .......................
Removal of stomach, partial .......................
Removal of stomach, partial .......................
Removal of stomach, partial .......................
Removal of stomach, partial .......................
Removal of stomach, partial .......................
Vagotomy & pylorus repair ..........................
Vagotomy & pylorus repair ..........................
Lap gastric bypass/roux-en-y ......................
Lap gastr bypass incl smll i .........................
Laparoscopy, vagus nerve ..........................
Laparoscopy, vagus nerve ..........................
Laparoscopy, gastrostomy ..........................
Laparoscope proc, stom ..............................
Place gastrostomy tube ...............................
Nasal/orogastric w/stent ..............................
Change gastrostomy tube ...........................
Reposition gastrostomy tube .......................
Reconstruction of pylorus ............................
Fusion of stomach and bowel .....................
Fusion of stomach and bowel .....................
Fusion of stomach and bowel .....................
Place gastrostomy tube ...............................
Place gastrostomy tube ...............................
Place gastrostomy tube ...............................
Repair of stomach lesion ............................
V-band gastroplasty ....................................
Gastroplasty w/o v-band .............................
Gastroplasty duodenal switch .....................
Gastric bypass for obesity ...........................
Gastric bypass incl small i ..........................
Revision gastroplasty ..................................
Revise stomach-bowel fusion .....................
Revise stomach-bowel fusion .....................
Revise stomach-bowel fusion .....................
Revise stomach-bowel fusion .....................
Repair stomach opening .............................
Repair stomach-bowel fistula ......................
Stomach surgery procedure ........................
Freeing of bowel adhesion ..........................
Incision of small bowel ................................
Insert needle cath bowel .............................
Explore small intestine ................................
Decompress small bowel ............................
Incision of large bowel ................................
Reduce bowel obstruction ...........................
Correct malrotation of bowel .......................
Biopsy of bowel ...........................................
Excise intestine lesion(s) .............................
Excision of bowel lesion(s) ..........................
Removal of small intestine ..........................
Removal of small intestine ..........................
Removal of small intestine ..........................
Enterectomy w/o taper, cong ......................
Enterectomy w/taper, cong .........................
Enterectomy cong, add-on ..........................
Bowel to bowel fusion .................................
Enterectomy, cadaver donor .......................
Enterectomy, live donor ..............................
Intestine transplnt, cadaver .........................
Intestine transplant, live ..............................
Remove intestinal allograft ..........................
20.05
23.15
13.09
10.00
1.91
11.98
14.61
17.85
30.05
30.74
32.54
22.61
22.61
23.12
25.13
2.06
29.02
29.67
17.02
17.27
27.89
30.02
10.15
12.15
7.74
0.00
4.49
0.81
1.10
2.01
13.70
14.66
15.38
19.23
9.54
7.85
15.61
15.57
18.48
18.66
0.00
24.06
26.93
29.41
24.73
26.17
25.01
26.53
9.70
24.66
0.00
16.24
12.53
2.63
14.00
14.09
14.29
14.04
22.01
2.01
11.81
14.30
17.00
4.45
17.55
35.52
41.02
4.45
14.50
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
5.82
1.18
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
Facility
PE
RVUs
8.20
9.34
6.97
5.09
0.69
5.22
6.07
7.47
11.60
11.77
12.36
9.03
9.03
9.19
9.90
0.68
11.70
11.47
7.17
7.28
11.14
12.02
4.71
5.63
4.16
0.00
2.14
0.27
0.45
0.69
5.81
6.10
6.33
7.91
4.85
4.53
6.83
6.69
7.69
7.68
0.00
9.88
10.74
11.64
9.69
10.20
9.81
10.32
4.51
9.78
0.00
6.64
5.39
0.87
5.87
5.92
5.96
5.88
8.59
0.75
5.18
6.03
6.99
1.49
7.16
13.91
15.47
1.49
6.15
0.00
0.00
0.00
0.00
0.00
Malpractice
RVUs
2.64
3.09
1.48
1.36
0.14
1.58
1.93
2.35
3.95
4.03
4.29
2.98
2.98
3.05
3.32
0.27
3.80
3.90
2.25
2.24
3.15
3.53
1.33
1.55
1.01
0.00
0.43
0.02
0.09
0.13
1.81
1.93
2.03
2.53
1.25
1.03
1.97
2.05
2.44
2.45
0.00
3.18
3.55
3.87
3.27
3.46
3.30
3.50
1.27
3.26
0.00
2.14
1.64
0.35
1.85
1.86
1.89
1.85
2.90
0.17
1.55
1.86
2.24
0.58
2.26
4.68
5.75
0.61
1.87
0.00
0.00
0.00
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00160
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
7.01
3.32
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
Facility
total
30.89
35.57
21.54
16.45
2.74
18.79
22.61
27.67
45.60
46.54
49.20
34.61
34.61
35.35
38.35
3.02
44.52
45.04
26.44
26.79
42.18
45.57
16.19
19.33
12.90
0.00
7.06
1.10
1.65
2.84
21.32
22.69
23.74
29.67
15.64
13.41
24.41
24.31
28.60
28.79
0.00
37.12
41.23
44.92
37.69
39.83
38.12
40.35
15.48
37.70
0.00
25.02
19.56
3.84
21.72
21.86
22.14
21.77
33.51
2.94
18.54
22.19
26.23
6.51
26.97
54.11
62.24
6.55
22.52
0.00
0.00
0.00
0.00
0.00
Global
090
090
090
090
000
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
YYY
010
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
090
090
ZZZ
090
090
090
090
090
000
090
090
090
ZZZ
090
090
090
ZZZ
090
XXX
XXX
XXX
XXX
XXX
45923
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
44139
44140
44141
44143
44144
44145
44146
44147
44150
44151
44152
44153
44155
44156
44160
44200
44201
44202
44203
44204
44205
44206
44207
44208
44210
44211
44212
44238
44239
44300
44310
44312
44314
44316
44320
44322
44340
44345
44346
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380
44382
44383
44385
44386
44388
44389
44390
44391
44392
44393
44394
44397
44500
44602
44603
44604
44605
44615
44620
44625
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Mobilization of colon ....................................
Partial removal of colon ..............................
Partial removal of colon ..............................
Partial removal of colon ..............................
Partial removal of colon ..............................
Partial removal of colon ..............................
Partial removal of colon ..............................
Partial removal of colon ..............................
Removal of colon ........................................
Removal of colon/ileostomy ........................
Removal of colon/ileostomy ........................
Removal of colon/ileostomy ........................
Removal of colon/ileostomy ........................
Removal of colon/ileostomy ........................
Removal of colon ........................................
Laparoscopy, enterolysis .............................
Laparoscopy, jejunostomy ...........................
Lap resect s/intestine singl ..........................
Lap resect s/intestine, addl .........................
Laparo partial colectomy .............................
Lap colectomy part w/ileum ........................
Lap part colectomy w/stoma .......................
L colectomy/coloproctostomy ......................
L colectomy/coloproctostomy ......................
Laparo total proctocolectomy ......................
Laparo total proctocolectomy ......................
Laparo total proctocolectomy ......................
Laparoscope proc, intestine ........................
Laparoscope proc, rectum ..........................
Open bowel to skin .....................................
Ileostomy/jejunostomy .................................
Revision of ileostomy ..................................
Revision of ileostomy ..................................
Devise bowel pouch ....................................
Colostomy ....................................................
Colostomy with biopsies ..............................
Revision of colostomy .................................
Revision of colostomy .................................
Revision of colostomy .................................
Small bowel endoscopy ..............................
Small bowel endoscopy/biopsy ...................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Small bowel endoscopy/stent ......................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Small bowel endoscopy/biopsy ...................
Small bowel endoscopy ..............................
S bowel endoscope w/stent ........................
Small bowel endoscopy ..............................
Small bowel endoscopy ..............................
Ileoscopy w/stent .........................................
Endoscopy of bowel pouch .........................
Endoscopy, bowel pouch/biop ....................
Colonoscopy ................................................
Colonoscopy with biopsy .............................
Colonoscopy for foreign body .....................
Colonoscopy for bleeding ............................
Colonoscopy & polypectomy .......................
Colonoscopy, lesion removal ......................
Colonoscopy w/snare ..................................
Colonoscopy w/stent ...................................
Intro, gastrointestinal tube ...........................
Suture, small intestine .................................
Suture, small intestine .................................
Suture, large intestine .................................
Repair of bowel lesion .................................
Intestinal stricturoplasty ...............................
Repair bowel opening .................................
Repair bowel opening .................................
2.23
21.01
19.52
23.01
21.54
26.43
27.56
20.72
23.96
26.89
27.85
30.60
27.88
30.80
18.63
14.45
9.79
22.05
4.45
25.09
22.24
27.01
30.02
32.01
28.02
35.02
32.51
0.00
0.00
12.11
15.96
8.03
15.06
21.10
17.65
11.98
7.73
15.44
16.99
2.60
2.88
3.50
3.74
3.32
4.41
4.52
4.80
4.41
3.50
5.26
5.53
7.13
7.47
1.05
1.27
2.95
1.82
2.12
2.83
3.14
3.83
4.32
3.82
4.84
4.43
4.71
0.49
16.04
18.67
16.04
19.54
15.94
12.20
15.06
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.53
7.02
5.31
7.02
7.54
8.94
6.91
7.17
8.31
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
0.74
8.53
9.91
10.52
9.50
10.68
12.67
8.60
11.88
13.23
11.39
14.27
13.17
14.81
7.65
6.12
4.60
8.81
1.46
9.81
8.72
11.08
11.32
12.97
11.74
14.52
13.56
0.00
0.00
5.43
6.62
4.12
6.65
8.65
7.58
8.49
4.26
6.83
7.34
1.21
1.32
1.48
1.62
1.49
1.88
1.85
2.16
1.85
1.53
2.17
2.32
2.92
3.13
0.63
0.71
1.42
0.83
0.93
1.21
1.36
1.59
1.82
1.57
1.99
1.82
1.88
0.17
6.29
7.15
6.36
8.24
6.60
5.27
6.23
Malpractice
RVUs
0.28
2.70
2.52
3.04
2.85
3.28
3.40
2.55
3.03
3.48
3.51
3.54
3.27
3.94
2.36
1.89
1.30
2.84
0.57
3.10
2.74
3.45
3.66
3.87
3.41
4.16
3.77
0.00
0.00
1.60
1.98
0.92
1.74
2.37
2.25
1.54
0.99
1.96
2.12
0.19
0.21
0.27
0.27
0.24
0.32
0.33
0.37
0.35
0.27
0.42
0.40
0.52
0.62
0.08
0.12
0.21
0.15
0.20
0.26
0.27
0.32
0.34
0.34
0.42
0.38
0.39
0.03
2.11
2.41
2.11
2.51
2.06
1.51
1.85
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00161
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.51
9.34
8.40
10.43
11.68
13.60
11.06
12.43
13.12
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
3.26
32.25
31.95
36.57
33.89
40.39
43.62
31.87
38.87
43.60
42.75
48.41
44.31
49.56
28.64
22.46
15.69
33.71
6.48
38.00
33.71
41.54
45.00
48.85
43.17
53.70
49.84
0.00
0.00
19.15
24.57
13.06
23.45
32.12
27.48
22.01
12.98
24.23
26.45
4.00
4.40
5.25
5.63
5.05
6.61
6.70
7.33
6.61
5.30
7.85
8.25
10.58
11.23
1.76
2.10
4.57
2.80
3.26
4.30
4.76
5.74
6.48
5.73
7.25
6.63
6.98
0.69
24.44
28.23
24.51
30.29
24.60
18.99
23.14
Global
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
YYY
YYY
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
090
090
090
090
090
090
090
45924
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
44626
44640
44650
44660
44661
44680
44700
44701
44715
44720
44721
44799
44800
44820
44850
44899
44900
44901
44950
44955
44960
44970
44979
45000
45005
45020
45100
45108
45110
45111
45112
45113
45114
45116
45119
45120
45121
45123
45126
45130
45135
45136
45150
45160
45170
45190
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
45342
45345
45355
45378
45378
45379
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
53 .......
............
Status
A
A
A
A
A
A
A
A
C
A
A
C
A
A
A
C
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Repair bowel opening .................................
Repair bowel-skin fistula .............................
Repair bowel fistula .....................................
Repair bowel-bladder fistula ........................
Repair bowel-bladder fistula ........................
Surgical revision, intestine ..........................
Suspend bowel w/prosthesis .......................
Intraop colon lavage add-on .......................
Prepare donor intestine ...............................
Prep donor intestine/venous .......................
Prep donor intestine/artery ..........................
Unlisted procedure intestine ........................
Excision of bowel pouch .............................
Excision of mesentery lesion ......................
Repair of mesentery ....................................
Bowel surgery procedure ............................
Drain app abscess, open ............................
Drain app abscess, percut ..........................
Appendectomy .............................................
Appendectomy add-on ................................
Appendectomy .............................................
Laparoscopy, appendectomy ......................
Laparoscope proc, app ...............................
Drainage of pelvic abscess .........................
Drainage of rectal abscess .........................
Drainage of rectal abscess .........................
Biopsy of rectum .........................................
Removal of anorectal lesion ........................
Removal of rectum ......................................
Partial removal of rectum ............................
Removal of rectum ......................................
Partial proctectomy ......................................
Partial removal of rectum ............................
Partial removal of rectum ............................
Remove rectum w/reservoir ........................
Removal of rectum ......................................
Removal of rectum and colon .....................
Partial proctectomy ......................................
Pelvic exenteration ......................................
Excision of rectal prolapse ..........................
Excision of rectal prolapse ..........................
Excise ileoanal reservior .............................
Excision of rectal stricture ...........................
Excision of rectal lesion ..............................
Excision of rectal lesion ..............................
Destruction, rectal tumor .............................
Proctosigmoidoscopy dx .............................
Proctosigmoidoscopy dilate .........................
Proctosigmoidoscopy w/bx ..........................
Proctosigmoidoscopy fb ..............................
Proctosigmoidoscopy removal ....................
Proctosigmoidoscopy removal ....................
Proctosigmoidoscopy removal ....................
Proctosigmoidoscopy bleed ........................
Proctosigmoidoscopy ablate .......................
Proctosigmoidoscopy volvul ........................
Proctosigmoidoscopy w/stent ......................
Diagnostic sigmoidoscopy ...........................
Sigmoidoscopy and biopsy .........................
Sigmoidoscopy w/fb removal ......................
Sigmoidoscopy & polypectomy ...................
Sigmoidoscopy for bleeding ........................
Sigmoidoscopy w/submuc inj ......................
Sigmoidoscopy & decompress ....................
Sigmoidoscopy w/tumr remove ...................
Sigmoidoscopy w/ablate tumr .....................
Sig w/balloon dilation ..................................
Sigmoidoscopy w/ultrasound .......................
Sigmoidoscopy w/us guide bx .....................
Sigmoidoscopy w/stent ................................
Surgical colonoscopy ..................................
Diagnostic colonoscopy ...............................
Diagnostic colonoscopy ...............................
Colonoscopy w/fb removal ..........................
25.37
21.66
22.59
21.37
24.82
15.41
16.12
3.11
0.00
5.01
7.01
0.00
11.23
12.09
10.74
0.00
10.14
3.38
10.01
1.53
12.34
8.71
0.00
4.52
1.99
4.72
3.68
4.76
28.02
16.49
30.55
30.59
27.33
24.59
30.85
24.61
27.05
16.71
45.18
16.45
19.29
27.31
5.67
15.33
11.49
9.75
0.38
0.44
1.01
0.94
0.83
2.01
1.40
1.50
1.58
1.17
1.65
0.96
1.15
1.79
1.79
2.74
1.46
2.36
2.34
3.15
1.89
2.61
4.06
2.93
3.52
3.70
0.96
4.69
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
0.00
NA
NA
NA
0.00
NA
26.78
NA
NA
NA
NA
0.00
NA
3.94
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.56
18.29
2.68
3.03
2.10
2.86
2.95
2.57
3.10
NA
NA
2.33
3.20
5.02
5.08
NA
3.34
NA
5.50
3.72
6.40
NA
NA
NA
NA
6.60
2.33
7.80
Facility
PE
RVUs
9.65
8.45
8.78
8.77
9.74
6.37
6.68
1.03
0.00
1.67
2.33
0.00
5.38
5.44
4.94
0.00
4.67
1.15
4.26
0.53
5.27
4.06
0.00
3.02
1.55
3.33
2.40
2.78
12.24
7.10
11.60
12.48
10.73
9.88
12.33
10.07
10.96
6.81
19.60
6.73
8.34
12.34
3.01
6.62
5.21
4.64
0.29
0.37
0.51
0.49
0.45
0.85
0.65
0.68
0.74
0.58
0.69
0.55
0.65
0.86
0.87
1.24
0.75
1.07
.09
1.39
0.89
1.11
1.61
1.21
1.41
1.58
0.55
1.93
Malpractice
RVUs
3.26
2.77
2.92
2.13
2.80
1.99
1.83
0.37
0.00
0.37
0.97
0.00
1.47
1.59
1.39
0.00
1.33
0.22
1.31
0.20
1.63
1.14
0.00
0.52
0.25
0.55
0.44
0.59
3.35
2.06
3.42
3.48
3.35
2.87
3.35
2.89
3.24
1.85
4.32
1.79
2.35
2.81
0.61
1.67
1.35
1.13
0.04
0.05
0.11
0.11
0.09
0.22
0.15
0.15
0.16
0.13
0.16
0.08
0.09
0.16
0.15
0.20
0.11
0.21
0.19
0.26
0.15
0.19
0.30
0.23
0.36
0.30
0.08
0.39
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00162
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
0.00
NA
NA
NA
0.00
NA
30.37
NA
NA
NA
NA
0.00
NA
6.19
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.98
18.78
3.80
4.09
3.02
5.09
4.50
4.22
4.84
NA
NA
3.37
4.44
6.97
7.02
NA
4.91
NA
8.04
7.12
8.44
NA
NA
NA
NA
10.59
3.37
12.88
Facility
total
38.28
32.89
34.28
32.27
37.36
23.77
24.63
4.51
0.00
7.05
10.32
0.00
18.08
19.12
17.07
0.00
16.14
4.74
15.58
2.26
19.24
13.90
0.00
8.06
3.80
8.60
6.52
8.13
43.61
25.65
45.57
46.56
41.42
37.34
46.54
37.57
41.26
25.37
69.10
24.98
29.98
42.47
9.29
23.62
18.06
15.52
0.71
0.86
1.63
1.54
1.37
3.09
2.20
2.33
2.48
1.89
2.51
1.59
1.90
2.82
2.81
4.18
2.33
3.65
3.62
4.79
2.94
3.90
5.97
4.37
5.29
5.57
1.59
7.01
Global
090
090
090
090
090
090
090
ZZZ
XXX
XXX
XXX
YYY
090
090
090
YYY
090
000
090
ZZZ
090
090
YYY
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
45925
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
45380
45381
45382
45383
45384
45385
45386
45387
45391
45392
45500
45505
45520
45540
45541
45550
45560
45562
45563
45800
45805
45820
45825
45900
45905
45910
45915
45999
46020
46030
46040
46045
46050
46060
46070
46080
46083
46200
46210
46211
46220
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46285
46288
46320
46500
46600
46604
46606
46608
46610
46611
46612
46614
46615
46700
46705
46706
46715
46716
46730
46735
46740
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Colonoscopy and biopsy .............................
Colonoscopy, submucous inj ......................
Colonoscopy/control bleeding .....................
Lesion removal colonoscopy .......................
Lesion remove colonoscopy ........................
Lesion removal colonoscopy .......................
Colonoscopy dilate stricture ........................
Colonoscopy w/stent ...................................
Colonoscopy w/endoscope us ....................
Colonoscopy w/endoscopic fnb ...................
Repair of rectum ..........................................
Repair of rectum ..........................................
Treatment of rectal prolapse .......................
Correct rectal prolapse ................................
Correct rectal prolapse ................................
Repair rectum/remove sigmoid ...................
Repair of rectocele ......................................
Exploration/repair of rectum ........................
Exploration/repair of rectum ........................
Repair rect/bladder fistula ...........................
Repair fistula w/colostomy ..........................
Repair rectourethral fistula ..........................
Repair fistula w/colostomy ..........................
Reduction of rectal prolapse .......................
Dilation of anal sphincter .............................
Dilation of rectal narrowing .........................
Remove rectal obstruction ..........................
Rectum surgery procedure ..........................
Placement of seton .....................................
Removal of rectal marker ............................
Incision of rectal abscess ............................
Incision of rectal abscess ............................
Incision of anal abscess ..............................
Incision of rectal abscess ............................
Incision of anal septum ...............................
Incision of anal sphincter ............................
Incise external hemorrhoid ..........................
Removal of anal fissure ..............................
Removal of anal crypt .................................
Removal of anal crypts ...............................
Removal of anal tag ....................................
Ligation of hemorrhoid(s) ............................
Removal of anal tags ..................................
Hemorrhoidectomy ......................................
Hemorrhoidectomy ......................................
Remove hemorrhoids & fissure ...................
Remove hemorrhoids & fistula ....................
Hemorrhoidectomy ......................................
Remove hemorrhoids & fissure ...................
Remove hemorrhoids & fistula ....................
Removal of anal fistula ................................
Removal of anal fistula ................................
Removal of anal fistula ................................
Removal of anal fistula ................................
Repair anal fistula .......................................
Removal of hemorrhoid clot ........................
Injection into hemorrhoid(s) .........................
Diagnostic anoscopy ...................................
Anoscopy and dilation .................................
Anoscopy and biopsy ..................................
Anoscopy, remove for body ........................
Anoscopy, remove lesion ............................
Anoscopy .....................................................
Anoscopy, remove lesions ..........................
Anoscopy, control bleeding .........................
Anoscopy .....................................................
Repair of anal stricture ................................
Repair of anal stricture ................................
Repr of anal fistula w/glue ..........................
Rep perf anoper fistu ..................................
Rep perf anoper/vestib fistu ........................
Construction of absent anus .......................
Construction of absent anus .......................
Construction of absent anus .......................
4.44
4.20
5.69
5.87
4.70
5.31
4.58
5.91
5.10
6.55
7.29
7.59
0.55
16.28
13.41
23.02
10.58
15.39
23.48
17.78
20.79
18.49
21.26
2.62
2.30
2.81
3.15
0.00
2.91
1.23
4.96
4.32
1.19
5.69
2.72
2.49
1.40
3.42
2.68
4.25
1.56
2.04
2.58
3.89
4.60
5.40
5.73
6.37
7.08
7.50
3.72
4.56
5.98
4.09
7.13
1.61
1.61
0.50
1.31
0.81
1.51
1.32
1.81
2.34
2.01
2.69
9.14
6.90
2.39
7.20
15.08
26.76
32.18
30.02
Nonfacility
PE
RVUs
7.80
7.72
10.76
8.55
7.38
8.44
13.23
NA
NA
NA
NA
NA
1.77
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.28
0.00
2.40
1.41
5.50
NA
2.55
NA
NA
2.40
2.46
4.08
5.04
5.43
2.33
2.71
3.06
5.25
5.85
NA
NA
NA
NA
NA
4.97
4.76
NA
3.95
NA
2.12
2.26
1.52
9.37
3.69
4.23
3.92
3.20
5.32
2.48
2.43
NA
NA
0.00
NA
NA
NA
NA
NA
Facility
PE
RVUs
1.86
1.79
2.36
2.37
1.96
2.18
1.91
2.50
2.15
2.69
3.57
3.91
0.40
6.73
5.92
9.11
5.13
7.05
10.44
7.84
9.62
8.03
9.95
1.50
1.47
1.76
2.06
0.00
1.89
0.72
3.59
2.92
0.84
3.28
1.86
1.13
0.91
2.92
2.65
3.67
0.96
1.77
1.29
2.60
2.82
2.89
3.31
3.20
3.64
3.77
2.85
3.00
3.29
2.77
3.69
0.84
1.26
0.34
0.64
0.44
0.65
0.62
0.78
1.01
0.87
1.07
4.24
3.77
1.27
3.63
7.93
11.97
13.46
13.17
Malpractice
RVUs
0.35
0.30
0.41
0.48
0.38
0.42
0.39
0.48
0.42
0.42
0.75
0.86
0.05
1.84
1.55
2.61
1.13
1.83
3.10
1.85
2.02
1.58
2.31
0.30
0.27
0.30
0.30
0.00
0.31
0.14
0.62
0.54
0.14
0.67
0.36
0.30
0.15
0.39
0.31
0.48
0.17
0.23
0.30
0.48
0.58
0.64
0.68
0.76
0.79
0.83
0.46
0.52
0.66
0.44
0.79
0.18
0.16
0.05
0.12
0.09
0.16
0.15
0.19
0.28
0.20
0.33
0.94
0.91
0.28
0.92
1.58
2.46
3.20
2.41
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00163
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
12.59
12.22
16.86
14.91
12.46
14.17
18.20
NA
NA
NA
NA
NA
2.37
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
7.72
0.00
5.62
2.78
11.08
NA
3.88
NA
NA
5.20
4.01
7.89
8.02
10.16
4.06
4.98
5.94
9.62
11.03
NA
NA
NA
NA
NA
9.15
9.84
NA
8.48
NA
3.91
4.04
2.07
10.81
4.59
5.91
5.40
5.20
7.95
4.69
5.45
NA
NA
2.67
NA
NA
NA
NA
NA
Facility
total
6.65
6.29
8.47
8.72
7.04
7.91
6.88
8.89
7.67
9.66
11.61
12.36
1.00
24.85
20.88
34.74
16.84
24.27
37.02
27.46
32.43
28.09
33.53
4.41
4.05
4.86
5.51
0.00
5.10
2.09
9.17
7.78
2.17
9.64
4.93
3.92
2.47
6.73
5.64
8.40
2.70
4.05
4.17
6.97
8.00
8.93
9.72
10.33
11.51
12.10
7.02
8.08
9.94
7.30
11.62
2.63
3.04
0.89
2.08
1.34
2.32
2.10
2.78
3.64
3.08
4.09
14.32
11.58
3.94
11.75
24.59
41.19
48.85
45.60
Global
000
000
000
000
000
000
000
000
000
000
090
090
000
090
090
090
090
090
090
090
090
090
090
010
010
010
010
YYY
010
010
090
090
010
090
090
010
010
090
090
090
010
010
010
090
090
090
090
090
090
090
090
090
090
090
090
010
010
000
000
000
000
000
000
000
000
000
090
090
010
090
090
090
090
090
45926
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
46742
46744
46746
46748
46750
46751
46753
46754
46760
46761
46762
46900
46910
46916
46917
46922
46924
46934
46935
46936
46937
46938
46940
46942
46945
46946
46947
46999
47000
47001
47010
47011
47015
47100
47120
47122
47125
47130
47135
47136
47140
47141
47142
47143
47144
47145
47146
47147
47300
47350
47360
47361
47362
47370
47371
47379
47380
47381
47382
47399
47400
47420
47425
47460
47480
47490
47500
47505
47510
47511
47525
47530
47550
47552
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
R
R
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
C
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Repair of imperforated anus .......................
Repair of cloacal anomaly ...........................
Repair of cloacal anomaly ...........................
Repair of cloacal anomaly ...........................
Repair of anal sphincter ..............................
Repair of anal sphincter ..............................
Reconstruction of anus ...............................
Removal of suture from anus ......................
Repair of anal sphincter ..............................
Repair of anal sphincter ..............................
Implant artificial sphincter ............................
Destruction, anal lesion(s) ...........................
Destruction, anal lesion(s) ...........................
Cryosurgery, anal lesion(s) .........................
Laser surgery, anal lesions .........................
Excision of anal lesion(s) ............................
Destruction, anal lesion(s) ...........................
Destruction of hemorrhoids .........................
Destruction of hemorrhoids .........................
Destruction of hemorrhoids .........................
Cryotherapy of rectal lesion ........................
Cryotherapy of rectal lesion ........................
Treatment of anal fissure ............................
Treatment of anal fissure ............................
Ligation of hemorrhoids ...............................
Ligation of hemorrhoids ...............................
Hemorrhoidopexy by stapling ......................
Anus surgery procedure ..............................
Needle biopsy of liver ..................................
Needle biopsy, liver add-on ........................
Open drainage, liver lesion .........................
Percut drain, liver lesion ..............................
Inject/aspirate liver cyst ...............................
Wedge biopsy of liver ..................................
Partial removal of liver ................................
Extensive removal of liver ...........................
Partial removal of liver ................................
Partial removal of liver ................................
Transplantation of liver ................................
Transplantation of liver ................................
Partial removal, donor liver .........................
Partial removal, donor liver .........................
Partial removal, donor liver .........................
Prep donor liver, whole ...............................
Prep donor liver, 3-segment ........................
Prep donor liver, lobe split ..........................
Prep donor liver/venous ..............................
Prep donor liver/arterial ...............................
Surgery for liver lesion ................................
Repair liver wound ......................................
Repair liver wound ......................................
Repair liver wound ......................................
Repair liver wound ......................................
Laparo ablate liver tumor rf .........................
Laparo ablate liver cryosurg ........................
Laparoscope procedure, liver ......................
Open ablate liver tumor rf ...........................
Open ablate liver tumor cryo .......................
Percut ablate liver rf ....................................
Liver surgery procedure ..............................
Incision of liver duct ....................................
Incision of bile duct .....................................
Incision of bile duct .....................................
Incise bile duct sphincter .............................
Incision of gallbladder .................................
Incision of gallbladder .................................
Injection for liver x-rays ...............................
Injection for liver x-rays ...............................
Insert catheter, bile duct ..............................
Insert bile duct drain ....................................
Change bile duct catheter ...........................
Revise/reinsert bile tube ..............................
Bile duct endoscopy add-on ........................
Biliary endoscopy thru skin .........................
35.82
52.66
58.25
64.24
10.25
8.78
8.30
2.20
14.44
13.85
12.72
1.91
1.86
1.86
1.86
1.86
2.77
3.51
2.43
3.69
2.70
4.66
2.32
2.04
1.84
2.59
5.21
0.00
1.90
1.90
16.02
3.70
15.12
11.67
35.52
55.16
49.22
53.38
81.56
68.64
55.03
67.53
75.04
0.00
0.00
0.00
6.01
7.01
15.09
19.57
26.93
47.14
18.52
19.70
19.70
0.00
23.02
23.29
15.20
0.00
32.50
19.89
19.84
18.05
10.82
7.23
1.96
0.76
7.84
10.50
5.55
5.85
3.03
6.04
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
3.53
NA
NA
NA
2.72
3.04
3.30
9.15
3.33
8.93
5.32
3.49
5.13
3.09
4.24
2.08
1.94
3.37
3.73
NA
0.00
4.66
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
15.88
34.20
NA
NA
Facility
PE
RVUs
16.88
21.39
24.73
25.56
5.05
5.23
3.85
1.72
7.10
6.00
5.77
1.33
1.07
1.52
1.15
1.08
1.36
3.23
1.25
2.63
1.23
3.08
1.10
1.07
2.65
2.58
2.73
0.00
0.66
0.64
8.67
1.27
7.48
5.98
14.87
20.98
19.10
20.51
31.02
26.67
22.05
26.60
29.09
0.00
0.00
0.00
2.00
2.33
7.14
8.75
11.43
18.17
8.58
8.04
8.03
0.00
9.22
9.55
6.19
0.00
13.33
8.62
8.70
8.55
5.85
5.80
0.68
0.26
5.27
5.35
2.95
3.89
1.00
2.43
Malpractice
RVUs
3.19
6.38
7.68
3.36
1.10
0.94
0.94
0.19
1.59
1.43
1.24
0.17
0.19
0.11
0.21
0.22
0.26
0.32
0.23
0.34
0.14
0.58
0.23
0.19
0.19
0.27
0.75
0.00
0.12
0.25
1.80
0.22
1.83
1.53
4.65
7.19
6.45
6.94
9.93
8.41
5.17
5.17
5.17
0.00
0.00
0.00
0.83
0.97
1.98
2.58
3.37
5.85
2.50
2.55
2.60
0.00
2.86
2.84
0.96
0.00
3.07
2.62
2.61
2.20
1.42
0.43
0.12
0.04
0.46
0.62
0.33
0.37
0.40
0.42
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00164
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
5.93
NA
NA
NA
4.80
5.09
5.27
11.23
5.42
11.95
9.14
6.15
9.16
5.92
9.48
4.63
4.17
5.41
6.59
NA
0.00
6.69
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
21.77
40.42
NA
NA
Facility
total
55.89
80.42
90.65
93.15
16.40
14.94
13.08
4.11
23.13
21.28
19.72
3.41
3.13
3.49
3.22
3.16
4.39
7.06
3.91
6.66
4.07
8.32
3.65
3.31
4.69
5.44
8.69
0.00
2.69
2.79
26.49
5.18
24.43
19.18
55.05
83.33
74.76
80.83
122.51
103.72
82.25
99.30
109.30
0.00
0.00
0.00
8.84
10.32
24.21
30.90
41.73
71.16
29.60
30.29
30.33
0.00
35.10
35.68
22.35
0.00
48.90
31.13
31.15
28.80
18.09
13.47
2.76
1.06
13.56
16.47
8.83
10.11
4.42
8.89
Global
090
090
090
090
090
090
090
010
090
090
090
010
010
010
010
010
010
090
010
090
010
090
010
010
090
090
090
YYY
000
ZZZ
090
000
090
090
090
090
090
090
090
090
090
090
090
XXX
090
090
XXX
XXX
090
090
090
090
090
090
090
YYY
090
090
010
YYY
090
090
090
090
090
090
000
000
090
090
010
090
ZZZ
000
45927
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
47553
47554
47555
47556
47560
47561
47562
47563
47564
47570
47579
47600
47605
47610
47612
47620
47630
47700
47701
47711
47712
47715
47716
47720
47721
47740
47741
47760
47765
47780
47785
47800
47801
47802
47900
47999
48000
48001
48005
48020
48100
48102
48120
48140
48145
48146
48148
48150
48152
48153
48154
48155
48160
48180
48400
48500
48510
48511
48520
48540
48545
48547
48551
48552
48554
48556
48999
49000
49002
49010
49020
49021
49040
49041
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
A
A
A
A
A
A
A
A
A
C
A
R
A
C
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Biliary endoscopy thru skin .........................
Biliary endoscopy thru skin .........................
Biliary endoscopy thru skin .........................
Biliary endoscopy thru skin .........................
Laparoscopy w/cholangio ............................
Laparo w/cholangio/biopsy ..........................
Laparoscopic cholecystectomy ...................
Laparo cholecystectomy/graph ...................
Laparo cholecystectomy/explr .....................
Laparo cholecystoenterostomy ...................
Laparoscope proc, biliary ............................
Removal of gallbladder ...............................
Removal of gallbladder ...............................
Removal of gallbladder ...............................
Removal of gallbladder ...............................
Removal of gallbladder ...............................
Remove bile duct stone ..............................
Exploration of bile ducts ..............................
Bile duct revision .........................................
Excision of bile duct tumor ..........................
Excision of bile duct tumor ..........................
Excision of bile duct cyst .............................
Fusion of bile duct cyst ...............................
Fuse gallbladder & bowel ............................
Fuse upper gi structures .............................
Fuse gallbladder & bowel ............................
Fuse gallbladder & bowel ............................
Fuse bile ducts and bowel ..........................
Fuse liver ducts & bowel .............................
Fuse bile ducts and bowel ..........................
Fuse bile ducts and bowel ..........................
Reconstruction of bile ducts ........................
Placement, bile duct support .......................
Fuse liver duct & intestine ...........................
Suture bile duct injury .................................
Bile tract surgery procedure ........................
Drainage of abdomen ..................................
Placement of drain, pancreas .....................
Resect/debride pancreas ............................
Removal of pancreatic stone ......................
Biopsy of pancreas, open ...........................
Needle biopsy, pancreas .............................
Removal of pancreas lesion ........................
Partial removal of pancreas ........................
Partial removal of pancreas ........................
Pancreatectomy ...........................................
Removal of pancreatic duct ........................
Partial removal of pancreas ........................
Pancreatectomy ...........................................
Pancreatectomy ...........................................
Pancreatectomy ...........................................
Removal of pancreas ..................................
Pancreas removal/transplant .......................
Fuse pancreas and bowel ...........................
Injection, intraop add-on ..............................
Surgery of pancreatic cyst ..........................
Drain pancreatic pseudocyst .......................
Drain pancreatic pseudocyst .......................
Fuse pancreas cyst and bowel ...................
Fuse pancreas cyst and bowel ...................
Pancreatorrhaphy ........................................
Duodenal exclusion .....................................
Prep donor pancreas ...................................
Prep donor pancreas/venous ......................
Transpl allograft pancreas ...........................
Removal, allograft pancreas .......................
Pancreas surgery procedure .......................
Exploration of abdomen ..............................
Reopening of abdomen ...............................
Exploration behind abdomen ......................
Drain abdominal abscess ............................
Drain abdominal abscess ............................
Drain, open, abdom abscess ......................
Drain, percut, abdom abscess ....................
6.35
9.07
7.57
8.57
4.89
5.18
11.09
11.94
14.24
12.59
0.00
13.59
14.70
18.83
18.79
20.65
9.12
15.63
27.83
23.05
30.25
18.81
16.45
15.92
19.13
18.49
21.35
25.86
24.89
26.51
31.19
23.32
15.18
21.56
19.91
0.00
28.09
35.47
42.19
15.71
12.23
4.68
15.86
22.96
24.03
26.41
17.34
48.03
43.77
47.92
44.12
24.65
0.00
24.73
1.95
15.29
14.32
4.00
15.60
19.73
18.19
25.84
0.00
4.31
34.19
15.72
0.00
11.68
10.49
12.28
22.86
3.38
13.53
4.00
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
8.56
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
21.86
NA
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
NA
21.59
NA
20.71
Facility
PE
RVUs
2.17
3.38
2.60
2.94
1.63
1.88
4.93
5.24
5.87
5.31
0.00
6.04
6.41
7.80
7.76
8.37
5.10
7.31
11.28
9.75
12.16
8.31
7.69
7.37
8.43
8.24
9.13
10.66
10.59
11.02
12.65
9.89
8.39
9.49
8.73
0.00
11.45
13.61
16.29
7.25
5.54
2.01
6.81
9.40
9.69
11.78
7.48
19.10
17.84
19.14
17.89
11.47
0.00
10.02
0.67
7.24
7.52
1.37
6.62
7.98
7.86
10.33
0.00
1.44
18.44
8.08
0.00
5.34
4.98
5.89
10.37
1.15
6.52
1.37
Malpractice
RVUs
0.37
0.96
0.45
0.50
0.65
0.66
1.46
1.58
1.88
1.65
0.00
1.79
1.94
2.48
2.47
2.73
0.65
2.06
3.67
3.04
3.92
2.48
2.14
2.10
2.52
2.41
2.82
3.41
3.29
3.49
4.09
3.07
1.16
2.85
2.64
0.00
3.47
4.68
5.54
2.12
1.62
0.28
2.09
3.02
3.17
3.49
2.29
6.30
5.78
6.29
5.82
3.26
0.00
3.27
0.15
2.02
1.82
0.24
2.05
2.60
2.37
3.41
0.00
0.31
4.18
2.07
0.00
1.52
1.37
1.51
2.84
0.20
1.69
0.24
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00165
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
13.52
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
26.10
NA
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
NA
25.17
NA
24.95
Facility
total
8.89
13.41
10.62
12.01
7.17
7.72
17.48
18.76
21.99
19.55
0.00
21.42
23.04
29.11
29.01
31.76
14.86
25.00
42.77
35.84
46.33
29.60
26.29
25.39
30.08
29.14
33.31
39.93
38.77
41.02
47.93
36.27
24.73
33.90
31.28
0.00
43.01
53.77
64.02
25.09
19.39
6.97
24.76
35.37
36.88
41.68
27.12
73.43
67.39
73.35
67.83
39.38
0.00
38.02
2.77
24.55
23.66
5.61
24.27
30.31
28.42
39.58
0.00
6.06
56.81
25.87
0.00
18.54
16.85
19.68
36.07
4.73
21.74
5.60
Global
000
000
000
000
000
000
090
090
090
090
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
090
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
XXX
090
ZZZ
090
090
000
090
090
090
090
XXX
XXX
090
090
YYY
090
090
090
090
000
090
000
45928
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
49060
49061
49062
49080
49081
49085
49180
49200
49201
49215
49220
49250
49255
49320
49321
49322
49323
49329
49400
49419
49420
49421
49422
49423
49424
49425
49426
49427
49428
49429
49491
49492
49495
49496
49500
49501
49505
49507
49520
49521
49525
49540
49550
49553
49555
49557
49560
49561
49565
49566
49568
49570
49572
49580
49582
49585
49587
49590
49600
49605
49606
49610
49611
49650
49651
49659
49900
49904
49905
49906
49999
50010
50020
50021
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
C
C
A
A
A
Physician
work
RVUs 3
Description
Drain, open, retrop abscess ........................
Drain, percut, retroper absc ........................
Drain to peritoneal cavity ............................
Puncture, peritoneal cavity ..........................
Removal of abdominal fluid .........................
Remove abdomen foreign body ..................
Biopsy, abdominal mass .............................
Removal of abdominal lesion ......................
Remove abdom lesion, complex .................
Excise sacral spine tumor ...........................
Multiple surgery, abdomen ..........................
Excision of umbilicus ...................................
Removal of omentum ..................................
Diag laparo separate proc ...........................
Laparoscopy, biopsy ...................................
Laparoscopy, aspiration ..............................
Laparo drain lymphocele .............................
Laparo proc, abdm/per/oment .....................
Air injection into abdomen ...........................
Insrt abdom cath for chemotx .....................
Insert abdom drain, temp ............................
Insert abdom drain, perm ............................
Remove perm cannula/catheter ..................
Exchange drainage catheter .......................
Assess cyst, contrast inject .........................
Insert abdomen-venous drain .....................
Revise abdomen-venous shunt ...................
Injection, abdominal shunt ..........................
Ligation of shunt ..........................................
Removal of shunt ........................................
Rpr hern preemie reduc ..............................
Rpr ing hern premie, blocked ......................
Rpr ing hernia baby, reduc .........................
Rpr ing hernia baby, blocked ......................
Rpr ing hernia, init, reduce ..........................
Rpr ing hernia, init blocked .........................
Prp i/hern init reduc >5 yr ...........................
Prp i/hern init block >5 yr ............................
Rerepair ing hernia, reduce ........................
Rerepair ing hernia, blocked .......................
Repair ing hernia, sliding ............................
Repair lumbar hernia ...................................
Rpr rem hernia, init, reduce ........................
Rpr fem hernia, init blocked ........................
Rerepair fem hernia, reduce .......................
Rerepair fem hernia, blocked ......................
Rpr ventral hern init, reduc .........................
Rpr ventral hern init, block ..........................
Rerepair ventrl hern, reduce .......................
Rerepair ventrl hern, block ..........................
Hernia repair w/mesh ..................................
Rpr epigastric hern, reduce .........................
Rpr epigastric hern, blocked .......................
Rpr umbil hern, reduc < 5 yr .......................
Rpr umbil hern, block < 5 yr .......................
Rpr umbil hern, reduc > 5 yr .......................
Rpr umbil hern, block > 5 yr .......................
Repair spigelian hernia ...............................
Repair umbilical lesion ................................
Repair umbilical lesion ................................
Repair umbilical lesion ................................
Repair umbilical lesion ................................
Repair umbilical lesion ................................
Laparo hernia repair initial ..........................
Laparo hernia repair recur ..........................
Laparo proc, hernia repair ...........................
Repair of abdominal wall .............................
Omental flap, extra-abdom ..........................
Omental flap, intra-abdom ...........................
Free omental flap, microvasc ......................
Abdomen surgery procedure .......................
Exploration of kidney ...................................
Renal abscess, open drain .........................
Renal abscess, percut drain .......................
15.87
3.70
11.36
1.35
1.26
12.14
1.73
10.25
14.85
33.52
14.89
8.36
11.14
5.10
5.40
5.70
9.49
0.00
1.88
6.65
2.22
5.54
6.25
1.46
0.76
11.37
9.64
0.89
6.06
7.40
11.13
14.04
5.89
8.80
5.48
8.89
7.61
9.58
9.64
11.97
8.58
10.39
8.64
9.45
9.04
11.15
11.57
14.26
11.57
14.41
4.89
5.69
6.73
4.11
6.65
6.23
7.57
8.55
10.96
76.04
18.61
10.50
8.93
6.27
8.25
0.00
12.28
20.01
6.55
0.00
0.00
10.98
14.67
3.38
Nonfacility
PE
RVUs
NA
20.47
NA
3.87
2.80
NA
3.17
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
3.03
NA
NA
NA
NA
14.27
3.70
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
0.00
0.00
NA
NA
22.82
Facility
PE
RVUs
7.69
1.27
5.43
0.48
0.45
5.45
0.60
5.04
6.97
13.82
6.56
4.23
5.56
2.61
2.62
2.95
4.56
0.00
0.64
3.52
1.16
3.12
2.86
0.55
0.31
5.48
4.71
0.31
3.73
3.35
5.10
6.08
2.97
4.26
3.18
4.19
3.73
4.42
4.40
5.18
4.06
4.70
4.09
4.38
4.23
4.93
5.09
5.98
5.16
6.05
1.63
3.15
3.44
2.58
3.45
3.28
3.71
4.06
5.26
27.99
7.55
5.11
6.74
3.18
4.03
0.00
6.21
14.59
2.26
0.00
0.00
5.82
8.25
1.16
Malpractice
RVUs
1.74
0.22
1.39
0.08
0.09
1.62
0.10
1.24
1.87
4.37
1.88
1.08
1.43
0.65
0.70
0.71
1.20
0.00
0.15
0.81
0.21
0.74
0.83
0.09
0.04
1.54
1.28
0.07
0.80
1.02
1.40
1.80
0.74
1.07
0.71
1.12
1.03
1.27
1.28
1.59
1.13
1.37
1.14
1.24
1.20
1.47
1.52
1.88
1.52
1.90
0.64
0.75
0.88
0.54
0.88
0.82
0.99
1.13
1.32
9.36
2.45
1.07
0.78
0.93
1.14
0.00
1.62
2.69
0.75
0.00
0.00
0.93
1.34
0.20
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00166
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
24.39
NA
5.30
4.15
NA
5.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
5.06
NA
NA
NA
NA
15.82
4.50
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
0.00
0.00
NA
NA
26.39
Facility
total
25.30
5.18
18.18
1.91
1.80
19.22
2.43
16.53
23.69
51.70
23.33
13.67
18.13
8.36
8.72
9.36
15.25
0.00
2.67
10.99
3.59
9.40
9.94
2.10
1.11
18.40
15.63
1.27
10.59
11.77
17.63
21.92
9.60
14.13
9.37
14.20
12.37
15.27
15.32
18.75
13.77
16.47
13.87
15.07
14.47
17.56
18.18
22.12
18.25
22.36
7.16
9.59
11.06
7.23
10.99
10.34
12.27
13.73
17.54
113.39
28.60
16.68
16.45
10.38
13.41
0.00
20.12
37.29
9.57
0.00
0.00
17.74
24.26
4.74
Global
090
000
090
000
000
090
000
090
090
090
090
090
090
010
010
010
090
YYY
000
090
000
090
010
000
000
090
090
000
010
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
090
090
ZZZ
090
YYY
090
090
000
45929
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
50040
50045
50060
50065
50070
50075
50080
50081
50100
50120
50125
50130
50135
50200
50205
50220
50225
50230
50234
50236
50240
50280
50290
50320
50323
50325
50327
50328
50329
50340
50360
50365
50370
50380
50390
50391
50392
50393
50394
50395
50396
50398
50400
50405
50500
50520
50525
50526
50540
50541
50542
50543
50544
50545
50546
50547
50548
50549
50551
50553
50555
50557
50561
50562
50570
50572
50574
50575
50576
50580
50590
50600
50605
50610
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Drainage of kidney ......................................
Exploration of kidney ...................................
Removal of kidney stone .............................
Incision of kidney .........................................
Incision of kidney .........................................
Removal of kidney stone .............................
Removal of kidney stone .............................
Removal of kidney stone .............................
Revise kidney blood vessels .......................
Exploration of kidney ...................................
Explore and drain kidney ............................
Removal of kidney stone .............................
Exploration of kidney ...................................
Biopsy of kidney ..........................................
Biopsy of kidney ..........................................
Remove kidney, open .................................
Removal kidney open, complex ..................
Removal kidney open, radical .....................
Removal of kidney & ureter ........................
Removal of kidney & ureter ........................
Partial removal of kidney .............................
Removal of kidney lesion ............................
Removal of kidney lesion ............................
Remove kidney, living donor .......................
Prep cadaver renal allograft ........................
Prep donor renal graft .................................
Prep renal graft/venous ...............................
Prep renal graft/arterial ...............................
Prep renal graft/ureteral ..............................
Removal of kidney .......................................
Transplantation of kidney ............................
Transplantation of kidney ............................
Remove transplanted kidney .......................
Reimplantation of kidney .............................
Drainage of kidney lesion ............................
Instll rx agnt into rnal tub ............................
Insert kidney drain .......................................
Insert ureteral tube ......................................
Injection for kidney x-ray .............................
Create passage to kidney ...........................
Measure kidney pressure ............................
Change kidney tube ....................................
Revision of kidney/ureter .............................
Revision of kidney/ureter .............................
Repair of kidney wound ..............................
Close kidney-skin fistula ..............................
Repair renal-abdomen fistula ......................
Repair renal-abdomen fistula ......................
Revision of horseshoe kidney .....................
Laparo ablate renal cyst ..............................
Laparo ablate renal mass ...........................
Laparo partial nephrectomy ........................
Laparoscopy, pyeloplasty ............................
Laparo radical nephrectomy ........................
Laparoscopic nephrectomy .........................
Laparo removal donor kidney .....................
Laparo remove w/ureter ..............................
Laparoscope proc, renal .............................
Kidney endoscopy .......................................
Kidney endoscopy .......................................
Kidney endoscopy & biopsy ........................
Kidney endoscopy & treatment ...................
Kidney endoscopy & treatment ...................
Renal scope w/tumor resect .......................
Kidney endoscopy .......................................
Kidney endoscopy .......................................
Kidney endoscopy & biopsy ........................
Kidney endoscopy .......................................
Kidney endoscopy & treatment ...................
Kidney endoscopy & treatment ...................
Fragmenting of kidney stone .......................
Exploration of ureter ....................................
Insert ureteral support .................................
Removal of ureter stone ..............................
14.95
15.47
19.31
20.80
20.33
25.35
14.72
21.81
16.10
15.92
16.53
17.29
19.19
2.64
11.31
17.15
20.24
22.08
22.41
24.87
22.01
15.68
14.74
22.22
0.00
0.00
4.01
3.51
3.35
12.15
31.54
36.82
13.73
20.77
1.96
1.96
3.38
4.16
0.76
3.38
2.09
1.46
19.51
23.94
19.58
17.23
22.28
24.03
19.94
16.01
20.01
25.51
22.41
24.01
20.49
25.51
24.41
0.00
5.60
5.99
6.53
6.62
7.60
10.92
9.55
10.35
11.02
13.99
10.99
11.86
9.10
15.85
15.47
15.93
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.68
NA
NA
2.72
NA
NA
16.40
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
4.47
4.72
5.03
5.04
5.51
NA
NA
NA
NA
NA
NA
NA
13.68
NA
NA
NA
Facility
PE
RVUs
7.61
7.41
9.10
6.01
9.43
11.47
7.28
10.27
7.67
7.79
7.75
8.29
8.99
1.32
5.32
8.12
9.34
9.88
10.18
11.78
10.38
7.62
6.95
11.43
0.00
0.00
1.35
1.18
1.13
6.71
15.94
18.27
7.40
12.41
0.68
0.74
1.61
1.88
0.70
1.61
1.15
0.55
9.04
10.26
8.86
8.35
9.57
10.40
8.96
7.41
9.49
11.90
9.75
10.60
9.49
11.70
10.57
0.00
2.34
2.52
2.69
2.73
3.09
4.95
3.81
4.07
4.37
5.49
4.34
4.69
4.92
7.56
7.37
7.84
Malpractice
RVUs
1.03
1.24
1.36
1.59
1.44
1.80
1.04
1.54
2.06
1.21
1.43
1.22
1.33
0.16
1.30
1.35
1.50
1.55
1.59
1.76
1.55
1.19
1.41
2.35
0.00
0.00
0.29
0.26
0.25
1.65
3.81
4.42
1.67
2.50
0.12
0.14
0.20
0.25
0.05
0.21
0.13
0.09
1.38
1.78
2.01
1.49
1.83
1.96
1.36
1.13
1.39
1.80
1.58
1.70
1.57
2.76
1.72
0.00
0.40
0.39
0.45
0.47
0.54
0.73
0.68
0.85
0.77
0.99
0.78
0.83
0.65
1.13
1.45
1.43
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00167
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.79
NA
NA
3.53
NA
NA
17.95
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
10.48
11.11
12.01
12.13
13.64
NA
NA
NA
NA
NA
NA
NA
23.43
NA
NA
NA
Facility
total
23.59
24.12
29.76
28.40
31.20
38.62
23.04
33.62
25.83
24.92
25.71
26.81
29.51
4.11
17.93
26.63
31.08
33.51
34.19
38.41
33.94
24.49
23.10
36.00
0.00
0.00
5.65
4.95
4.73
20.51
51.29
59.52
22.80
35.69
2.76
2.85
5.18
6.29
1.51
5.19
3.38
2.10
29.93
35.98
30.45
27.07
33.68
36.38
30.26
24.55
30.89
39.21
33.74
36.31
31.55
39.97
36.70
0.00
8.35
8.90
9.67
9.82
11.22
16.60
14.04
15.27
16.16
20.46
16.11
17.38
14.67
24.54
24.29
25.20
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
000
090
090
090
090
090
090
090
090
090
090
XXX
XXX
XXX
XXX
XXX
090
090
090
090
090
000
000
000
000
000
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
000
000
000
000
000
090
000
000
000
000
000
000
090
090
090
090
45930
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
50620
50630
50650
50660
50684
50686
50688
50690
50700
50715
50722
50725
50727
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
50930
50940
50945
50947
50948
50949
50951
50953
50955
50957
50961
50970
50972
50974
50976
50980
51000
51005
51010
51020
51030
51040
51045
51050
51060
51065
51080
51500
51520
51525
51530
51535
51550
51555
51565
51570
51575
51580
51585
51590
51595
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of ureter stone ..............................
Removal of ureter stone ..............................
Removal of ureter ........................................
Removal of ureter ........................................
Injection for ureter x-ray ..............................
Measure ureter pressure .............................
Change of ureter tube .................................
Injection for ureter x-ray ..............................
Revision of ureter ........................................
Release of ureter .........................................
Release of ureter .........................................
Release/revise ureter ..................................
Revise ureter ...............................................
Revise ureter ...............................................
Fusion of ureter & kidney ............................
Fusion of ureter & kidney ............................
Fusion of ureters .........................................
Splicing of ureters .......................................
Reimplant ureter in bladder .........................
Reimplant ureter in bladder .........................
Reimplant ureter in bladder .........................
Reimplant ureter in bladder .........................
Implant ureter in bowel ................................
Fusion of ureter & bowel .............................
Urine shunt to intestine ...............................
Construct bowel bladder .............................
Construct bowel bladder .............................
Revise urine flow .........................................
Replace ureter by bowel .............................
Appendico-vesicostomy ...............................
Transplant ureter to skin .............................
Repair of ureter ...........................................
Closure ureter/skin fistula ............................
Closure ureter/bowel fistula .........................
Release of ureter .........................................
Laparoscopy ureterolithotomy .....................
Laparo new ureter/bladder ..........................
Laparo new ureter/bladder ..........................
Laparoscope proc, ureter ............................
Endoscopy of ureter ....................................
Endoscopy of ureter ....................................
Ureter endoscopy & biopsy .........................
Ureter endoscopy & treatment ....................
Ureter endoscopy & treatment ....................
Ureter endoscopy ........................................
Ureter endoscopy & catheter ......................
Ureter endoscopy & biopsy .........................
Ureter endoscopy & treatment ....................
Ureter endoscopy & treatment ....................
Drainage of bladder .....................................
Drainage of bladder .....................................
Drainage of bladder .....................................
Incise & treat bladder ..................................
Incise & treat bladder ..................................
Incise & drain bladder .................................
Incise bladder/drain ureter ..........................
Removal of bladder stone ...........................
Removal of ureter stone ..............................
Remove ureter calculus ..............................
Drainage of bladder abscess ......................
Removal of bladder cyst .............................
Removal of bladder lesion ..........................
Removal of bladder lesion ..........................
Removal of bladder lesion ..........................
Repair of ureter lesion .................................
Partial removal of bladder ...........................
Partial removal of bladder ...........................
Revise bladder & ureter(s) ..........................
Removal of bladder .....................................
Removal of bladder & nodes ......................
Remove bladder/revise tract .......................
Removal of bladder & nodes ......................
Remove bladder/revise tract .......................
Remove bladder/revise tract .......................
15.17
14.95
17.41
19.56
0.76
1.51
1.17
1.16
15.22
18.91
16.36
18.50
8.19
12.02
18.43
19.52
18.43
19.52
18.37
19.55
20.56
20.53
14.53
20.06
19.94
21.90
28.20
31.29
20.01
20.90
15.37
13.63
14.34
18.73
14.52
17.00
24.51
22.51
0.00
5.84
6.24
6.75
6.79
6.05
7.14
6.89
9.18
9.05
6.85
0.78
1.02
3.53
6.71
6.77
4.40
6.77
6.92
8.86
8.86
5.96
10.14
9.30
13.98
12.38
12.58
15.67
21.24
21.63
24.25
30.46
31.09
35.25
32.68
37.15
Nonfacility
PE
RVUs
NA
NA
NA
NA
4.95
3.46
NA
1.88
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
4.63
4.79
6.34
4.97
4.74
NA
NA
NA
NA
NA
1.80
4.33
5.61
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
7.35
7.26
8.32
9.17
0.55
0.88
1.12
0.78
7.83
8.92
7.93
8.71
4.89
6.12
8.33
9.27
8.59
9.08
8.59
9.12
9.37
9.44
7.37
9.22
9.51
9.64
12.72
13.62
9.67
10.32
7.50
6.74
7.23
8.70
7.19
8.00
11.02
9.77
0.00
2.43
2.81
3.09
2.79
2.53
2.91
2.84
3.63
3.62
2.80
0.26
0.36
2.03
4.32
4.37
3.13
4.21
4.21
5.16
5.01
3.93
5.26
5.29
7.05
6.32
6.54
7.46
9.74
10.17
11.12
13.75
14.21
15.79
14.45
16.33
Malpractice
RVUs
1.07
1.09
1.23
1.38
0.05
0.11
0.07
0.07
1.27
2.13
1.90
1.52
0.61
1.00
1.96
1.38
1.55
1.45
1.51
1.61
1.98
1.45
1.19
2.31
1.54
1.89
2.07
2.37
1.47
1.57
1.29
1.14
1.01
1.28
1.26
1.36
2.16
1.70
0.00
0.41
0.43
0.48
0.48
0.41
0.52
0.49
0.64
0.66
0.48
0.05
0.10
0.28
0.47
0.58
0.31
0.52
0.49
0.62
0.63
0.43
1.03
0.69
0.99
1.05
1.23
1.31
1.69
1.63
1.71
2.16
2.24
2.48
2.27
2.59
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00168
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
5.76
5.08
NA
3.12
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
10.88
11.46
13.58
12.24
11.20
NA
NA
NA
NA
NA
2.63
5.45
9.42
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
23.59
23.30
26.97
30.11
1.37
2.50
2.37
2.02
24.32
29.96
26.19
28.73
13.68
19.15
28.72
30.17
28.56
30.05
28.47
30.28
31.91
31.42
23.09
31.59
30.99
33.44
42.98
47.28
31.15
32.79
24.16
21.51
22.58
28.71
22.97
26.37
37.69
33.99
0.00
8.68
9.49
10.32
10.06
8.99
10.57
10.23
13.45
13.33
10.13
1.09
1.48
5.83
11.50
11.72
7.84
11.50
11.62
14.64
14.50
10.32
16.43
15.28
22.01
19.76
20.35
24.44
32.68
33.44
37.08
46.37
47.54
53.52
49.39
56.08
Global
090
090
090
090
000
000
010
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
YYY
000
000
000
000
000
000
000
000
000
000
000
000
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45931
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
51596
51597
51600
51605
51610
51700
51701
51702
51703
51705
51710
51715
51720
51725
51725
51725
51726
51726
51726
51736
51736
51736
51741
51741
51741
51772
51772
51772
51784
51784
51784
51785
51785
51785
51792
51792
51792
51795
51795
51795
51797
51797
51797
51798
51800
51820
51840
51841
51845
51860
51865
51880
51900
51920
51925
51940
51960
51980
51990
51992
52000
52001
52005
52007
52010
52204
52214
52224
52234
52235
52240
52250
52260
52265
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Remove bladder/create pouch ....................
Removal of pelvic structures .......................
Injection for bladder x-ray ...........................
Preparation for bladder xray .......................
Injection for bladder x-ray ...........................
Irrigation of bladder .....................................
Insert bladder catheter ................................
Insert temp bladder cath .............................
Insert bladder cath, complex .......................
Change of bladder tube ..............................
Change of bladder tube ..............................
Endoscopic injection/implant .......................
Treatment of bladder lesion ........................
Simple cystometrogram ...............................
Simple cystometrogram ...............................
Simple cystometrogram ...............................
Complex cystometrogram ...........................
Complex cystometrogram ...........................
Complex cystometrogram ...........................
Urine flow measurement .............................
Urine flow measurement .............................
Urine flow measurement .............................
Electro-uroflowmetry, first ............................
Electro-uroflowmetry, first ............................
Electro-uroflowmetry, first ............................
Urethra pressure profile ..............................
Urethra pressure profile ..............................
Urethra pressure profile ..............................
Anal/urinary muscle study ...........................
Anal/urinary muscle study ...........................
Anal/urinary muscle study ...........................
Anal/urinary muscle study ...........................
Anal/urinary muscle study ...........................
Anal/urinary muscle study ...........................
Urinary reflex study .....................................
Urinary reflex study .....................................
Urinary reflex study .....................................
Urine voiding pressure study ......................
Urine voiding pressure study ......................
Urine voiding pressure study ......................
Intraabdominal pressure test .......................
Intraabdominal pressure test .......................
Intraabdominal pressure test .......................
Us urine capacity measure .........................
Revision of bladder/urethra .........................
Revision of urinary tract ..............................
Attach bladder/urethra .................................
Attach bladder/urethra .................................
Repair bladder neck ....................................
Repair of bladder wound .............................
Repair of bladder wound .............................
Repair of bladder opening ...........................
Repair bladder/vagina lesion .......................
Close bladder-uterus fistula ........................
Hysterectomy/bladder repair .......................
Correction of bladder defect ........................
Revision of bladder & bowel .......................
Construct bladder opening ..........................
Laparo urethral suspension .........................
Laparo sling operation .................................
Cystoscopy ..................................................
Cystoscopy, removal of clots ......................
Cystoscopy & ureter catheter ......................
Cystoscopy and biopsy ...............................
Cystoscopy & duct catheter ........................
Cystoscopy ..................................................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and radiotracer ........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
39.54
38.37
0.88
0.64
1.05
0.88
0.50
0.50
1.47
1.02
1.49
3.74
1.96
1.51
1.51
0.00
1.71
1.71
0.00
0.61
0.61
0.00
1.14
1.14
0.00
1.61
1.61
0.00
1.53
1.53
0.00
1.53
1.53
0.00
1.10
1.10
0.00
1.53
1.53
0.00
1.60
1.60
0.00
0.00
17.42
17.90
10.71
13.04
9.74
12.02
15.05
7.67
12.98
11.81
15.59
28.45
23.03
11.36
12.50
14.02
2.01
5.45
2.37
3.03
3.03
2.37
3.71
3.15
4.63
5.45
9.73
4.50
3.92
2.95
Nonfacility
PE
RVUs
NA
NA
5.08
NA
2.29
1.65
1.55
2.06
2.77
2.31
3.37
NA
1.86
5.51
0.57
4.94
7.56
0.65
6.91
0.66
0.23
0.43
0.92
0.43
0.49
5.53
0.61
4.91
4.03
0.57
3.46
4.52
0.58
3.95
5.83
0.43
5.39
7.32
0.58
6.75
5.74
0.61
5.13
0.39
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.39
5.34
5.72
16.13
10.59
14.04
36.60
34.94
NA
NA
NA
NA
NA
12.97
Facility
PE
RVUs
17.59
16.73
0.32
0.39
0.68
0.32
0.20
0.25
0.67
0.69
0.92
1.59
0.81
NA
0.57
NA
NA
0.65
NA
NA
0.23
NA
NA
0.43
NA
NA
0.61
NA
NA
0.57
NA
NA
0.58
NA
NA
0.43
NA
NA
0.58
NA
NA
0.61
NA
NA
8.48
8.52
5.82
6.70
5.32
6.15
7.37
4.26
6.71
6.19
8.45
12.82
11.01
6.10
6.34
6.88
0.90
2.21
1.07
1.38
1.37
1.08
1.59
1.38
1.98
2.31
3.93
1.98
1.70
1.33
Malpractice
RVUs
2.77
2.81
0.06
0.04
0.07
0.06
0.04
0.04
0.10
0.07
0.11
0.29
0.14
0.16
0.12
0.04
0.18
0.13
0.05
0.06
0.05
0.01
0.11
0.09
0.02
0.20
0.15
0.05
0.16
0.12
0.04
0.15
0.11
0.04
0.20
0.07
0.13
0.22
0.12
0.10
0.17
0.12
0.05
0.08
1.32
1.74
1.06
1.24
0.79
1.16
1.23
0.72
1.21
1.18
2.03
2.14
1.63
0.86
1.39
1.41
0.14
0.39
0.17
0.22
0.21
0.17
0.26
0.22
0.33
0.39
0.69
0.32
0.28
0.22
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00169
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
6.02
NA
3.41
2.59
2.09
2.60
4.35
3.41
4.97
NA
3.97
7.19
2.20
4.98
9.45
2.49
6.96
1.33
0.89
0.44
2.17
1.66
0.51
7.34
2.37
4.96
5.73
2.23
3.50
6.21
2.22
3.99
7.13
1.61
5.52
9.08
2.23
6.85
7.51
2.33
5.18
0.47
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.55
11.18
8.26
19.37
13.83
16.59
40.57
38.31
NA
NA
NA
NA
NA
16.13
Facility
total
59.90
57.90
1.26
1.07
1.80
1.26
0.74
0.79
2.24
1.79
2.53
5.61
2.92
NA
2.20
NA
NA
2.49
NA
NA
0.89
NA
NA
1.66
NA
NA
2.37
NA
NA
2.23
NA
NA
2.22
NA
NA
1.61
NA
NA
2.23
NA
NA
2.33
NA
NA
27.22
28.16
17.59
20.97
15.85
19.33
23.65
12.64
20.90
19.18
26.08
43.40
35.67
18.33
20.23
22.30
3.06
8.06
3.62
4.62
4.61
3.63
5.56
4.74
6.94
8.15
14.34
6.80
5.89
4.49
Global
090
090
000
000
000
000
000
000
000
010
010
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
XXX
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
000
000
000
000
000
000
000
45932
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
52270
52275
52276
52277
52281
52282
52283
52285
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52351
52352
52353
52354
52355
52400
52402
52450
52500
52510
52601
52606
52612
52614
52620
52630
52640
52647
52648
52700
53000
53010
53020
53025
53040
53060
53080
53085
53200
53210
53215
53220
53230
53235
53240
53250
53260
53265
53270
53275
53400
53405
53410
53415
53420
53425
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Cystoscopy & revise urethra .......................
Cystoscopy & revise urethra .......................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy, implant stent ...........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Remove bladder stone ................................
Remove bladder stone ................................
Cystoscopy and treatment ..........................
Cystoscopy, stone removal .........................
Cystoscopy, inject material .........................
Cystoscopy and treatment ..........................
Cystoscopy and treatment ..........................
Create passage to kidney ...........................
Cysto w/ureter stricture tx ...........................
Cysto w/up stricture tx .................................
Cysto w/renal stricture tx .............................
Cysto/uretero, stricture tx ............................
Cysto/uretero w/up stricture ........................
Cystouretero w/renal strict ..........................
Cystouretero & or pyeloscope .....................
Cystouretero w/stone remove .....................
Cystouretero w/lithotripsy ............................
Cystouretero w/biopsy .................................
Cystouretero w/excise tumor .......................
Cystouretero w/congen repr ........................
Cystourethro cut ejacul duct .......................
Incision of prostate ......................................
Revision of bladder neck .............................
Dilation prostatic urethra .............................
Prostatectomy (TURP) ................................
Control postop bleeding ..............................
Prostatectomy, first stage ............................
Prostatectomy, second stage ......................
Remove residual prostate ...........................
Remove prostate regrowth ..........................
Relieve bladder contracture ........................
Laser surgery of prostate ............................
Laser surgery of prostate ............................
Drainage of prostate abscess .....................
Incision of urethra ........................................
Incision of urethra ........................................
Incision of urethra ........................................
Incision of urethra ........................................
Drainage of urethra abscess .......................
Drainage of urethra abscess .......................
Drainage of urinary leakage ........................
Drainage of urinary leakage ........................
Biopsy of urethra .........................................
Removal of urethra ......................................
Removal of urethra ......................................
Treatment of urethra lesion .........................
Removal of urethra lesion ...........................
Removal of urethra lesion ...........................
Surgery for urethra pouch ...........................
Removal of urethra gland ............................
Treatment of urethra lesion .........................
Treatment of urethra lesion .........................
Removal of urethra gland ............................
Repair of urethra defect ..............................
Revise urethra, stage 1 ...............................
Revise urethra, stage 2 ...............................
Reconstruction of urethra ............................
Reconstruction of urethra ............................
Reconstruct urethra, stage 1 .......................
Reconstruct urethra, stage 2 .......................
3.37
4.70
5.00
6.17
2.81
6.40
3.74
3.61
4.59
5.31
5.51
5.31
2.82
5.21
6.72
9.20
4.70
6.16
5.19
5.04
2.84
4.83
6.00
6.50
7.20
7.71
8.21
9.24
5.86
6.88
7.98
7.34
8.83
9.69
5.28
7.65
8.48
6.72
12.37
8.14
7.99
6.84
6.61
7.26
6.62
10.36
11.21
6.80
2.28
3.64
1.77
1.13
6.40
2.64
6.29
10.27
2.60
12.58
15.59
7.00
9.59
10.14
6.45
5.89
2.99
3.13
3.10
4.53
12.78
14.49
16.45
19.42
14.09
15.99
Nonfacility
PE
RVUs
10.79
15.22
NA
NA
7.08
NA
4.14
4.23
NA
NA
NA
NA
4.79
8.76
28.18
NA
NA
NA
30.65
37.29
5.70
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
70.90
NA
NA
NA
NA
NA
NA
NA
2.08
NA
NA
1.46
NA
NA
NA
NA
NA
NA
NA
2.27
2.83
2.30
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
1.49
1.99
2.13
2.59
1.30
2.66
1.65
1.60
1.97
2.27
2.03
2.21
1.23
2.18
2.71
3.67
1.94
2.52
2.14
2.08
1.26
2.05
2.62
2.79
3.06
3.34
3.53
3.92
2.56
2.99
3.40
3.16
3.73
4.48
2.02
4.40
4.70
3.71
6.08
4.23
4.40
4.00
3.57
3.82
3.53
5.42
5.70
3.78
1.67
3.21
0.80
0.63
3.88
1.50
6.21
7.86
1.15
6.55
7.67
4.21
5.39
5.61
3.96
3.64
1.63
1.67
1.69
2.55
6.83
7.31
8.18
8.22
6.54
7.86
Malpractice
RVUs
0.24
0.33
0.35
0.44
0.20
0.45
0.26
0.26
0.32
0.38
0.46
0.38
0.20
0.37
0.48
0.65
0.33
0.44
0.37
0.36
0.21
0.35
0.43
0.46
0.51
0.55
0.58
0.65
0.41
0.49
0.57
0.52
0.63
0.68
0.40
0.54
0.60
0.48
0.87
0.57
0.56
0.48
0.47
0.51
0.47
0.73
0.79
0.48
0.16
0.24
0.13
0.08
0.45
0.28
0.52
0.92
0.20
0.89
1.10
0.49
0.73
0.72
0.52
0.49
0.25
0.24
0.30
0.32
0.98
1.10
1.16
1.37
0.96
1.13
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00170
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
14.40
20.24
NA
NA
10.08
NA
8.14
8.09
NA
NA
NA
NA
7.81
14.34
35.38
NA
NA
NA
36.21
42.69
8.75
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
81.99
NA
NA
NA
NA
NA
NA
NA
4.99
NA
NA
4.25
NA
NA
NA
NA
NA
NA
NA
5.51
6.19
5.70
NA
NA
NA
NA
NA
NA
NA
Facility
total
5.10
7.02
7.48
9.20
4.31
9.51
5.65
5.47
6.88
7.97
8.00
7.90
4.25
7.76
9.91
13.52
6.97
9.12
7.70
7.48
4.31
7.23
9.05
9.75
10.77
11.59
12.31
13.81
8.83
10.37
11.95
11.03
13.19
14.85
7.70
12.58
13.78
10.91
19.33
12.93
12.95
11.33
10.65
11.59
10.63
16.51
17.70
11.06
4.11
7.09
2.70
1.84
10.73
4.42
13.02
19.05
3.95
20.01
24.36
11.70
15.71
16.47
10.93
10.02
4.87
5.04
5.09
7.39
20.58
22.90
25.80
29.01
21.59
24.99
Global
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
010
090
000
000
090
010
090
090
000
090
090
090
090
090
090
090
010
010
010
010
090
090
090
090
090
090
45933
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
53430
53431
53440
53442
53444
53445
53446
53447
53448
53449
53450
53460
53500
53502
53505
53510
53515
53520
53600
53601
53605
53620
53621
53660
53661
53665
53850
53852
53853
53899
54000
54001
54015
54050
54055
54056
54057
54060
54065
54100
54105
54110
54111
54112
54115
54120
54125
54130
54135
54150
54152
54160
54161
54162
54163
54164
54200
54205
54220
54230
54231
54235
54240
54240
54240
54250
54250
54250
54300
54304
54308
54312
54316
54318
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Reconstruction of urethra ............................
Reconstruct urethra/bladder ........................
Male sling procedure ...................................
Remove/revise male sling ...........................
Insert tandem cuff .......................................
Insert uro/ves nck sphincter ........................
Remove uro sphincter .................................
Remove/replace ur sphincter ......................
Remov/replc ur sphinctr comp ....................
Repair uro sphincter ....................................
Revision of urethra ......................................
Revision of urethra ......................................
Urethrlys, transvag w/ scope .......................
Repair of urethra injury ...............................
Repair of urethra injury ...............................
Repair of urethra injury ...............................
Repair of urethra injury ...............................
Repair of urethra defect ..............................
Dilate urethra stricture .................................
Dilate urethra stricture .................................
Dilate urethra stricture .................................
Dilate urethra stricture .................................
Dilate urethra stricture .................................
Dilation of urethra ........................................
Dilation of urethra ........................................
Dilation of urethra ........................................
Prostatic microwave thermotx .....................
Prostatic rf thermotx ....................................
Prostatic water thermother ..........................
Urology surgery procedure ..........................
Slitting of prepuce .......................................
Slitting of prepuce .......................................
Drain penis lesion ........................................
Destruction, penis lesion(s) .........................
Destruction, penis lesion(s) .........................
Cryosurgery, penis lesion(s) .......................
Laser surg, penis lesion(s) ..........................
Excision of penis lesion(s) ..........................
Destruction, penis lesion(s) .........................
Biopsy of penis ............................................
Biopsy of penis ............................................
Treatment of penis lesion ............................
Treat penis lesion, graft ..............................
Treat penis lesion, graft ..............................
Treatment of penis lesion ............................
Partial removal of penis ..............................
Removal of penis ........................................
Remove penis & nodes ...............................
Remove penis & nodes ...............................
Circumcision ................................................
Circumcision ................................................
Circumcision ................................................
Circumcision ................................................
Lysis penil circumic lesion ...........................
Repair of circumcision .................................
Frenulotomy of penis ...................................
Treatment of penis lesion ............................
Treatment of penis lesion ............................
Treatment of penis lesion ............................
Prepare penis study ....................................
Dynamic cavernosometry ............................
Penile injection ............................................
Penis study ..................................................
Penis study ..................................................
Penis study ..................................................
Penis study ..................................................
Penis study ..................................................
Penis study ..................................................
Revision of penis .........................................
Revision of penis .........................................
Reconstruction of urethra ............................
Reconstruction of urethra ............................
Reconstruction of urethra ............................
Reconstruction of urethra ............................
16.35
19.90
13.63
11.57
13.41
14.07
10.23
13.50
21.16
9.71
6.14
7.12
12.21
7.64
7.64
10.11
13.32
8.69
1.21
0.98
1.28
1.62
1.35
0.71
0.72
0.76
9.46
9.89
5.24
0.00
1.54
2.19
5.32
1.24
1.22
1.24
1.24
1.93
2.42
1.90
3.50
10.13
13.58
15.87
6.15
9.98
13.54
20.15
26.37
1.81
2.31
2.48
3.28
3.01
3.01
2.51
1.06
7.94
2.42
1.34
2.04
1.19
1.31
1.31
0.00
2.22
2.22
0.00
10.41
12.49
11.83
13.58
16.82
11.25
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.21
1.34
NA
2.05
2.13
1.36
1.35
NA
88.85
84.87
53.22
0.00
2.98
3.29
NA
1.81
1.72
1.88
2.38
3.23
2.90
3.02
4.45
NA
NA
NA
4.90
NA
NA
NA
NA
4.16
NA
4.20
NA
4.74
NA
NA
1.90
NA
3.90
1.21
1.48
1.09
1.12
0.47
0.64
0.98
0.82
0.17
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
7.95
9.43
6.96
6.10
6.75
8.00
5.98
7.35
10.38
5.49
3.83
4.26
6.83
4.47
4.46
5.77
6.71
5.13
0.50
0.44
0.48
0.71
0.58
0.37
0.35
0.28
4.72
5.22
3.35
0.00
1.12
1.32
2.90
1.15
0.92
1.23
1.00
1.25
1.43
0.99
2.18
5.51
6.75
7.86
3.98
5.45
6.79
9.51
11.79
0.70
1.36
1.25
1.83
1.72
2.30
2.10
1.02
5.26
1.14
0.75
1.02
0.70
NA
0.47
NA
NA
0.82
NA
6.23
7.09
6.69
7.82
8.81
6.34
Malpractice
RVUs
1.15
1.41
0.96
0.82
0.94
0.99
0.72
0.95
1.50
0.68
0.43
0.50
0.90
0.62
0.54
0.74
1.05
0.61
0.09
0.07
0.09
0.11
0.10
0.05
0.05
0.06
0.67
0.70
0.37
0.00
0.11
0.15
0.38
0.08
0.08
0.06
0.09
0.13
0.13
0.10
0.25
0.72
0.96
1.11
0.43
0.68
0.95
1.52
1.87
0.16
0.19
0.19
0.23
0.21
0.21
0.18
0.08
0.56
0.17
0.09
0.16
0.08
0.17
0.11
0.06
0.02
0.16
0.02
0.76
0.88
0.84
1.24
1.21
1.39
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00171
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.51
2.39
NA
3.78
3.58
2.12
2.12
NA
98.98
95.46
58.83
0.00
4.63
5.63
NA
3.13
3.02
3.18
3.71
5.29
5.45
5.02
8.20
NA
NA
NA
11.48
NA
NA
NA
NA
6.13
NA
6.88
NA
7.96
NA
NA
3.04
NA
6.49
2.65
3.68
2.36
2.60
1.90
0.70
3.23
3.20
0.19
NA
NA
NA
NA
NA
NA
Facility
total
25.45
30.74
21.55
18.50
21.10
23.06
16.93
21.80
33.04
15.88
10.40
11.88
19.95
12.73
12.63
16.62
21.08
14.43
1.81
1.49
1.85
2.44
2.04
1.13
1.12
1.10
14.85
15.81
8.96
0.00
2.77
3.66
8.60
2.48
2.22
2.53
2.33
3.32
3.99
2.99
5.93
16.36
21.29
24.84
10.56
16.11
21.28
31.18
40.03
2.67
3.86
3.92
5.34
4.94
5.52
4.78
2.16
13.76
3.73
2.18
3.23
1.97
NA
1.90
NA
NA
3.20
NA
17.40
20.47
19.36
22.63
26.84
18.98
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
000
090
090
090
YYY
010
010
010
010
010
010
010
010
010
000
010
090
090
090
090
090
090
090
090
XXX
010
010
010
010
010
010
010
090
000
000
000
000
000
000
000
000
000
000
090
090
090
090
090
090
45934
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
54322
54324
54326
54328
54332
54336
54340
54344
54348
54352
54360
54380
54385
54390
54400
54401
54405
54406
54408
54410
54411
54415
54416
54417
54420
54430
54435
54440
54450
54500
54505
54512
54520
54522
54530
54535
54550
54560
54600
54620
54640
54650
54660
54670
54680
54690
54692
54699
54700
54800
54820
54830
54840
54860
54861
54900
54901
55000
55040
55041
55060
55100
55110
55120
55150
55175
55180
55200
55250
55300
55400
55450
55500
55520
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Reconstruction of urethra ............................
Reconstruction of urethra ............................
Reconstruction of urethra ............................
Revise penis/urethra ...................................
Revise penis/urethra ...................................
Revise penis/urethra ...................................
Secondary urethral surgery .........................
Secondary urethral surgery .........................
Secondary urethral surgery .........................
Reconstruct urethra/penis ...........................
Penis plastic surgery ...................................
Repair penis ................................................
Repair penis ................................................
Repair penis and bladder ............................
Insert semi-rigid prosthesis .........................
Insert self-contd prosthesis .........................
Insert multi-comp penis pros .......................
Remove muti-comp penis pros ...................
Repair multi-comp penis pros .....................
Remove/replace penis prosth .....................
Remov/replc penis pros, comp ...................
Remove self-contd penis pros ....................
Remv/repl penis contain pros .....................
Remv/replc penis pros, compl .....................
Revision of penis .........................................
Revision of penis .........................................
Revision of penis .........................................
Repair of penis ............................................
Preputial stretching ......................................
Biopsy of testis ............................................
Biopsy of testis ............................................
Excise lesion testis ......................................
Removal of testis .........................................
Orchiectomy, partial ....................................
Removal of testis .........................................
Extensive testis surgery ..............................
Exploration for testis ....................................
Exploration for testis ....................................
Reduce testis torsion ...................................
Suspension of testis ....................................
Suspension of testis ....................................
Orchiopexy (Fowler-Stephens) ....................
Revision of testis .........................................
Repair testis injury .......................................
Relocation of testis(es) ................................
Laparoscopy, orchiectomy ..........................
Laparoscopy, orchiopexy ............................
Laparoscope proc, testis .............................
Drainage of scrotum ....................................
Biopsy of epididymis ...................................
Exploration of epididymis ............................
Remove epididymis lesion ..........................
Remove epididymis lesion ..........................
Removal of epididymis ................................
Removal of epididymis ................................
Fusion of spermatic ducts ...........................
Fusion of spermatic ducts ...........................
Drainage of hydrocele .................................
Removal of hydrocele .................................
Removal of hydroceles ................................
Repair of hydrocele .....................................
Drainage of scrotum abscess .....................
Explore scrotum ..........................................
Removal of scrotum lesion ..........................
Removal of scrotum ....................................
Revision of scrotum .....................................
Revision of scrotum .....................................
Incision of sperm duct .................................
Removal of sperm duct(s) ...........................
Prepare, sperm duct x-ray ..........................
Repair of sperm duct ...................................
Ligation of sperm duct .................................
Removal of hydrocele .................................
Removal of sperm cord lesion ....................
13.02
16.32
15.73
15.66
17.08
20.05
8.92
15.95
17.15
24.75
11.93
13.19
15.40
21.62
9.00
10.28
13.44
12.10
12.76
15.51
16.01
8.21
10.87
14.20
11.42
10.15
6.12
0.00
1.12
1.31
3.46
8.59
5.23
9.51
8.59
12.16
7.79
11.13
7.01
4.90
6.90
11.45
5.11
6.41
12.66
10.96
12.89
0.00
3.43
2.33
5.14
5.38
5.20
6.32
8.91
13.21
17.95
1.43
5.36
7.75
5.52
2.13
5.70
5.09
7.22
5.24
10.72
4.24
3.30
3.51
8.50
4.12
5.59
6.03
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.99
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.08
NA
NA
NA
3.74
NA
NA
NA
NA
NA
12.12
11.22
NA
NA
7.06
NA
NA
Facility
PE
RVUs
7.28
8.87
8.66
8.24
8.69
11.00
5.40
8.70
9.18
12.36
6.83
7.19
9.36
10.88
5.00
6.69
6.85
6.33
6.73
7.78
8.24
4.88
6.30
7.28
6.21
5.85
4.09
0.00
0.50
0.65
2.15
4.70
3.16
5.36
4.87
6.19
4.31
5.74
4.05
2.78
4.20
6.03
3.39
3.95
6.67
5.61
6.14
0.00
2.13
1.03
3.32
3.45
3.19
3.85
5.03
6.74
8.13
0.74
3.26
4.52
3.45
1.72
3.58
3.35
4.36
3.45
6.05
2.67
2.51
1.53
4.68
2.20
3.35
3.31
Malpractice
RVUs
0.92
1.14
1.11
0.98
1.21
2.20
0.63
1.54
1.23
2.24
0.84
0.93
0.86
1.54
0.64
0.73
0.95
0.86
0.90
1.10
1.13
0.58
0.77
1.00
0.81
0.72
0.43
0.00
0.08
0.10
0.27
0.67
0.50
0.89
0.66
0.95
0.59
0.90
0.51
0.37
0.62
1.16
0.44
0.47
1.16
1.02
1.30
0.00
0.28
0.23
0.40
0.41
0.37
0.45
0.63
0.93
1.82
0.11
0.43
0.60
0.46
0.17
0.43
0.39
0.56
0.37
0.90
0.33
0.25
0.25
0.64
0.29
0.55
0.75
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00172
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
2.20
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.63
NA
NA
NA
6.04
NA
NA
NA
NA
NA
16.69
14.77
NA
NA
11.47
NA
NA
Facility
total
21.22
26.34
25.51
24.88
26.98
33.25
14.95
26.19
27.57
39.35
19.60
21.31
25.62
34.04
14.64
17.70
21.24
19.30
20.39
24.39
25.38
13.66
17.94
22.48
18.45
16.72
10.64
0.00
1.70
2.06
5.88
13.96
8.89
15.76
14.11
19.30
12.68
17.77
11.57
8.05
11.72
18.64
8.94
10.83
20.48
17.59
20.33
0.00
5.84
3.60
8.86
9.25
8.76
10.62
14.57
20.87
27.89
2.28
9.05
12.86
9.43
4.02
9.71
8.83
12.15
9.06
17.67
7.23
6.05
5.28
13.81
6.61
9.49
10.09
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
010
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
YYY
010
000
090
090
090
090
090
090
090
000
090
090
090
010
090
090
090
090
090
090
090
000
090
010
090
090
45935
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
55530
55535
55540
55550
55559
55600
55605
55650
55680
55700
55705
55720
55725
55801
55810
55812
55815
55821
55831
55840
55842
55845
55859
55860
55862
55865
55866
55870
55873
55899
55970
55980
56405
56420
56440
56441
56501
56515
56605
56606
56620
56625
56630
56631
56632
56633
56634
56637
56640
56700
56720
56740
56800
56805
56810
56820
56821
57000
57010
57020
57022
57023
57061
57065
57100
57105
57106
57107
57109
57110
57111
57112
57120
57130
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
N
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Revise spermatic cord veins .......................
Revise spermatic cord veins .......................
Revise hernia & sperm veins ......................
Laparo ligate spermatic vein .......................
Laparo proc, spermatic cord .......................
Incise sperm duct pouch .............................
Incise sperm duct pouch .............................
Remove sperm duct pouch .........................
Remove sperm pouch lesion ......................
Biopsy of prostate .......................................
Biopsy of prostate .......................................
Drainage of prostate abscess .....................
Drainage of prostate abscess .....................
Removal of prostate ....................................
Extensive prostate surgery ..........................
Extensive prostate surgery ..........................
Extensive prostate surgery ..........................
Removal of prostate ....................................
Removal of prostate ....................................
Extensive prostate surgery ..........................
Extensive prostate surgery ..........................
Extensive prostate surgery ..........................
Percut/needle insert, pros ...........................
Surgical exposure, prostate ........................
Extensive prostate surgery ..........................
Extensive prostate surgery ..........................
Laparo radical prostatectomy ......................
Electroejaculation ........................................
Cryoablate prostate .....................................
Genital surgery procedure ...........................
Sex transformation, M to F .........................
Sex transformation, F to M .........................
I & D of vulva/perineum ..............................
Drainage of gland abscess .........................
Surgery for vulva lesion ..............................
Lysis of labial lesion(s) ................................
Destroy, vulva lesions, sim .........................
Destroy vulva lesion/s compl ......................
Biopsy of vulva/perineum ............................
Biopsy of vulva/perineum ............................
Partial removal of vulva ...............................
Complete removal of vulva .........................
Extensive vulva surgery ..............................
Extensive vulva surgery ..............................
Extensive vulva surgery ..............................
Extensive vulva surgery ..............................
Extensive vulva surgery ..............................
Extensive vulva surgery ..............................
Extensive vulva surgery ..............................
Partial removal of hymen ............................
Incision of hymen ........................................
Remove vagina gland lesion .......................
Repair of vagina ..........................................
Repair clitoris ...............................................
Repair of perineum ......................................
Exam of vulva w/scope ...............................
Exam/biopsy of vulva w/scope ....................
Exploration of vagina ...................................
Drainage of pelvic abscess .........................
Drainage of pelvic fluid ................................
I & d vaginal hematoma, pp ........................
I & d vag hematoma, non-ob ......................
Destroy vag lesions, simple ........................
Destroy vag lesions, complex .....................
Biopsy of vagina ..........................................
Biopsy of vagina ..........................................
Remove vagina wall, partial ........................
Remove vagina tissue, part ........................
Vaginectomy partial w/nodes ......................
Remove vagina wall, complete ...................
Remove vagina tissue, compl .....................
Vaginectomy w/nodes, compl .....................
Closure of vagina ........................................
Remove vagina lesion .................................
5.66
6.56
7.68
6.57
0.00
6.38
7.97
11.80
5.19
1.57
4.57
7.65
8.69
17.81
22.60
27.52
30.47
14.26
15.63
22.71
24.39
28.57
12.53
14.46
18.40
22.89
30.75
2.59
19.48
0.00
0.00
0.00
1.44
1.39
2.85
1.97
1.53
2.77
1.10
0.55
7.47
8.41
12.36
16.21
20.30
16.48
17.89
21.98
22.18
2.53
0.68
4.57
3.89
18.87
4.13
1.50
2.05
2.98
6.03
1.50
2.57
4.75
1.25
2.62
1.20
1.69
6.36
23.02
27.01
14.30
27.01
29.02
7.41
2.43
Nonfacility
PE
RVUs
NA
NA
NA
NA
0.00
NA
NA
NA
NA
4.22
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.83
NA
0.00
0.00
0.00
1.31
2.14
NA
1.82
1.76
2.55
1.05
0.47
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.30
1.72
NA
NA
0.92
NA
NA
1.63
2.26
1.06
1.76
NA
NA
NA
NA
NA
NA
NA
2.13
Facility
PE
RVUs
3.41
3.89
3.86
3.59
0.00
3.89
4.86
6.12
3.39
0.76
2.60
4.35
5.02
8.72
10.31
12.47
13.65
7.15
7.67
10.68
11.28
12.67
6.72
7.23
8.62
10.64
13.70
1.25
10.16
0.00
0.00
0.00
1.14
0.98
1.70
1.48
1.24
1.79
0.45
0.22
4.72
5.22
6.69
8.62
9.30
8.40
9.22
10.81
10.38
1.84
0.51
2.53
2.21
9.45
2.27
0.66
0.89
1.78
3.81
0.58
1.49
2.57
1.13
1.66
0.48
1.42
4.16
10.42
12.16
7.17
12.41
12.99
4.55
1.55
Malpractice
RVUs
0.45
0.47
0.94
0.57
0.00
0.62
0.64
0.92
0.47
0.11
0.32
0.95
0.70
1.34
1.60
2.04
2.16
1.01
1.10
1.61
1.72
2.02
0.89
1.02
1.49
1.63
2.16
0.16
1.38
0.00
0.00
0.00
0.17
0.16
0.34
0.20
0.18
0.33
0.13
0.07
0.90
1.02
1.49
1.95
2.38
1.97
2.16
2.60
2.88
0.30
0.08
0.56
0.44
2.14
0.49
0.18
0.25
0.31
0.71
0.18
0.26
0.58
0.15
0.31
0.14
0.20
0.73
2.71
3.21
1.73
3.17
3.07
0.89
0.29
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00173
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
0.00
NA
NA
NA
NA
5.90
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.57
NA
0.00
0.00
0.00
2.92
3.69
NA
4.00
3.48
5.64
2.28
1.09
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.98
4.03
NA
NA
2.60
NA
NA
3.03
5.19
2.40
3.65
NA
NA
NA
NA
NA
NA
NA
4.86
Facility
total
9.52
10.92
12.47
10.74
0.00
10.89
13.46
18.84
9.05
2.45
7.49
12.94
14.40
27.86
34.51
42.03
46.28
22.42
24.40
35.00
37.39
43.25
20.13
22.71
28.51
35.16
46.62
3.99
31.02
0.00
0.00
0.00
2.75
2.53
4.88
3.65
2.95
4.89
1.68
0.84
13.09
14.64
20.55
26.78
31.98
26.86
29.26
35.39
35.44
4.67
1.27
7.66
6.54
30.46
6.89
2.34
3.20
5.06
10.55
2.26
4.32
7.90
2.53
4.58
1.82
3.31
11.25
36.14
42.39
23.20
42.60
45.08
12.85
4.27
Global
090
090
090
090
YYY
090
090
090
090
000
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
090
YYY
XXX
XXX
010
010
010
010
010
010
000
ZZZ
090
090
090
090
090
090
090
090
090
010
000
010
010
090
010
000
000
010
090
000
010
010
010
010
000
010
090
090
090
090
090
090
090
010
45936
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
57135
57150
57155
57160
57170
57180
57200
57210
57220
57230
57240
57250
57260
57265
57267
57268
57270
57280
57282
57283
57284
57287
57288
57289
57291
57292
57300
57305
57307
57308
57310
57311
57320
57330
57335
57400
57410
57415
57420
57421
57425
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57520
57522
57530
57531
57540
57545
57550
57555
57556
57700
57720
57800
57820
58100
58120
58140
58145
58146
58150
58152
58180
58200
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Remove vagina lesion .................................
Treat vagina infection ..................................
Insert uteri tandems/ovoids .........................
Insert pessary/other device .........................
Fitting of diaphragm/cap ..............................
Treat vaginal bleeding .................................
Repair of vagina ..........................................
Repair vagina/perineum ..............................
Revision of urethra ......................................
Repair of urethral lesion ..............................
Repair bladder & vagina .............................
Repair rectum & vagina ..............................
Repair of vagina ..........................................
Extensive repair of vagina ...........................
Insert mesh/pelvic flr addon ........................
Repair of bowel bulge .................................
Repair of bowel pouch ................................
Suspension of vagina ..................................
Colpopexy, extraperitoneal ..........................
Colpopexy, intraperitoneal ...........................
Repair paravaginal defect ...........................
Revise/remove sling repair ..........................
Repair bladder defect ..................................
Repair bladder & vagina .............................
Construction of vagina ................................
Construct vagina with graft .........................
Repair rectum-vagina fistula .......................
Repair rectum-vagina fistula .......................
Fistula repair & colostomy ...........................
Fistula repair, transperine ...........................
Repair urethrovaginal lesion .......................
Repair urethrovaginal lesion .......................
Repair bladder-vagina lesion ......................
Repair bladder-vagina lesion ......................
Repair vagina ..............................................
Dilation of vagina .........................................
Pelvic examination ......................................
Remove vaginal foreign body .....................
Exam of vagina w/scope .............................
Exam/biopsy of vag w/scope ......................
Laparoscopy, surg, colpopexy ....................
Exam of cervix w/scope ..............................
Bx/curett of cervix w/scope .........................
Biopsy of cervix w/scope .............................
Endocerv curettage w/scope .......................
Bx of cervix w/scope, leep ..........................
Conz of cervix w/scope, leep ......................
Biopsy of cervix ...........................................
Endocervical curettage ................................
Cauterization of cervix .................................
Cryocautery of cervix ..................................
Laser surgery of cervix ................................
Conization of cervix .....................................
Conization of cervix .....................................
Removal of cervix ........................................
Removal of cervix, radical ...........................
Removal of residual cervix ..........................
Remove cervix/repair pelvis ........................
Removal of residual cervix ..........................
Remove cervix/repair vagina .......................
Remove cervix, repair bowel .......................
Revision of cervix ........................................
Revision of cervix ........................................
Dilation of cervical canal .............................
D & c of residual cervix ...............................
Biopsy of uterus lining .................................
Dilation and curettage .................................
Myomectomy abdom method ......................
Myomectomy vag method ...........................
Myomectomy abdom complex ....................
Total hysterectomy ......................................
Total hysterectomy ......................................
Partial hysterectomy ....................................
Extensive hysterectomy ..............................
2.68
0.55
.27
0.89
0.91
1.58
3.94
5.17
4.31
5.64
6.07
5.53
8.28
11.34
4.89
6.76
12.11
15.05
6.87
10.86
12.71
10.71
13.03
11.58
7.96
13.10
7.62
13.78
15.94
9.95
6.78
7.99
8.02
12.35
18.74
2.27
1.75
2.17
1.60
2.20
15.76
1.50
2.33
1.99
1.85
2.84
3.44
0.97
1.14
1.90
1.90
1.90
4.04
3.36
4.79
28.02
12.22
13.04
5.53
8.96
8.38
3.55
4.13
0.77
1.67
1.53
3.28
14.61
8.05
19.01
15.25
20.61
15.30
21.60
Nonfacility
PE
RVUs
2.23
1.01
NA
1.01
1.33
2.08
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.34
1.81
NA
1.27
1.61
1.69
1.63
5.57
5.84
2.43
1.44
1.53
1.79
1.70
3.85
3.09
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.75
1.46
1.30
2.27
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
1.66
0.21
4.44
0.34
0.32
1.21
2.90
3.41
3.10
3.54
3.93
3.55
4.79
5.98
1.93
4.19
6.22
7.37
4.49
5.90
7.20
6.02
6.58
6.31
4.96
6.94
4.27
6.22
6.93
5.08
4.24
4.58
4.75
6.33
9.27
1.12
0.92
1.46
0.69
0.94
6.86
0.80
1.13
0.85
0.81
1.36
1.44
0.63
1.09
1.03
1.36
1.39
2.83
2.42
3.34
13.03
6.16
6.60
3.79
5.03
4.85
3.14
3.09
0.47
1.13
0.71
1.85
6.99
4.74
8.83
7.36
9.68
7.32
9.79
Malpractice
RVUs
0.31
0.07
0.43
0.10
0.11
0.19
0.46
0.62
0.51
0.54
0.62
0.65
0.97
1.32
0.64
0.79
1.42
1.67
1.02
1.02
1.41
0.90
1.12
1.21
0.93
1.58
0.87
1.72
2.01
1.14
0.54
0.65
0.69
1.06
1.91
0.26
0.18
0.24
0.19
0.27
1.75
0.18
0.28
0.24
0.22
0.34
0.41
0.12
0.14
0.23
0.23
0.23
0.49
0.41
0.58
3.34
1.49
1.52
0.67
1.09
0.92
0.41
0.49
0.09
0.20
0.18
0.39
1.81
0.97
2.32
1.84
2.47
1.64
2.54
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00174
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
5.21
1.64
NA
2.01
2.35
3.85
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.13
4.28
NA
2.95
4.23
3.93
3.70
8.75
9.69
3.52
2.72
3.66
3.92
3.83
8.38
6.85
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.62
3.33
3.01
5.94
NA
NA
NA
NA
NA
NA
NA
Facility
total
4.64
0.83
11.15
1.33
1.34
2.99
7.30
9.20
7.92
9.72
10.62
9.74
14.04
18.64
7.46
11.74
19.75
24.09
12.38
17.78
21.32
17.63
20.73
19.10
13.85
21.61
12.76
21.72
24.88
16.17
11.56
13.22
13.46
19.74
29.92
3.65
2.86
3.88
2.48
3.42
24.37
2.49
3.75
3.09
2.88
4.53
5.29
1.72
2.38
3.17
3.49
3.52
7.36
6.19
8.71
44.39
19.88
21.15
9.99
15.08
14.15
7.10
7.71
1.33
3.00
2.42
5.51
23.41
13.75
30.16
24.45
32.76
24.27
33.93
Global
010
000
090
000
000
010
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
010
000
000
090
000
000
000
000
000
000
000
010
010
010
010
090
090
090
090
090
090
090
090
090
090
090
000
010
000
010
090
090
090
090
090
090
090
45937
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
58210
58240
58260
58262
58263
58267
58270
58275
58280
58285
58290
58291
58292
58293
58294
58300
58301
58321
58322
58323
58340
58345
58346
58350
58353
58356
58400
58410
58520
58540
58545
58546
58550
58552
58553
58554
58555
58558
58559
58560
58561
58562
58563
58565
58578
58579
58600
58605
58611
58615
58660
58661
58662
58670
58671
58672
58673
58679
58700
58720
58740
58750
58752
58760
58770
58800
58805
58820
58822
58823
58825
58900
58920
58925
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Extensive hysterectomy ..............................
Removal of pelvis contents .........................
Vaginal hysterectomy ..................................
Vag hyst including t/o ..................................
Vag hyst w/t/o & vag repair .........................
Vag hyst w/urinary repair ............................
Vag hyst w/enterocele repair ......................
Hysterectomy/revise vagina ........................
Hysterectomy/revise vagina ........................
Extensive hysterectomy ..............................
Vag hyst complex ........................................
Vag hyst incl t/o, complex ...........................
Vag hyst t/o & repair, compl .......................
Vag hyst w/uro repair, compl ......................
Vag hyst w/enterocele, compl .....................
Insert intrauterine device .............................
Remove intrauterine device ........................
Artificial insemination ...................................
Artificial insemination ...................................
Sperm washing ............................................
Catheter for hysterography .........................
Reopen fallopian tube .................................
Insert heyman uteri capsule ........................
Reopen fallopian tube .................................
Endometr ablate, thermal ............................
Endometrial cryoablation .............................
Suspension of uterus ..................................
Suspension of uterus ..................................
Repair of ruptured uterus ............................
Revision of uterus .......................................
Laparoscopic myomectomy .........................
Laparo-myomectomy, complex ...................
Laparo-asst vag hysterectomy ....................
Laparo-vag hyst incl t/o ...............................
Laparo-vag hyst, complex ...........................
Laparo-vag hyst w/t/o, compl ......................
Hysteroscopy, dx, sep proc .........................
Hysteroscopy, biopsy ..................................
Hysteroscopy, lysis ......................................
Hysteroscopy, resect septum ......................
Hysteroscopy, remove myoma ....................
Hysteroscopy, remove fb ............................
Hysteroscopy, ablation ................................
Hysteroscopy, sterilization ...........................
Laparo proc, uterus .....................................
Hysteroscope procedure .............................
Division of fallopian tube .............................
Division of fallopian tube .............................
Ligate oviduct(s) add-on ..............................
Occlude fallopian tube(s) ............................
Laparoscopy, lysis .......................................
Laparoscopy, remove adnexa .....................
Laparoscopy, excise lesions .......................
Laparoscopy, tubal cautery .........................
Laparoscopy, tubal block ............................
Laparoscopy, fimbrioplasty ..........................
Laparoscopy, salpingostomy .......................
Laparo proc, oviduct-ovary ..........................
Removal of fallopian tube ...........................
Removal of ovary/tube(s) ............................
Revise fallopian tube(s) ...............................
Repair oviduct .............................................
Revise ovarian tube(s) ................................
Remove tubal obstruction ...........................
Create new tubal opening ...........................
Drainage of ovarian cyst(s) .........................
Drainage of ovarian cyst(s) .........................
Drain ovary abscess, open .........................
Drain ovary abscess, percut .......................
Drain pelvic abscess, percut .......................
Transposition, ovary(s) ................................
Biopsy of ovary(s) .......................................
Partial removal of ovary(s) ..........................
Removal of ovarian cyst(s) .........................
28.87
38.41
12.99
14.78
16.07
17.04
14.27
15.77
17.01
22.27
19.01
20.80
22.09
23.08
20.29
1.01
1.27
0.92
1.10
0.23
0.88
4.66
6.75
1.01
3.56
6.37
6.36
12.74
11.92
14.65
14.61
19.01
14.20
16.01
19.01
22.01
3.34
4.75
6.17
7.00
10.01
5.21
6.17
7.03
0.00
0.00
5.60
5.00
1.45
3.90
11.29
11.05
11.79
5.60
5.60
12.89
13.75
0.00
12.05
11.36
14.01
14.85
14.85
13.14
13.98
4.14
5.88
4.22
10.13
3.38
10.98
5.99
11.36
11.36
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.33
1.28
1.12
1.18
0.47
3.02
NA
NA
1.50
33.29
6.85
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.16
NA
NA
NA
NA
NA
52.70
46.78
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
3.56
NA
NA
NA
21.63
NA
NA
NA
NA
Facility
PE
RVUs
12.91
17.43
6.61
7.28
7.77
8.25
6.96
7.66
8.15
9.74
8.96
9.69
10.16
10.44
9.37
0.38
0.47
0.36
0.41
0.09
0.68
2.48
3.93
0.92
2.02
2.59
3.91
6.33
5.92
6.85
7.06
8.75
7.18
7.88
8.78
10.24
1.52
2.13
2.68
3.02
4.19
2.30
2.70
3.88
0.00
0.00
3.29
3.06
0.56
2.62
5.17
5.02
5.68
3.23
3.23
6.06
6.45
0.00
5.91
5.69
7.03
7.22
6.79
6.62
6.78
2.93
3.49
3.35
5.19
1.16
5.69
3.57
5.49
5.62
Malpractice
RVUs
3.37
4.22
1.57
1.79
1.94
2.06
1.73
1.91
2.06
2.70
2.29
2.52
2.67
2.78
2.39
0.12
0.15
0.10
0.13
0.03
0.09
0.41
0.56
0.12
0.43
0.82
0.75
1.45
1.47
1.78
1.77
2.30
1.72
1.72
2.30
2.27
0.40
0.57
0.74
0.84
1.21
0.63
0.74
1.19
0.00
0.00
0.66
0.59
0.18
0.47
1.40
1.34
1.43
0.67
0.68
1.60
1.69
0.00
1.51
1.39
1.71
1.84
1.80
1.79
1.73
0.43
0.69
0.52
1.16
0.24
1.32
0.69
1.43
1.41
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00175
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.46
2.70
2.14
2.41
0.73
3.99
NA
NA
2.64
37.28
14.05
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.90
NA
NA
NA
NA
NA
59.62
55.01
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
8.13
NA
NA
NA
25.24
NA
NA
NA
NA
Facility
total
45.14
60.06
21.16
23.85
25.78
27.35
22.96
25.34
27.23
34.72
30.26
33.01
34.93
36.29
32.05
1.51
1.89
1.38
1.64
0.35
1.65
7.55
11.24
2.05
6.01
9.78
11.03
20.51
19.31
23.28
23.44
30.06
23.10
25.62
30.09
34.52
5.26
7.45
9.60
10.86
15.41
8.14
9.61
12.11
0.00
0.00
9.55
8.65
2.19
6.98
17.87
17.41
18.90
9.50
9.51
20.55
21.88
0.00
19.48
18.44
22.74
23.91
23.44
21.54
22.49
7.50
10.06
8.09
16.48
4.77
17.99
10.25
18.28
18.39
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
XXX
000
000
000
000
000
010
090
010
010
010
090
090
090
090
090
090
090
090
090
090
000
000
000
000
000
000
000
090
YYY
YYY
090
090
ZZZ
010
090
010
090
090
090
090
090
YYY
090
090
090
090
090
090
090
090
090
090
090
000
090
090
090
090
45938
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
58940
58943
58950
58951
58952
58953
58954
58956
58960
58970
58974
58976
58999
59000
59001
59012
59015
59020
59020
59020
59025
59025
59025
59030
59050
59051
59070
59072
59074
59076
59100
59120
59121
59130
59135
59136
59140
59150
59151
59160
59200
59300
59320
59325
59350
59400
59409
59410
59412
59414
59425
59426
59430
59510
59514
59515
59525
59610
59612
59614
59618
59620
59622
59812
59820
59821
59830
59840
59841
59850
59851
59852
59855
59856
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
R
R
R
R
Physician
work
RVUs 3
Description
Removal of ovary(s) ....................................
Removal of ovary(s) ....................................
Resect ovarian malignancy .........................
Resect ovarian malignancy .........................
Resect ovarian malignancy .........................
Tah, rad dissect for debulk .........................
Tah rad debulk/lymph remove ....................
Bso, omentectomy w/tah .............................
Exploration of abdomen ..............................
Retrieval of oocyte ......................................
Transfer of embryo ......................................
Transfer of embryo ......................................
Genital surgery procedure ...........................
Amniocentesis, diagnostic ...........................
Amniocentesis, therapeutic .........................
Fetal cord puncture,prenatal .......................
Chorion biopsy ............................................
Fetal contract stress test .............................
Fetal contract stress test .............................
Fetal contract stress test .............................
Fetal non-stress test ....................................
Fetal non-stress test ....................................
Fetal non-stress test ....................................
Fetal scalp blood sample ............................
Fetal monitor w/report .................................
Fetal monitor/interpret only .........................
Transabdom amnioinfus w/us .....................
Umbilical cord occlud w/us ..........................
Fetal fluid drainage w/us .............................
Fetal shunt placement, w/us .......................
Remove uterus lesion .................................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
Treat ectopic pregnancy ..............................
D & c after delivery .....................................
Insert cervical dilator ...................................
Episiotomy or vaginal repair ........................
Revision of cervix ........................................
Revision of cervix ........................................
Repair of uterus ...........................................
Obstetrical care ...........................................
Obstetrical care ...........................................
Obstetrical care ...........................................
Antepartum manipulation ............................
Deliver placenta ...........................................
Antepartum care only ..................................
Antepartum care only ..................................
Care after delivery .......................................
Cesarean delivery .......................................
Cesarean delivery only ................................
Cesarean delivery .......................................
Remove uterus after cesarean ....................
Vbac delivery ...............................................
Vbac delivery only .......................................
Vbac care after delivery ..............................
Attempted vbac delivery ..............................
Attempted vbac delivery only ......................
Attempted vbac after care ...........................
Treatment of miscarriage ............................
Care of miscarriage .....................................
Treatment of miscarriage ............................
Treat uterus infection ..................................
Abortion .......................................................
Abortion .......................................................
Abortion .......................................................
Abortion .......................................................
Abortion .......................................................
Abortion .......................................................
Abortion .......................................................
7.29
18.44
16.93
22.39
25.02
32.01
35.02
20.82
14.66
3.53
0.00
3.83
0.00
1.30
3.01
3.45
2.20
0.66
0.66
0.00
0.53
0.53
0.00
1.99
0.89
0.74
5.25
9.01
5.25
9.01
12.35
11.49
11.67
14.23
13.89
13.19
5.46
11.67
11.49
2.72
0.79
2.41
2.48
4.07
4.95
23.08
13.51
14.79
1.71
1.61
4.81
8.29
2.13
26.23
15.98
17.37
8.55
24.63
15.07
16.35
27.80
17.54
18.94
4.01
4.01
4.47
6.11
3.02
5.24
5.91
5.93
8.25
6.12
7.48
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.27
0.00
2.63
0.00
2.01
NA
NA
1.54
0.83
0.26
0.58
0.48
0.21
0.27
NA
NA
NA
5.16
NA
4.51
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.09
1.15
2.34
NA
NA
NA
NA
NA
NA
NA
NA
4.16
7.48
1.21
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.34
4.20
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
4.08
8.48
8.24
10.22
11.50
14.24
15.44
10.08
7.21
1.46
0.00
1.79
0.00
0.66
1.39
1.51
1.02
NA
0.26
NA
NA
0.21
NA
0.75
0.34
0.28
2.29
3.56
2.29
3.56
6.36
6.14
6.21
4.59
7.09
6.48
2.49
5.90
5.95
1.99
0.30
1.02
1.22
1.86
1.84
15.13
5.17
6.16
0.80
0.62
1.80
3.14
0.91
17.03
6.06
7.67
3.22
15.63
5.90
6.77
17.88
6.59
8.59
2.50
3.53
3.36
3.91
2.09
2.93
3.22
3.70
4.94
3.48
4.00
Malpractice
RVUs
0.91
2.22
2.04
2.63
3.02
3.83
4.17
4.00
1.79
0.43
0.00
0.47
0.00
0.31
0.71
0.82
0.52
0.26
0.16
0.10
0.15
0.13
0.02
0.47
0.21
0.17
0.28
0.16
0.28
0.16
2.94
2.72
2.78
3.38
3.30
3.13
1.29
2.78
2.73
0.64
0.19
0.57
0.59
0.88
1.17
5.48
3.21
3.51
0.40
0.38
1.14
1.97
0.50
6.23
3.79
4.12
1.94
5.85
3.58
3.88
6.59
4.16
4.49
0.95
0.95
1.06
1.44
0.71
1.24
1.28
1.28
1.80
1.45
1.78
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00176
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.23
0.00
6.93
0.00
3.63
NA
NA
4.26
1.76
1.08
0.68
1.16
0.87
0.29
NA
NA
NA
10.69
NA
10.04
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.44
2.13
5.33
NA
NA
NA
NA
NA
NA
NA
NA
10.11
17.74
3.84
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.30
9.72
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
12.29
29.13
27.22
35.24
39.54
50.08
54.63
34.90
23.66
5.42
0.00
6.09
0.00
2.27
5.10
5.77
3.75
NA
1.08
NA
NA
0.87
NA
3.22
1.44
1.19
7.82
12.73
7.82
12.73
21.65
20.35
20.67
22.20
24.28
22.80
9.24
20.35
20.17
5.35
1.28
4.01
4.30
6.80
7.96
43.68
21.89
24.46
2.91
2.62
7.75
13.40
3.55
49.50
25.83
29.16
13.71
46.11
24.55
27.00
52.26
28.28
32.02
7.46
8.49
8.89
11.46
5.81
9.41
10.41
10.91
14.99
11.05
13.26
Global
090
090
090
090
090
090
090
090
090
000
000
000
YYY
000
000
000
000
000
000
000
000
000
000
000
XXX
XXX
000
000
000
000
090
090
090
090
090
090
090
090
090
010
000
000
000
000
000
MMM
MMM
MMM
MMM
MMM
MMM
MMM
MMM
MMM
MMM
MMM
ZZZ
MMM
MMM
MMM
MMM
MMM
MMM
090
090
090
090
010
010
090
090
090
090
090
45939
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
59857
59866
59870
59871
59897
59898
59899
60000
60001
60100
60200
60210
60212
60220
60225
60240
60252
60254
60260
60270
60271
60280
60281
60500
60502
60505
60512
60520
60521
60522
60540
60545
60600
60605
60650
60659
60699
61000
61001
61020
61026
61050
61055
61070
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61215
61250
61253
61304
61305
61312
61313
61314
61315
61316
61320
61321
61322
61323
61330
61332
61333
61334
61340
61343
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
R
R
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Abortion .......................................................
Abortion (mpr) .............................................
Evacuate mole of uterus .............................
Remove cerclage suture .............................
Fetal invas px w/us .....................................
Laparo proc, ob care/deliver .......................
Maternity care procedure ............................
Drain thyroid/tongue cyst ............................
Aspirate/inject thyriod cyst ..........................
Biopsy of thyroid ..........................................
Remove thyroid lesion .................................
Partial thyroid excision ................................
Partial thyroid excision ................................
Partial removal of thyroid ............................
Partial removal of thyroid ............................
Removal of thyroid ......................................
Removal of thyroid ......................................
Extensive thyroid surgery ............................
Repeat thyroid surgery ................................
Removal of thyroid ......................................
Removal of thyroid ......................................
Remove thyroid duct lesion .........................
Remove thyroid duct lesion .........................
Explore parathyroid glands .........................
Re-explore parathyroids ..............................
Explore parathyroid glands .........................
Autotransplant parathyroid ..........................
Removal of thymus gland ...........................
Removal of thymus gland ...........................
Removal of thymus gland ...........................
Explore adrenal gland .................................
Explore adrenal gland .................................
Remove carotid body lesion ........................
Remove carotid body lesion ........................
Laparoscopy adrenalectomy .......................
Laparo proc, endocrine ...............................
Endocrine surgery procedure ......................
Remove cranial cavity fluid .........................
Remove cranial cavity fluid .........................
Remove brain cavity fluid ............................
Injection into brain canal .............................
Remove brain canal fluid ............................
Injection into brain canal .............................
Brain canal shunt procedure .......................
Twist drill hole .............................................
Drill skull for implantation ............................
Drill skull for drainage .................................
Burr hole for puncture .................................
Pierce skull for biopsy .................................
Pierce skull for drainage .............................
Pierce skull for drainage .............................
Pierce skull & remove clot ..........................
Pierce skull for drainage .............................
Pierce skull, implant device .........................
Insert brain-fluid device ...............................
Pierce skull & explore .................................
Pierce skull & explore .................................
Open skull for exploration ...........................
Open skull for exploration ...........................
Open skull for drainage ...............................
Open skull for drainage ...............................
Open skull for drainage ...............................
Open skull for drainage ...............................
Implt cran bone flap to abdo .......................
Open skull for drainage ...............................
Open skull for drainage ...............................
Decompressive craniotomy .........................
Decompressive lobectomy ..........................
Decompress eye socket ..............................
Explore/biopsy eye socket ..........................
Explore orbit/remove lesion .........................
Explore orbit/remove object ........................
Subtemporal decompression .......................
Incise skull (press relief) .............................
9.30
4.00
6.01
2.13
0.00
0.00
0.00
1.76
0.97
1.56
9.56
10.88
16.04
11.90
14.20
16.07
20.58
27.00
17.47
20.28
16.83
5.87
8.54
16.24
20.36
21.50
4.45
16.81
18.88
23.11
17.03
19.89
17.94
20.25
20.01
0.00
0.00
1.58
1.49
1.51
1.69
1.51
2.10
0.89
5.14
5.00
10.19
8.77
15.91
17.58
12.42
15.00
16.33
5.84
4.89
10.42
12.36
21.97
26.62
24.58
24.94
24.24
27.70
1.39
25.63
28.52
29.52
31.01
23.34
27.29
27.97
18.28
18.67
29.79
Nonfacility
PE
RVUs
NA
NA
NA
NA
0.00
0.00
0.00
1.94
1.57
1.38
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
4.63
1.86
4.43
1.11
0.00
0.00
0.00
1.73
0.33
0.55
5.87
5.53
7.54
6.03
7.28
7.41
9.87
13.74
8.44
10.12
8.36
4.59
5.72
7.28
9.19
10.63
1.58
8.03
9.28
11.00
7.94
8.85
10.62
11.93
8.14
0.00
0.00
0.98
1.03
1.33
1.38
1.31
1.48
1.02
3.87
2.46
7.02
5.88
9.69
10.16
7.65
9.30
9.63
2.84
3.95
6.72
7.56
12.56
14.98
14.74
14.50
12.75
15.67
0.59
14.43
15.77
15.34
15.73
13.39
15.22
15.20
10.39
10.90
16.44
Malpractice
RVUs
2.01
0.87
1.42
0.50
0.00
0.00
0.00
0.15
0.07
0.10
1.01
1.23
1.94
1.32
1.64
1.85
2.29
2.60
1.93
2.32
1.74
0.54
0.73
2.00
2.53
2.64
0.53
2.19
2.81
3.26
1.74
2.07
2.19
2.49
2.28
0.00
0.00
0.13
0.16
0.34
0.33
0.11
0.17
0.17
1.32
1.29
2.63
2.09
4.11
4.31
3.00
4.20
4.22
1.50
1.26
2.76
2.61
5.61
6.07
6.34
6.43
6.26
7.14
0.35
6.60
7.12
7.61
8.01
2.31
4.82
3.91
1.74
4.83
7.62
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00177
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
0.00
0.00
0.00
3.85
2.61
3.05
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
1.71
1.65
1.85
2.02
NA
NA
1.06
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
15.94
6.73
11.87
3.75
0.00
0.00
0.00
3.64
1.38
2.21
16.44
17.65
25.52
19.25
23.12
25.33
32.75
43.35
27.84
32.72
26.93
11.00
14.98
25.52
32.08
34.77
6.55
27.04
30.97
37.37
26.71
30.81
30.75
34.67
30.43
0.00
0.00
2.70
2.68
3.18
3.40
2.94
3.75
2.08
10.33
8.75
19.84
16.74
29.71
32.05
23.08
28.50
30.18
10.18
10.10
19.90
22.54
40.14
47.67
45.66
45.87
43.25
50.51
2.33
46.66
51.41
52.46
54.76
39.03
47.33
47.07
30.41
34.40
53.84
Global
090
000
090
000
YYY
YYY
YYY
010
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
YYY
YYY
000
000
000
000
000
000
000
090
000
090
090
090
090
090
090
090
000
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
45940
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
61345
61440
61450
61458
61460
61470
61480
61490
61500
61501
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61537
61538
61539
61540
61541
61542
61543
61544
61545
61546
61548
61550
61552
61556
61557
61558
61559
61563
61564
61566
61567
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61609
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Relieve cranial pressure ..............................
Incise skull for surgery ................................
Incise skull for surgery ................................
Incise skull for brain wound ........................
Incise skull for surgery ................................
Incise skull for surgery ................................
Incise skull for surgery ................................
Incise skull for surgery ................................
Removal of skull lesion ...............................
Remove infected skull bone ........................
Removal of brain lesion ..............................
Remove brain lining lesion ..........................
Removal of brain abscess ...........................
Removal of brain lesion ..............................
Implt brain chemotx add-on ........................
Removal of brain lesion ..............................
Remove brain lining lesion ..........................
Removal of brain lesion ..............................
Removal of brain lesion ..............................
Removal of brain abscess ...........................
Removal of brain lesion ..............................
Removal of brain lesion ..............................
Removal of brain lesion ..............................
Implant brain electrodes ..............................
Implant brain electrodes ..............................
Removal of brain lesion ..............................
Remove brain electrodes ............................
Removal of brain lesion ..............................
Removal of brain tissue ..............................
Removal of brain tissue ..............................
Removal of brain tissue ..............................
Removal of brain tissue ..............................
Incision of brain tissue ................................
Removal of brain tissue ..............................
Removal of brain tissue ..............................
Remove & treat brain lesion .......................
Excision of brain tumor ...............................
Removal of pituitary gland ..........................
Removal of pituitary gland ..........................
Release of skull seams ...............................
Release of skull seams ...............................
Incise skull/sutures ......................................
Incise skull/sutures ......................................
Excision of skull/sutures ..............................
Excision of skull/sutures ..............................
Excision of skull tumor ................................
Excision of skull tumor ................................
Removal of brain tissue ..............................
Incision of brain tissue ................................
Remove foreign body, brain ........................
Incise skull for brain wound ........................
Skull base/brainstem surgery ......................
Skull base/brainstem surgery ......................
Craniofacial approach, skull ........................
Craniofacial approach, skull ........................
Craniofacial approach, skull ........................
Craniofacial approach, skull ........................
Orbitocranial approach/skull ........................
Orbitocranial approach/skull ........................
Resect nasopharynx, skull ..........................
Infratemporal approach/skull .......................
Infratemporal approach/skull .......................
Orbitocranial approach/skull ........................
Transtemporal approach/skull .....................
Transcochlear approach/skull .....................
Transcondylar approach/skull .....................
Transpetrosal approach/skull ......................
Resect/excise cranial lesion ........................
Resect/excise cranial lesion ........................
Resect/excise cranial lesion ........................
Resect/excise cranial lesion ........................
Resect/excise cranial lesion ........................
Resect/excise cranial lesion ........................
Transect artery, sinus ..................................
27.21
26.64
25.96
27.30
28.41
26.07
26.50
25.67
17.93
14.85
28.47
35.11
25.27
24.62
1.38
37.33
41.41
54.87
44.50
29.47
27.88
52.19
43.88
14.64
19.72
20.98
11.63
35.54
25.01
26.82
32.09
30.02
28.87
31.03
29.24
25.51
43.82
31.31
21.54
14.66
19.57
22.27
22.39
25.59
32.81
26.84
33.85
31.01
35.52
24.61
26.40
34.38
52.45
30.36
34.62
31.67
36.23
34.67
38.63
25.11
41.80
43.70
39.66
29.59
35.65
37.98
33.43
25.86
27.91
29.35
38.85
36.29
42.12
9.90
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
15.07
13.94
13.98
15.18
16.01
13.55
14.94
14.02
10.58
9.06
16.35
19.25
14.13
13.97
0.62
20.64
22.14
29.56
23.66
16.06
15.32
28.57
24.30
8.96
11.30
11.83
7.29
19.34
14.46
14.99
17.37
16.93
15.84
17.43
16.02
13.50
23.67
17.12
12.46
6.92
9.46
11.14
13.35
13.91
18.91
14.87
17.88
17.43
20.22
13.62
14.81
19.10
33.91
24.92
22.74
26.53
24.49
23.90
25.74
21.90
27.92
28.74
25.87
21.85
23.83
22.44
22.65
19.34
19.99
21.48
24.52
23.18
25.94
4.72
Malpractice
RVUs
7.02
6.88
5.77
7.01
6.02
5.88
6.71
6.90
4.10
3.21
7.33
9.05
6.52
6.33
0.35
9.62
10.60
11.18
11.36
7.60
7.14
7.05
6.13
3.78
5.10
5.42
3.01
9.18
6.92
6.92
8.30
8.30
6.58
8.01
7.54
5.95
10.60
7.65
3.42
0.98
1.06
4.64
5.78
1.36
8.48
5.15
8.75
6.92
6.52
5.86
6.77
5.32
5.56
3.36
3.91
7.19
9.18
8.16
7.01
4.36
5.29
5.64
10.04
3.97
3.39
8.81
5.68
3.78
6.61
2.85
8.94
6.88
10.72
2.55
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00178
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
49.30
47.46
45.71
49.49
50.43
45.51
48.16
46.59
32.60
27.12
52.15
63.41
45.92
44.91
2.36
67.60
74.15
95.61
79.52
53.13
50.34
87.82
74.31
27.37
36.12
38.24
21.93
64.06
46.39
48.73
57.76
55.25
51.29
56.47
52.80
44.96
78.09
56.08
37.43
22.56
30.09
38.05
41.52
40.86
60.19
46.87
60.48
55.36
62.26
44.09
47.98
58.80
91.92
58.65
61.27
65.39
69.90
66.72
71.37
51.37
75.01
78.08
75.57
55.41
62.87
69.23
61.75
48.98
54.51
53.68
72.31
66.35
78.79
17.17
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
45941
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
61610
61611
61612
61613
61615
61616
61618
61619
61623
61624
61626
61680
61682
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710
61711
61720
61735
61750
61751
61760
61770
61790
61791
61793
61795
61850
61860
61863
61864
61867
61868
61870
61875
61880
61885
61886
61888
62000
62005
62010
62100
62115
62116
62117
62120
62121
62140
62141
62142
62143
62145
62146
62147
62148
62160
62161
62162
62163
62164
62165
62180
62190
62192
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Transect artery, sinus ..................................
Transect artery, sinus ..................................
Transect artery, sinus ..................................
Remove aneurysm, sinus ............................
Resect/excise lesion, skull ..........................
Resect/excise lesion, skull ..........................
Repair dura ..................................................
Repair dura ..................................................
Endovasc tempory vessel occl ....................
Transcath occlusion, cns .............................
Transcath occlusion, non-cns .....................
Intracranial vessel surgery ..........................
Intracranial vessel surgery ..........................
Intracranial vessel surgery ..........................
Intracranial vessel surgery ..........................
Intracranial vessel surgery ..........................
Intracranial vessel surgery ..........................
Brain aneurysm repr, complx ......................
Brain aneurysm repr, complx ......................
Brain aneurysm repr, simple .......................
Inner skull vessel surgery ...........................
Clamp neck artery .......................................
Revise circulation to head ...........................
Revise circulation to head ...........................
Revise circulation to head ...........................
Fusion of skull arteries ................................
Incise skull/brain surgery .............................
Incise skull/brain surgery .............................
Incise skull/brain biopsy ..............................
Brain biopsy w/ct/mr guide ..........................
Implant brain electrodes ..............................
Incise skull for treatment .............................
Treat trigeminal nerve .................................
Treat trigeminal tract ...................................
Focus radiation beam ..................................
Brain surgery using computer .....................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrode ................................
Implant neuroelectrde, add’l ........................
Implant neuroelectrode ................................
Implant neuroelectrde, add’l ........................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Revise/remove neuroelectrode ...................
Insrt/redo neurostim 1 array ........................
Implant neurostim arrays .............................
Revise/remove neuroreceiver .....................
Treat skull fracture ......................................
Treat skull fracture ......................................
Treatment of head injury .............................
Repair brain fluid leakage ...........................
Reduction of skull defect .............................
Reduction of skull defect .............................
Reduction of skull defect .............................
Repair skull cavity lesion .............................
Incise skull repair ........................................
Repair of skull defect ..................................
Repair of skull defect ..................................
Remove skull plate/flap ...............................
Replace skull plate/flap ...............................
Repair of skull & brain .................................
Repair of skull with graft .............................
Repair of skull with graft .............................
Retr bone flap to fix skull ............................
Neuroendoscopy add-on .............................
Dissect brain w/scope .................................
Remove colloid cyst w/scope ......................
Neuroendoscopy w/fb removal ....................
Remove brain tumor w/scope .....................
Remove pituit tumor w/scope ......................
Establish brain cavity shunt ........................
Establish brain cavity shunt ........................
Establish brain cavity shunt ........................
29.69
7.42
27.90
40.88
32.08
43.36
16.99
20.72
9.97
20.16
16.63
30.72
61.60
39.83
64.52
29.33
51.89
50.54
48.44
50.54
48.44
17.47
36.22
35.32
29.69
36.35
16.77
20.44
18.21
17.63
22.28
21.45
10.86
14.62
17.24
4.04
12.39
20.88
19.01
4.50
31.35
7.93
14.95
15.07
6.29
5.85
8.01
5.07
12.54
16.18
19.82
22.04
21.67
23.60
26.61
23.36
21.59
13.52
14.92
10.79
13.06
18.83
16.13
19.35
2.00
3.01
20.01
25.26
15.51
27.51
22.01
21.07
11.07
12.25
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
12.81
3.72
12.98
25.62
22.18
27.92
10.21
11.95
4.07
7.17
5.79
17.06
31.45
21.58
33.92
16.37
26.84
27.39
26.12
27.19
25.43
10.25
18.95
15.74
13.97
19.36
9.79
11.91
10.39
10.61
8.51
12.04
5.79
8.74
9.91
1.98
7.61
11.78
11.56
2.23
17.66
3.92
9.43
8.60
4.50
5.25
6.26
3.56
6.22
8.90
11.47
12.49
11.50
13.10
15.04
18.07
15.08
8.16
8.86
6.86
7.89
10.66
9.43
11.05
0.84
1.49
11.85
14.54
9.73
14.65
13.05
12.03
6.95
7.48
Malpractice
RVUs
7.66
1.88
4.30
8.42
4.72
8.24
3.71
3.94
1.05
1.95
1.24
7.93
15.85
10.28
16.66
6.92
13.39
12.81
12.50
12.98
10.76
4.05
8.84
2.50
4.51
9.39
2.78
2.72
4.71
4.55
5.40
3.54
2.81
3.39
4.45
0.79
3.21
4.94
5.41
5.41
5.41
5.41
3.86
2.94
1.66
1.59
1.96
1.33
1.06
3.86
5.12
4.83
5.49
6.09
4.52
2.99
4.16
3.46
3.75
2.72
3.36
4.49
3.61
4.31
0.48
0.77
5.17
5.89
4.00
5.36
3.00
4.97
2.79
3.01
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00179
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
50.15
13.03
45.18
74.92
58.98
79.52
30.92
36.62
15.09
29.28
23.66
55.71
108.90
71.69
115.09
52.62
92.12
90.74
87.06
90.72
84.63
31.78
64.01
53.56
48.16
65.10
29.34
35.07
33.31
32.79
36.19
37.03
19.47
26.75
31.61
6.80
23.22
37.61
35.98
12.14
54.42
17.25
28.24
26.61
12.45
12.69
16.22
9.96
19.82
28.94
36.41
39.37
38.67
42.78
46.17
44.42
40.83
25.14
27.53
20.37
24.30
33.98
29.17
34.71
3.32
5.27
37.03
45.69
29.24
47.53
38.07
38.07
20.81
22.74
Global
ZZZ
ZZZ
ZZZ
090
090
090
090
090
000
000
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
ZZZ
090
ZZZ
090
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
ZZZ
090
090
090
090
090
090
090
090
45942
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
62194
62200
62201
62220
62223
62225
62230
62252
62252
62252
62256
62258
62263
62264
62268
62269
62270
62272
62273
62280
62281
62282
62284
62287
62290
62291
62292
62294
62310
62311
62318
62319
62350
62351
62355
62360
62361
62362
62365
62367
62368
63001
63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
63042
63043
63044
63045
63046
63047
63048
63050
63051
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
63085
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Replace/irrigate catheter .............................
Establish brain cavity shunt ........................
Brain cavity shunt w/scope .........................
Establish brain cavity shunt ........................
Establish brain cavity shunt ........................
Replace/irrigate catheter .............................
Replace/revise brain shunt ..........................
Csf shunt reprogram ...................................
Csf shunt reprogram ...................................
Csf shunt reprogram ...................................
Remove brain cavity shunt ..........................
Replace brain cavity shunt ..........................
Epidural lysis mult sessions ........................
Epidural lysis on single day ........................
Drain spinal cord cyst ..................................
Needle biopsy, spinal cord ..........................
Spinal fluid tap, diagnostic ..........................
Drain cerebro spinal fluid ............................
Inject epidural patch ....................................
Treat spinal cord lesion ...............................
Treat spinal cord lesion ...............................
Treat spinal canal lesion .............................
Injection for myelogram ...............................
Percutaneous diskectomy ...........................
Inject for spine disk x-ray ............................
Inject for spine disk x-ray ............................
Injection into disk lesion ..............................
Injection into spinal artery ...........................
Inject spine c/t .............................................
Inject spine l/s (cd) ......................................
Inject spine w/cath, c/t .................................
Inject spine w/cath l/s (cd) ..........................
Implant spinal canal cath ............................
Implant spinal canal cath ............................
Remove spinal canal catheter .....................
Insert spine infusion device .........................
Implant spine infusion pump .......................
Implant spine infusion pump .......................
Remove spine infusion device ....................
Analyze spine infusion pump ......................
Analyze spine infusion pump ......................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Neck spine disk surgery ..............................
Low back disk surgery ................................
Spinal disk surgery add-on .........................
Laminotomy, single cervical ........................
Laminotomy, single lumbar .........................
Laminotomy, add’l cervical ..........................
Laminotomy, add’l lumbar ...........................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Removal of spinal lamina ............................
Remove spinal lamina add-on ....................
Cervical laminoplasty ..................................
C-laminoplasty w/graft/plate ........................
Decompress spinal cord ..............................
Decompress spinal cord ..............................
Decompress spine cord add-on ..................
Decompress spinal cord ..............................
Decompress spine cord add-on ..................
Neck spine disk surgery ..............................
Neck spine disk surgery ..............................
Spine disk surgery, thorax ..........................
Spine disk surgery, thorax ..........................
Removal of vertebral body ..........................
Remove vertebral body add-on ...................
Removal of vertebral body ..........................
5.03
18.33
14.87
13.01
12.88
5.41
10.54
0.74
0.74
0.00
6.60
14.55
6.14
4.43
4.74
5.02
1.13
1.35
2.15
2.64
2.67
2.33
1.54
8.09
3.01
2.92
7.87
11.83
1.91
1.54
2.04
1.87
6.87
10.01
5.45
2.63
5.42
7.04
5.42
0.48
0.75
15.83
15.96
14.93
14.53
15.41
19.36
19.21
15.95
14.82
12.00
3.16
18.82
17.47
0.00
0.00
16.51
15.81
14.62
3.27
20.79
24.30
22.00
20.37
5.26
24.62
3.27
19.42
4.05
21.45
3.29
23.74
4.37
26.93
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
1.35
0.36
0.99
NA
NA
12.01
7.34
10.84
13.60
2.88
3.51
2.60
6.38
5.32
7.60
4.79
NA
6.76
5.66
NA
NA
4.51
4.58
5.36
4.65
NA
NA
NA
NA
NA
NA
NA
0.22
0.29
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
2.47
10.62
9.26
7.83
8.10
4.03
6.36
NA
0.36
NA
4.62
8.54
3.10
1.38
2.19
2.02
0.56
0.71
0.69
0.99
0.87
0.90
0.69
5.57
1.38
1.23
4.34
5.73
0.63
0.58
0.63
0.59
3.85
6.96
3.09
2.63
3.82
4.27
3.50
0.12
0.18
9.30
9.63
9.73
8.08
9.87
11.62
11.52
10.15
9.47
8.23
1.55
11.23
11.06
0.00
0.00
10.13
9.94
9.65
1.62
11.41
12.97
12.84
12.25
2.56
14.08
1.62
11.81
2.00
12.43
1.59
13.98
2.16
15.05
Malpractice
RVUs
0.92
4.64
3.67
3.34
3.13
1.39
2.70
0.21
0.19
0.02
1.71
3.73
0.41
0.27
0.43
0.37
0.08
0.18
0.13
0.30
0.19
0.17
0.13
0.58
0.23
0.26
0.82
1.24
0.12
0.09
0.12
0.11
1.02
2.24
0.71
0.34
0.80
1.18
0.86
0.00
0.00
3.76
3.72
3.34
3.37
3.48
4.75
4.58
3.63
3.71
3.00
0.79
4.67
4.25
0.00
0.00
3.98
3.55
3.23
0.72
4.66
4.66
5.27
4.75
1.22
5.69
0.69
4.62
0.96
3.98
0.66
5.54
1.02
4.48
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00180
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
2.30
1.29
1.01
NA
NA
18.56
12.04
16.01
18.99
4.09
5.05
4.88
9.32
8.18
10.10
6.46
NA
9.99
8.83
NA
NA
6.55
6.21
7.53
6.64
NA
NA
NA
NA
NA
NA
NA
0.70
1.04
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
8.42
33.59
27.80
24.18
24.11
10.83
19.60
NA
1.29
NA
12.93
26.82
9.65
6.08
7.36
7.41
1.78
2.24
2.98
3.93
3.72
3.40
2.36
14.23
4.61
4.41
13.03
18.80
2.67
2.21
2.80
2.58
11.74
19.21
9.25
5.59
10.04
12.50
9.79
0.60
0.93
28.90
29.31
28.00
25.98
28.76
35.73
35.30
29.73
28.00
23.24
5.49
34.72
32.78
0.00
0.00
30.62
29.30
27.50
5.60
36.86
41.93
40.11
37.37
9.04
44.39
5.57
35.85
7.00
37.87
5.54
43.26
7.55
46.47
Global
010
090
090
090
090
090
090
XXX
XXX
XXX
090
090
010
010
000
000
000
000
000
010
010
010
000
090
000
000
090
090
000
000
000
000
090
090
090
090
090
090
090
XXX
XXX
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
ZZZ
ZZZ
090
090
090
ZZZ
090
090
090
090
ZZZ
090
ZZZ
090
ZZZ
090
ZZZ
090
ZZZ
090
45943
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278
63280
63281
63282
63283
63285
63286
63287
63290
63295
63300
63301
63302
63303
63304
63305
63306
63307
63308
63600
63610
63615
63650
63655
63660
63685
63688
63700
63702
63704
63706
63707
63709
63710
63740
63741
63744
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Remove vertebral body add-on ...................
Removal of vertebral body ..........................
Remove vertebral body add-on ...................
Removal of vertebral body ..........................
Remove vertebral body add-on ...................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Remove vertebral body add-on ...................
Incise spinal cord tract(s) ............................
Drainage of spinal cyst ................................
Drainage of spinal cyst ................................
Revise spinal cord ligaments ......................
Revise spinal cord ligaments ......................
Incise spinal column/nerves ........................
Incise spinal column/nerves ........................
Incise spinal column/nerves ........................
Incise spinal column & cord ........................
Incise spinal column & cord ........................
Incise spinal column & cord ........................
Incise spinal column & cord ........................
Incise spinal column & cord ........................
Incise spinal column & cord ........................
Release of spinal cord ................................
Revise spinal cord vessels ..........................
Revise spinal cord vessels ..........................
Revise spinal cord vessels ..........................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Excise intraspinal lesion ..............................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Biopsy/excise spinal tumor ..........................
Repair of laminectomy defect .....................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Removal of vertebral body ..........................
Remove vertebral body add-on ...................
Remove spinal cord lesion ..........................
Stimulation of spinal cord ............................
Remove lesion of spinal cord ......................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Revise/remove neuroelectrode ...................
Insrt/redo spine n generator ........................
Revise/remove neuroreceiver .....................
Repair of spinal herniation ..........................
Repair of spinal herniation ..........................
Repair of spinal herniation ..........................
Repair of spinal herniation ..........................
Repair spinal fluid leakage ..........................
Repair spinal fluid leakage ..........................
Graft repair of spine defect .........................
Install spinal shunt .......................................
Install spinal shunt .......................................
Revision of spinal shunt ..............................
3.20
35.59
4.33
28.18
3.04
32.01
32.01
4.83
19.84
17.67
22.00
18.28
20.51
15.05
17.45
17.55
19.20
18.85
22.31
21.12
25.39
26.90
19.19
40.78
41.22
41.21
21.57
22.31
17.96
18.53
26.81
26.93
25.33
24.30
23.69
23.46
20.84
20.57
28.37
28.07
26.40
25.01
36.02
35.65
36.71
37.39
5.26
24.44
27.62
27.83
30.51
30.34
32.04
32.23
31.64
5.25
14.03
8.74
16.29
6.74
10.29
6.16
7.04
5.39
16.54
18.49
21.19
24.12
11.26
14.33
14.08
11.36
8.26
8.11
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
53.74
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
1.55
18.93
2.11
15.60
1.42
18.84
18.78
2.41
11.62
10.42
12.54
10.77
10.76
7.93
9.90
10.21
11.48
10.81
13.11
11.95
8.28
14.73
11.10
19.47
22.08
21.75
12.49
12.89
10.83
10.13
15.13
15.23
14.36
14.03
13.47
13.38
12.24
12.10
15.96
15.82
15.00
14.34
19.49
19.46
19.96
20.12
2.07
13.97
15.16
15.47
16.47
16.88
17.60
17.37
16.65
2.53
5.29
2.21
9.07
3.09
6.75
3.53
4.05
3.47
10.06
10.87
12.61
13.24
7.53
9.16
8.84
7.22
4.68
5.16
Malpractice
RVUs
0.59
6.20
0.82
4.21
0.48
5.69
5.69
0.69
4.86
4.48
5.68
3.95
5.30
2.79
3.24
6.34
3.26
4.87
5.76
5.36
6.43
1.40
4.96
9.01
10.41
10.64
5.43
5.54
4.37
3.69
6.82
6.90
6.18
5.74
5.80
5.83
5.01
4.55
7.27
7.17
6.76
6.26
9.18
9.21
9.39
9.02
1.03
5.97
5.39
5.53
4.68
6.41
5.71
8.33
4.46
1.29
1.52
0.86
2.84
0.53
2.43
0.78
1.05
0.89
3.52
4.12
4.57
6.23
2.51
3.09
3.40
2.93
1.66
1.89
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00181
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
63.34
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
5.33
60.72
7.26
47.99
4.93
56.54
56.48
7.93
36.32
32.57
40.22
33.00
36.57
25.77
30.59
34.10
33.94
34.53
41.18
38.44
40.10
43.04
35.25
69.26
73.72
73.60
39.49
40.74
33.16
32.35
48.76
49.06
45.87
44.06
42.95
42.66
38.09
37.22
51.59
51.06
48.17
45.61
64.69
64.32
66.06
66.54
8.36
44.37
48.17
48.82
51.66
53.63
55.35
57.93
52.75
9.07
20.83
11.80
28.20
10.36
19.47
10.47
12.14
9.76
30.12
33.48
38.37
43.58
21.30
26.58
26.32
21.51
14.60
15.16
Global
ZZZ
090
ZZZ
090
ZZZ
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
ZZZ
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
45944
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
63746
64400
64402
64405
64408
64410
64412
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447
64448
64449
64450
64470
64472
64475
64476
64479
64480
64483
64484
64505
64508
64510
64517
64520
64530
64550
64553
64555
64560
64561
64565
64573
64575
64577
64580
64581
64585
64590
64595
64600
64605
64610
64612
64613
64614
64620
64622
64623
64626
64627
64630
64640
64680
64681
64702
64704
64708
64712
64713
64714
64716
64718
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Removal of spinal shunt ..............................
N block inj, trigeminal ..................................
N block inj, facial .........................................
N block inj, occipital ....................................
N block inj, vagus ........................................
N block inj, phrenic ......................................
N block inj, spinal accessor ........................
N block inj, cervical plexus ..........................
N block inj, brachial plexus .........................
N block cont infuse, b plex ..........................
N block inj, axillary ......................................
N block inj, suprascapular ...........................
N block inj, intercost, sng ............................
N block inj, intercost, mlt .............................
N block inj, ilio-ing/hypogi ...........................
N block inj, pudendal ...................................
N block inj, paracervical ..............................
N block inj, sciatic, sng ...............................
N blk inj, sciatic, cont inf .............................
N block inj fem, single .................................
N block inj fem, cont inf ..............................
N block inj, lumbar plexus ...........................
N block, other peripheral .............................
Inj paravertebral c/t .....................................
Inj paravertebral c/t add-on .........................
Inj paravertebral l/s ......................................
Inj paravertebral l/s add-on .........................
Inj foramen epidural c/t ...............................
Inj foramen epidural add-on ........................
Inj foramen epidural l/s ................................
Inj foramen epidural add-on ........................
N block, spenopalatine gangl ......................
N block, carotid sinus s/p ............................
N block, stellate ganglion ............................
N block inj, hypogas plxs ............................
N block, lumbar/thoracic ..............................
N block inj, celiac pelus ..............................
Apply neurostimulator ..................................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Implant neuroelectrodes ..............................
Revise/remove neuroelectrode ...................
Insrt/redo perph n generator .......................
Revise/remove neuroreceiver .....................
Injection treatment of nerve ........................
Injection treatment of nerve ........................
Injection treatment of nerve ........................
Destroy nerve, face muscle ........................
Destroy nerve, spine muscle .......................
Destroy nerve, extrem musc .......................
Injection treatment of nerve ........................
Destr paravertebrl nerve l/s .........................
Destr paravertebral n add-on ......................
Destr paravertebrl nerve c/t ........................
Destr paravertebral n add-on ......................
Injection treatment of nerve ........................
Injection treatment of nerve ........................
Injection treatment of nerve ........................
Injection treatment of nerve ........................
Revise finger/toe nerve ...............................
Revise hand/foot nerve ...............................
Revise arm/leg nerve ..................................
Revision of sciatic nerve .............................
Revision of arm nerve(s) .............................
Revise low back nerve(s) ............................
Revision of cranial nerve .............................
Revise ulnar nerve at elbow .......................
6.43
1.11
1.25
1.32
1.41
1.43
1.18
1.40
1.48
3.50
1.44
1.32
1.18
1.68
1.75
1.46
1.45
1.48
3.26
1.50
3.01
3.01
1.27
1.85
1.29
1.41
0.98
2.20
1.54
1.90
1.33
1.36
1.12
1.22
2.20
1.35
1.58
0.18
2.31
2.27
2.36
6.74
1.76
7.50
4.35
4.62
4.12
13.51
2.06
2.40
1.73
3.45
5.61
7.16
1.96
1.96
2.20
2.85
3.01
0.99
3.29
1.16
3.01
2.77
2.63
3.55
4.23
4.57
6.12
7.76
11.00
10.33
6.31
5.99
Nonfacility
PE
RVUs
NA
1.83
1.59
1.42
1.57
2.36
2.49
1.77
2.66
NA
2.84
2.49
3.62
5.65
1.62
2.47
2.42
2.52
NA
NA
NA
NA
1.25
6.70
2.16
6.37
1.95
6.90
2.62
7.23
3.01
1.21
3.15
3.19
2.65
4.76
4.14
0.27
2.70
2.98
2.54
29.47
3.12
NA
NA
NA
NA
NA
10.39
6.92
9.61
8.75
8.92
8.48
2.41
2.86
3.07
4.75
7.17
2.74
7.26
4.18
2.69
3.94
6.22
8.67
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
3.70
0.42
0.59
0.45
0.83
0.45
0.42
0.49
0.45
0.77
0.48
0.43
0.41
0.51
0.53
0.56
0.68
0.49
0.97
0.42
0.79
0.91
0.47
0.69
0.33
0.62
0.24
0.87
0.46
0.81
0.36
0.64
0.76
0.50
0.87
0.54
0.64
0.05
1.81
1.26
1.25
3.21
1.24
5.15
2.84
3.20
3.44
6.11
2.13
2.33
1.90
1.62
2.13
3.64
1.30
1.20
1.28
1.29
1.33
0.22
1.90
0.26
1.42
1.78
1.40
2.01
3.76
3.29
4.73
4.79
5.70
4.09
5.84
5.84
Malpractice
RVUs
1.53
0.07
0.09
0.08
0.10
0.09
0.08
0.08
0.09
0.31
0.11
0.07
0.08
0.11
0.13
0.10
0.16
0.10
0.20
0.09
0.18
0.15
0.13
0.11
0.08
0.10
0.07
0.12
0.10
0.11
0.08
0.10
0.07
0.07
0.11
0.08
0.10
0.01
0.18
0.19
0.22
0.51
0.13
1.60
0.61
1.04
0.36
1.05
0.20
0.19
0.19
0.34
0.79
1.58
0.11
0.11
0.10
0.20
0.18
0.06
0.20
0.07
0.22
0.29
0.18
0.28
0.61
0.61
0.96
0.95
1.82
1.19
0.63
1.05
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00182
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
3.01
2.93
2.82
3.08
3.89
3.75
3.25
4.23
NA
4.40
3.89
4.89
7.44
3.51
4.03
4.03
4.11
NA
NA
NA
NA
2.65
8.66
3.53
7.89
3.00
9.22
4.26
9.25
4.42
2.68
4.35
4.49
4.96
6.19
5.82
0.46
5.20
5.44
5.12
36.73
5.01
NA
NA
NA
NA
NA
12.65
9.51
11.54
12.54
15.32
17.22
4.48
4.93
5.37
7.80
10.35
3.79
10.75
5.41
5.92
7.00
9.03
12.50
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
11.66
1.60
1.93
1.85
2.34
1.97
1.68
1.97
2.02
4.58
2.03
1.82
1.67
2.30
2.41
2.12
2.29
2.07
4.43
2.01
3.98
4.07
1.87
2.66
1.71
2.13
1.29
3.19
2.10
2.82
1.77
2.10
1.95
1.79
3.19
1.97
2.32
0.24
4.31
3.73
3.84
10.46
3.14
14.25
7.80
8.86
7.92
20.67
4.39
4.92
3.83
5.40
8.53
12.38
3.38
3.28
3.58
4.33
4.52
1.27
5.39
1.50
4.65
4.84
4.20
5.84
8.60
8.47
11.81
13.49
18.52
15.61
12.78
12.88
Global
090
000
000
000
000
000
000
000
000
010
000
000
000
000
000
000
000
000
010
000
010
010
000
000
ZZZ
000
ZZZ
000
ZZZ
000
ZZZ
000
000
000
000
000
000
000
010
010
010
010
010
090
090
090
090
090
010
010
010
010
010
010
010
010
010
010
010
ZZZ
010
ZZZ
010
010
010
010
090
090
090
090
090
090
090
090
45945
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
64719
64721
64722
64726
64727
64732
64734
64736
64738
64740
64742
64744
64746
64752
64755
64760
64761
64763
64766
64771
64772
64774
64776
64778
64782
64783
64784
64786
64787
64788
64790
64792
64795
64802
64804
64809
64818
64820
64821
64822
64823
64831
64832
64834
64835
64836
64837
64840
64856
64857
64858
64859
64861
64862
64864
64865
64866
64868
64870
64872
64874
64876
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
64901
64902
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Revise ulnar nerve at wrist .........................
Carpal tunnel surgery ..................................
Relieve pressure on nerve(s) ......................
Release foot/toe nerve ................................
Internal nerve revision .................................
Incision of brow nerve .................................
Incision of cheek nerve ...............................
Incision of chin nerve ..................................
Incision of jaw nerve ...................................
Incision of tongue nerve ..............................
Incision of facial nerve ................................
Incise nerve, back of head ..........................
Incise diaphragm nerve ...............................
Incision of vagus nerve ...............................
Incision of stomach nerves .........................
Incision of vagus nerve ...............................
Incision of pelvis nerve ................................
Incise hip/thigh nerve ..................................
Incise hip/thigh nerve ..................................
Sever cranial nerve .....................................
Incision of spinal nerve ...............................
Remove skin nerve lesion ...........................
Remove digit nerve lesion ...........................
Digit nerve surgery add-on ..........................
Remove limb nerve lesion ...........................
Limb nerve surgery add-on .........................
Remove nerve lesion ..................................
Remove sciatic nerve lesion .......................
Implant nerve end .......................................
Remove skin nerve lesion ...........................
Removal of nerve lesion .............................
Removal of nerve lesion .............................
Biopsy of nerve ...........................................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Remove sympathetic nerves .......................
Repair of digit nerve ....................................
Repair nerve add-on ...................................
Repair of hand or foot nerve .......................
Repair of hand or foot nerve .......................
Repair of hand or foot nerve .......................
Repair nerve add-on ...................................
Repair of leg nerve ......................................
Repair/transpose nerve ...............................
Repair arm/leg nerve ...................................
Repair sciatic nerve .....................................
Nerve surgery ..............................................
Repair of arm nerves ..................................
Repair of low back nerves ..........................
Repair of facial nerve ..................................
Repair of facial nerve ..................................
Fusion of facial/other nerve .........................
Fusion of facial/other nerve .........................
Fusion of facial/other nerve .........................
Subsequent repair of nerve .........................
Repair & revise nerve add-on .....................
Repair nerve/shorten bone ..........................
Nerve graft, head or neck ...........................
Nerve graft, head or neck ...........................
Nerve graft, hand or foot .............................
Nerve graft, hand or foot .............................
Nerve graft, arm or leg ................................
Nerve graft, arm or leg ................................
Nerve graft, hand or foot .............................
Nerve graft, hand or foot .............................
Nerve graft, arm or leg ................................
Nerve graft, arm or leg ................................
Nerve graft add-on ......................................
Nerve graft add-on ......................................
4.85
4.29
4.70
4.18
3.11
4.41
4.92
4.60
5.73
5.59
6.22
5.24
5.93
7.06
13.53
6.96
6.41
6.93
8.68
7.35
7.21
5.17
5.12
3.12
6.23
3.72
9.83
15.47
4.30
4.61
11.31
14.93
3.02
9.16
14.65
13.68
10.30
10.37
8.76
8.76
10.37
9.45
5.66
10.19
10.94
10.94
6.26
13.03
13.81
14.50
16.50
4.26
19.25
19.45
12.56
15.25
15.75
14.05
16.00
1.99
2.99
3.38
17.54
20.76
15.16
16.15
14.66
15.61
19.26
20.50
18.25
19.51
10.22
11.83
Nonfacility
PE
RVUs
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
PE
RVUs
4.39
5.17
2.96
2.77
1.46
3.45
3.99
3.98
4.54
5.06
4.61
3.71
4.29
4.18
5.57
3.41
3.50
5.06
5.25
5.45
4.83
3.77
3.61
1.46
3.76
1.78
6.43
9.57
2.06
3.43
7.05
8.63
1.53
4.96
6.92
5.58
5.10
6.92
7.13
7.03
7.91
6.88
2.85
6.90
7.48
7.45
3.14
8.05
8.93
9.37
10.48
2.13
11.42
11.75
8.49
13.11
12.78
11.16
8.55
1.05
1.48
1.70
11.26
13.11
9.71
7.41
8.65
9.60
9.45
10.93
10.41
11.53
5.09
5.76
Malpractice
RVUs
0.77
0.73
0.48
0.54
0.48
0.98
0.89
0.52
1.08
0.69
0.73
1.16
0.82
0.93
1.83
0.81
0.53
0.94
1.06
1.23
1.40
0.74
0.76
0.46
0.86
0.51
1.38
2.60
0.58
0.73
2.10
2.48
0.52
1.29
2.14
1.50
1.33
1.49
1.24
1.30
1.57
1.41
0.85
1.54
1.73
1.67
0.97
1.37
2.12
2.21
3.33
0.67
4.08
4.31
1.26
1.50
2.04
1.43
1.30
0.29
0.42
0.47
1.63
2.08
2.29
1.63
2.47
2.61
2.57
3.16
2.54
2.77
1.37
1.55
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00183
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
5.02
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Facility
total
10.01
10.19
8.14
7.49
5.04
8.84
9.80
9.10
11.36
11.34
11.56
10.11
11.04
12.17
20.93
11.19
10.44
12.93
14.99
14.03
13.45
9.68
9.49
5.03
10.85
6.01
17.64
27.64
6.94
8.77
20.46
26.04
5.07
15.41
23.71
20.76
16.73
18.78
17.13
17.09
19.85
17.74
9.36
18.63
20.15
20.07
10.37
22.44
24.86
26.08
30.31
7.06
34.75
35.50
22.31
29.86
30.57
26.64
25.85
3.33
4.89
5.54
30.42
35.96
27.16
25.19
25.78
27.82
31.27
34.59
31.20
33.80
16.68
19.15
Global
090
090
090
090
ZZZ
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
090
ZZZ
090
090
ZZZ
090
090
090
000
090
090
090
090
090
090
090
090
090
ZZZ
090
090
090
ZZZ
090
090
090
090
ZZZ
090
090
090
090
090
090
090
ZZZ
ZZZ
ZZZ
090
090
090
090
090
090
090
090
090
090
ZZZ
ZZZ
45946
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
64905
64907
64999
65091
65093
65101
65103
65105
65110
65112
65114
65125
65130
65135
65140
65150
65155
65175
65205
65210
65220
65222
65235
65260
65265
65270
65272
65273
65275
65280
65285
65286
65290
65400
65410
65420
65426
65430
65435
65436
65450
65600
65710
65730
65750
65755
65760
65765
65767
65770
65771
65772
65775
65780
65781
65782
65800
65805
65810
65815
65820
65850
65855
65860
65865
65870
65875
65880
65900
65920
65930
66020
66030
66130
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
N
N
A
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Nerve pedicle transfer .................................
Nerve pedicle transfer .................................
Nervous system surgery .............................
Revise eye ...................................................
Revise eye with implant ..............................
Removal of eye ...........................................
Remove eye/insert implant ..........................
Remove eye/attach implant .........................
Removal of eye ...........................................
Remove eye/revise socket ..........................
Remove eye/revise socket ..........................
Revise ocular implant ..................................
Insert ocular implant ....................................
Insert ocular implant ....................................
Attach ocular implant ...................................
Revise ocular implant ..................................
Reinsert ocular implant ...............................
Removal of ocular implant ..........................
Remove foreign body from eye ...................
Remove foreign body from eye ...................
Remove foreign body from eye ...................
Remove foreign body from eye ...................
Remove foreign body from eye ...................
Remove foreign body from eye ...................
Remove foreign body from eye ...................
Repair of eye wound ...................................
Repair of eye wound ...................................
Repair of eye wound ...................................
Repair of eye wound ...................................
Repair of eye wound ...................................
Repair of eye wound ...................................
Repair of eye wound ...................................
Repair of eye socket wound .......................
Removal of eye lesion .................................
Biopsy of cornea .........................................
Removal of eye lesion .................................
Removal of eye lesion .................................
Corneal smear .............................................
Curette/treat cornea ....................................
Curette/treat cornea ....................................
Treatment of corneal lesion ........................
Revision of cornea ......................................
Corneal transplant .......................................
Corneal transplant .......................................
Corneal transplant .......................................
Corneal transplant .......................................
Revision of cornea ......................................
Revision of cornea ......................................
Corneal tissue transplant ............................
Revise cornea with implant .........................
Radial keratotomy .......................................
Correction of astigmatism ...........................
Correction of astigmatism ...........................
Ocular reconst, transplant ...........................
Ocular reconst, transplant ...........................
Ocular reconst, transplant ...........................
Drainage of eye ...........................................
Drainage of eye ...........................................
Drainage of eye ...........................................
Drainage of eye ...........................................
Relieve inner eye pressure .........................
Incision of eye .............................................
Laser surgery of eye ...................................
Incise inner eye adhesions .........................
Incise inner eye adhesions .........................
Incise inner eye adhesions .........................
Incise inner eye adhesions .........................
Incise inner eye adhesions .........................
Remove eye lesion ......................................
Remove implant of eye ...............................
Remove blood clot from eye .......................
Injection treatment of eye ............................
Injection treatment of eye ............................
Remove eye lesion ......................................
14.03
18.84
0.00
6.46
6.87
7.03
7.58
8.50
13.96
16.39
17.54
3.13
7.15
7.33
8.03
6.26
8.67
6.28
0.71
0.84
0.71
0.93
7.58
10.96
12.60
1.90
3.82
4.36
5.34
7.67
12.91
5.51
5.41
6.06
1.47
4.17
5.25
1.47
0.92
4.19
3.28
3.40
12.35
14.26
15.01
14.90
0.00
0.00
0.00
17.57
0.00
4.29
5.79
10.25
17.68
15.01
1.91
1.91
4.87
5.05
8.14
10.52
3.85
3.55
5.60
6.27
6.54
7.09
10.93
8.41
7.44
1.59
1.25
7.70
Nonfacility
PE
RVUs
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
8.39
NA
NA
NA
NA
NA
NA
0.63
0.80
0.63
0.87
NA
NA
NA
4.94
7.38
NA
6.16
NA
NA
10.63
NA
8.08
2.03
8.48
9.74
1.26
0.98
4.00
3.98
4.85
NA
NA
NA
NA
0.00
0.00
0.00
NA
0.00
5.36
NA
NA
NA
NA
1.73
2.09
NA
9.56
NA
NA
4.18
3.92
NA
NA
NA
NA
NA
NA
NA
2.99
2.84
9.24
Facility
PE
RVUs
8.29
12.19
0.00
8.01
8.36
9.15
9.37
10.07
13.20
15.51
15.76
3.52
8.82
8.96
9.51
7.66
10.07
8.16
0.28
0.37
0.27
0.37
6.60
9.39
10.34
1.36
3.21
3.49
3.85
6.08
8.99
4.51
4.61
5.99
0.95
4.35
4.82
0.96
0.70
3.60
3.86
3.28
10.92
11.73
11.67
11.59
0.00
0.00
0.00
12.88
0.00
4.05
5.80
10.04
13.35
11.71
1.16
1.17
4.60
4.71
8.75
8.21
3.03
2.45
5.47
6.24
6.61
6.85
9.95
7.96
6.64
1.41
1.26
5.49
Malpractice
RVUs
2.00
3.16
0.00
0.32
0.34
0.35
0.37
0.42
0.81
1.30
1.02
0.19
0.35
0.36
0.40
0.31
0.50
0.31
0.03
0.04
0.05
0.04
0.37
0.57
0.62
0.09
0.19
0.22
0.26
0.38
0.64
0.27
0.31
0.30
0.07
0.21
0.25
0.07
0.04
0.21
0.16
0.17
0.61
0.70
0.74
0.73
0.00
0.00
0.00
0.87
0.00
0.21
0.28
0.44
0.44
0.44
0.09
0.09
0.24
0.25
0.40
0.52
0.19
0.18
0.28
0.31
0.32
0.35
0.54
0.41
0.37
0.08
0.06
0.38
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00184
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
11.71
NA
NA
NA
NA
NA
NA
1.37
1.68
1.39
1.85
NA
NA
NA
6.93
11.38
NA
11.76
NA
NA
16.41
NA
14.45
3.57
12.86
15.24
2.80
1.94
8.40
7.42
8.42
NA
NA
NA
NA
0.00
0.00
0.00
NA
0.00
9.86
NA
NA
NA
NA
3.73
4.10
NA
14.86
NA
NA
8.21
7.64
NA
NA
NA
NA
NA
NA
NA
4.66
4.15
17.31
Facility
total
24.32
34.19
0.00
14.79
15.57
16.53
17.31
18.99
27.96
33.20
34.31
6.83
16.32
16.65
17.93
14.23
19.24
14.75
1.02
1.25
1.03
1.34
14.55
20.92
23.56
3.35
7.22
8.07
9.45
14.13
22.54
10.30
10.33
12.35
2.49
8.73
10.32
2.50
1.66
8.00
7.30
6.85
23.89
26.69
27.42
27.22
0.00
0.00
0.00
31.31
0.00
8.55
11.88
20.73
31.46
27.16
3.16
3.17
9.71
10.01
17.29
19.25
7.07
6.17
11.35
12.82
13.48
14.29
21.42
16.78
14.45
3.08
2.57
13.56
Global
090
090
YYY
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
000
090
090
090
010
090
090
090
090
090
090
090
090
000
090
090
000
000
090
090
090
090
090
090
090
XXX
XXX
XXX
090
XXX
090
090
090
090
090
000
000
090
090
090
090
010
090
090
090
090
090
090
090
090
010
010
090
45947
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
Mod
66150 ..........
66155 ..........
66160 ..........
66165 ..........
66170 ..........
66172 ..........
66180 ..........
66185 ..........
66220 ..........
66225 ..........
66250 ..........
66500 ..........
66505 ..........
66600 ..........
66605 ..........
66625 ..........
66630 ..........
66635 ..........
66680 ..........
66682 ..........
66700 ..........
66710 ..........
66711 ..........
66720 ..........
66740 ..........
6761 ............
66762 ..........
66770 ..........
66820 ..........
66821 ..........
66825 ..........
66830 ..........
66840 ..........
66850 ..........
66852 ..........
66920 ..........
66930 ..........
66940 ..........
66982 ..........
66983 ..........
66984 ..........
66985 ..........
66986 ..........
66990 ..........
66999 ..........
67005 ..........
67010 ..........
67015 ..........
67025 ..........
67027 ..........
67028 ..........
67030 ..........
67031 ..........
67036 ..........
67038 ..........
67039 ..........
67040 ..........
67101 ..........
67105 ..........
67107 ..........
67108 ..........
67110 ..........
67112 ..........
67115 ..........
67120 ..........
67121 ..........
67141 ..........
67145 ..........
67208 ..........
67210 ..........
67218 ..........
67220 ..........
67221 ..........
67225 ..........
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
A
Physician
work
RVUs 3
Description
Glaucoma surgery .......................................
Glaucoma surgery .......................................
Glaucoma surgery .......................................
Glaucoma surgery .......................................
Glaucoma surgery .......................................
Incision of eye .............................................
Implant eye shunt ........................................
Revise eye shunt .........................................
Repair eye lesion ........................................
Repair/graft eye lesion ................................
Follow-up surgery of eye .............................
Incision of iris ..............................................
Incision of iris ..............................................
Remove iris and lesion ................................
Removal of iris ............................................
Removal of iris ............................................
Removal of iris ............................................
Removal of iris ............................................
Repair iris & ciliary body .............................
Repair iris & ciliary body .............................
Destruction, ciliary body ..............................
Ciliary transsleral therapy ............................
Ciliary endoscopic ablation .........................
Destruction, ciliary body ..............................
Destruction, ciliary body ..............................
Revision of iris .............................................
Revision of iris .............................................
Removal of inner eye lesion .......................
Incision, secondary cataract ........................
After cataract laser surgery .........................
Reposition intraocular lens ..........................
Removal of lens lesion ................................
Removal of lens material ............................
Removal of lens material ............................
Removal of lens material ............................
Extraction of lens .........................................
Extraction of lens .........................................
Extraction of lens .........................................
Cataract surgery, complex ..........................
Cataract surg w/iol, 1 stage ........................
Cataract surg w/iol, 1 stage ........................
Insert lens prosthesis ..................................
Exchange lens prosthesis ...........................
Ophthalmic endoscope add-on ...................
Eye surgery procedure ................................
Partial removal of eye fluid .........................
Partial removal of eye fluid .........................
Release of eye fluid ....................................
Replace eye fluid .........................................
Implant eye drug system .............................
Injection eye drug ........................................
Incise inner eye strands ..............................
Laser surgery, eye strands .........................
Removal of inner eye fluid ..........................
Strip retinal membrane ................................
Laser treatment of retina .............................
Laser treatment of retina .............................
Repair detached retina ................................
Repair detached retina ................................
Repair detached retina ................................
Repair detached retina ................................
Repair detached retina ................................
Rerepair detached retina .............................
Release encircling material .........................
Remove eye implant material .....................
Remove eye implant material .....................
Treatment of retina ......................................
Treatment of retina ......................................
Treatment of retinal lesion ..........................
Treatment of retinal lesion ..........................
Treatment of retinal lesion ..........................
Treatment of choroid lesion ........................
Ocular photodynamic ther ...........................
Eye photodynamic ther add-on ...................
8.31
8.30
10.17
8.02
12.16
15.05
14.56
8.15
7.78
11.05
5.98
3.71
4.08
8.69
12.80
5.13
6.16
6.25
5.44
6.21
4.78
4.78
6.61
4.78
4.78
4.07
4.58
5.18
3.89
2.35
8.24
8.21
7.92
9.12
9.98
8.87
10.18
8.94
13.51
9.00
10.23
8.40
12.28
1.51
0.00
5.70
6.87
6.92
6.84
10.85
2.53
4.84
3.67
11.89
21.25
14.53
17.23
7.54
7.41
14.85
20.83
8.82
16.86
4.99
5.98
10.67
5.20
5.37
6.70
8.83
18.54
13.14
4.01
0.47
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
11.17
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.20
5.03
NA
5.65
4.96
5.44
5.49
5.91
NA
3.97
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
8.89
NA
2.60
NA
4.46
NA
NA
NA
NA
8.91
7.88
NA
NA
9.91
NA
NA
8.27
NA
5.70
5.58
5.98
6.41
NA
10.16
4.15
0.25
Facility
PE
RVUs
9.16
9.11
9.93
9.01
11.92
14.84
10.51
7.20
6.93
8.54
5.37
4.49
4.84
8.01
9.77
4.63
5.59
5.62
5.15
6.42
3.87
3.77
6.35
4.63
3.89
4.23
4.20
4.70
5.58
3.52
8.76
6.80
6.71
7.47
7.92
7.13
7.96
7.43
9.65
6.09
7.27
7.30
8.98
0.67
0.00
4.77
5.30
6.29
6.09
7.82
1.43
5.70
3.56
8.91
15.11
11.87
13.34
6.39
6.02
11.06
14.10
7.23
11.54
4.97
5.42
8.34
4.76
4.83
5.40
5.75
11.83
8.81
1.79
0.21
Malpractice
RVUs
0.46
0.41
0.50
0.40
0.60
0.74
0.71
0.40
0.40
0.55
0.30
0.18
0.20
0.43
0.77
0.26
0.31
0.31
0.27
0.31
0.24
0.23
0.30
0.26
0.23
0.20
0.23
0.26
0.19
0.11
0.40
0.36
0.39
0.45
0.49
0.44
0.49
0.43
0.63
0.14
0.39
0.36
0.60
0.07
0.00
0.28
0.34
0.34
0.34
0.54
0.12
0.24
0.18
0.58
1.04
0.71
0.85
0.37
0.37
0.73
1.02
0.44
0.83
0.25
0.29
0.53
0.26
0.27
0.33
0.44
0.92
0.65
0.20
0.02
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00185
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
17.45
NA
NA
NA
NA
NA
NA
NA
NA
NA
10.21
10.04
NA
10.69
9.97
9.70
10.30
11.35
NA
6.44
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
16.08
NA
5.25
NA
8.31
NA
NA
NA
NA
16.81
15.67
NA
NA
19.16
NA
NA
14.54
NA
11.16
11.22
13.01
15.68
NA
23.94
8.35
0.74
Facility
total
17.93
17.81
20.60
17.42
24.68
30.63
25.78
15.75
15.11
20.14
11.65
8.38
9.12
17.12
23.34
10.02
12.06
12.18
10.86
12.95
8.88
8.78
13.26
9.67
8.90
8.49
9.01
10.14
9.66
5.98
17.40
15.36
15.01
17.04
18.39
16.44
18.63
16.80
23.79
15.23
17.89
16.06
21.86
2.26
0.00
10.75
12.52
13.55
13.27
19.21
4.08
10.78
7.41
21.38
37.40
27.11
31.43
14.30
13.80
26.64
35.95
16.49
29.24
10.21
11.69
19.54
10.22
10.47
12.43
15.02
31.29
22.60
6.00
0.70
Global
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
ZZZ
YYY
090
090
090
090
090
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
ZZZ
45948
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
67227
67228
67250
67255
67299
67311
67312
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67350
67399
67400
67405
67412
67413
67414
67415
67420
67430
67440
67445
67450
67500
67505
67515
67550
67560
67570
67599
67700
67710
67715
67800
67801
67805
67808
67810
67820
67825
67830
67835
67840
67850
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67909
67911
67912
67914
67915
67916
67917
67921
67922
67923
67924
67930
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Treatment of retinal lesion ..........................
Treatment of retinal lesion ..........................
Reinforce eye wall .......................................
Reinforce/graft eye wall ...............................
Eye surgery procedure ................................
Revise eye muscle ......................................
Revise two eye muscles .............................
Revise eye muscle ......................................
Revise two eye muscles .............................
Revise eye muscle(s) ..................................
Revise eye muscle(s) add-on .....................
Eye surgery follow-up add-on .....................
Rerevise eye muscles add-on .....................
Revise eye muscle w/suture .......................
Eye suture during surgery ...........................
Revise eye muscle add-on ..........................
Release eye tissue ......................................
Destroy nerve of eye muscle ......................
Biopsy eye muscle ......................................
Eye muscle surgery procedure ...................
Explore/biopsy eye socket ..........................
Explore/drain eye socket .............................
Explore/treat eye socket ..............................
Explore/treat eye socket ..............................
Explr/decompress eye socket .....................
Aspiration, orbital contents ..........................
Explore/treat eye socket ..............................
Explore/treat eye socket ..............................
Explore/drain eye socket .............................
Explr/decompress eye socket .....................
Explore/biopsy eye socket ..........................
Inject/treat eye socket .................................
Inject/treat eye socket .................................
Inject/treat eye socket .................................
Insert eye socket implant ............................
Revise eye socket implant ..........................
Decompress optic nerve .............................
Orbit surgery procedure ..............................
Drainage of eyelid abscess .........................
Incision of eyelid ..........................................
Incision of eyelid fold ...................................
Remove eyelid lesion ..................................
Remove eyelid lesions ................................
Remove eyelid lesions ................................
Remove eyelid lesion(s) ..............................
Biopsy of eyelid ...........................................
Revise eyelashes ........................................
Revise eyelashes ........................................
Revise eyelashes ........................................
Revise eyelashes ........................................
Remove eyelid lesion ..................................
Treat eyelid lesion .......................................
Closure of eyelid by suture .........................
Revision of eyelid ........................................
Revision of eyelid ........................................
Repair brow defect ......................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Revise eyelid defect ....................................
Revise eyelid defect ....................................
Correction eyelid w/implant .........................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid defect ....................................
Repair eyelid wound ....................................
6.58
12.75
8.67
8.91
0.00
6.65
8.55
7.53
9.67
7.86
4.33
4.06
4.49
3.98
2.49
4.93
7.35
2.97
2.88
0.00
9.77
7.94
9.51
10.01
11.13
1.76
20.07
13.40
13.10
14.43
13.52
0.79
0.82
0.61
10.19
10.60
13.59
0.00
1.35
1.02
1.22
1.38
1.88
2.22
3.80
1.48
0.89
1.38
1.70
5.56
2.04
1.69
1.35
3.80
5.07
6.14
6.97
7.03
6.37
6.26
6.79
5.13
5.40
5.27
5.68
3.68
3.19
5.31
6.02
3.40
3.07
5.88
5.79
3.61
Nonfacility
PE
RVUs
6.42
11.17
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.52
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.65
0.67
0.57
NA
NA
NA
0.00
5.70
5.07
5.09
1.58
1.91
2.46
NA
3.44
0.59
1.67
5.26
NA
5.22
3.41
3.13
6.35
7.35
8.72
NA
NA
9.07
9.25
NA
6.41
7.70
NA
17.75
6.06
5.70
7.74
8.14
5.91
5.63
7.82
8.56
5.47
Facility
PE
RVUs
5.40
8.35
8.85
9.54
0.00
5.88
6.60
6.41
7.33
6.78
1.90
1.79
1.97
1.75
1.09
2.15
6.37
1.97
1.84
0.00
10.83
9.42
10.47
10.36
11.56
0.74
16.76
14.29
13.73
13.40
14.17
0.28
0.30
0.37
10.89
10.97
13.08
0.00
1.24
1.18
1.26
1.02
1.23
1.61
3.69
0.67
0.56
1.38
1.47
4.52
1.62
1.45
0.92
3.71
4.70
5.11
5.26
5.32
5.33
5.11
4.92
5.19
4.82
4.66
5.37
2.99
2.74
4.65
4.95
2.83
2.70
4.86
4.58
2.12
Malpractice
RVUs
0.33
0.63
0.47
0.44
0.00
0.37
0.43
0.39
0.49
0.41
0.22
0.21
0.23
0.20
0.13
0.25
0.37
0.17
0.15
0.00
0.56
0.44
0.48
0.50
0.65
0.09
1.15
0.86
0.70
0.90
0.68
0.05
0.05
0.03
0.72
0.60
0.68
0.00
0.07
0.05
0.06
0.07
0.09
0.11
0.19
0.06
0.04
0.07
0.08
0.28
0.10
0.07
0.07
0.19
0.25
0.38
0.51
0.45
0.47
0.41
0.46
0.28
0.31
0.31
0.28
0.19
0.16
0.28
0.36
0.17
0.15
0.30
0.30
0.19
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00186
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
13.33
24.54
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.65
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.49
1.54
1.21
NA
NA
NA
0.00
7.12
6.14
6.37
3.03
3.89
4.79
NA
4.98
1.52
3.13
7.04
NA
7.37
5.17
4.56
10.34
12.67
15.24
NA
NA
15.92
15.92
NA
11.82
13.41
NA
23.71
9.92
9.05
13.33
14.52
9.48
8.84
14.00
14.65
9.26
Facility
total
12.32
21.73
17.98
18.89
0.00
12.91
15.58
14.32
17.49
15.05
6.45
6.05
6.69
5.93
3.72
7.33
14.09
5.10
4.86
0.00
21.16
17.80
20.46
20.87
23.34
2.60
37.98
28.55
27.52
28.73
28.36
1.12
1.17
1.01
21.80
22.17
27.35
0.00
2.66
2.25
2.54
2.47
3.21
3.95
7.68
2.22
1.49
2.84
3.25
10.36
3.76
3.21
2.35
7.70
10.02
11.63
12.74
12.80
12.17
11.78
12.17
10.60
10.53
10.24
11.33
6.85
6.09
10.24
11.33
6.40
5.91
11.04
10.67
5.91
Global
090
090
090
090
YYY
090
090
090
090
090
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
090
010
000
YYY
090
090
090
090
090
000
090
090
090
090
090
000
000
000
090
090
090
YYY
010
010
010
010
010
010
090
000
000
010
010
090
010
010
000
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
010
45949
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
67935
67938
67950
67961
67966
67971
67973
67974
67975
67999
68020
68040
68100
68110
68115
68130
68135
68200
68320
68325
68326
68328
68330
68335
68340
68360
68362
68371
68399
68400
68420
68440
68500
68505
68510
68520
68525
68530
68540
68550
68700
68705
68720
68745
68750
68760
68761
68770
68801
68810
68811
68815
68840
68850
68899
69000
69005
69020
69090
69100
69105
69110
69120
69140
69145
69150
69155
69200
69205
69210
69220
69222
69300
69310
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
N
A
A
A
A
A
A
A
A
A
A
A
A
A
R
A
Physician
work
RVUs 3
Description
Repair eyelid wound ....................................
Remove eyelid foreign body .......................
Revision of eyelid ........................................
Revision of eyelid ........................................
Revision of eyelid ........................................
Reconstruction of eyelid ..............................
Reconstruction of eyelid ..............................
Reconstruction of eyelid ..............................
Reconstruction of eyelid ..............................
Revision of eyelid ........................................
Incise/drain eyelid lining ..............................
Treatment of eyelid lesions .........................
Biopsy of eyelid lining .................................
Remove eyelid lining lesion ........................
Remove eyelid lining lesion ........................
Remove eyelid lining lesion ........................
Remove eyelid lining lesion ........................
Treat eyelid by injection ..............................
Revise/graft eyelid lining .............................
Revise/graft eyelid lining .............................
Revise/graft eyelid lining .............................
Revise/graft eyelid lining .............................
Revise eyelid lining .....................................
Revise/graft eyelid lining .............................
Separate eyelid adhesions ..........................
Revise eyelid lining .....................................
Revise eyelid lining .....................................
Harvest eye tissue, alograft ........................
Eyelid lining surgery ....................................
Incise/drain tear gland .................................
Incise/drain tear sac ....................................
Incise tear duct opening ..............................
Removal of tear gland .................................
Partial removal, tear gland ..........................
Biopsy of tear gland ....................................
Removal of tear sac ....................................
Biopsy of tear sac .......................................
Clearance of tear duct .................................
Remove tear gland lesion ...........................
Remove tear gland lesion ...........................
Repair tear ducts .........................................
Revise tear duct opening ............................
Create tear sac drain ..................................
Create tear duct drain .................................
Create tear duct drain .................................
Close tear duct opening ..............................
Close tear duct opening ..............................
Close tear system fistula .............................
Dilate tear duct opening ..............................
Probe nasolacrimal duct ..............................
Probe nasolacrimal duct ..............................
Probe nasolacrimal duct ..............................
Explore/irrigate tear ducts ...........................
Injection for tear sac x-ray ..........................
Tear duct system surgery ...........................
Drain external ear lesion .............................
Drain external ear lesion .............................
Drain outer ear canal lesion ........................
Pierce earlobes ...........................................
Biopsy of external ear .................................
Biopsy of external ear canal .......................
Remove external ear, partial .......................
Removal of external ear ..............................
Remove ear canal lesion(s) ........................
Remove ear canal lesion(s) ........................
Extensive ear canal surgery ........................
Extensive ear/neck surgery .........................
Clear outer ear canal ..................................
Clear outer ear canal ..................................
Remove impacted ear wax .........................
Clean out mastoid cavity .............................
Clean out mastoid cavity .............................
Revise external ear .....................................
Rebuild outer ear canal ...............................
6.22
1.33
5.82
5.69
6.57
9.80
12.88
12.85
9.14
0.00
1.37
0.85
1.35
1.77
2.36
4.93
1.84
0.49
5.37
7.36
7.15
8.19
4.83
7.19
4.17
4.37
7.34
4.90
0.00
1.69
2.30
0.94
11.02
10.94
4.61
7.52
4.43
3.66
10.60
13.27
6.60
2.06
8.97
8.64
8.67
1.73
1.36
7.02
0.94
1.90
2.35
3.21
1.25
0.80
0.00
1.45
2.11
1.48
0.00
0.81
0.85
3.44
4.05
7.98
2.63
13.44
20.81
0.77
1.20
0.61
0.83
1.40
6.36
10.79
Nonfacility
PE
RVUs
8.21
5.11
8.28
8.35
8.78
NA
NA
NA
NA
0.00
1.38
0.69
3.09
3.91
5.67
8.34
1.77
0.52
10.81
NA
NA
NA
9.00
NA
8.47
7.70
NA
NA
0.00
5.61
5.90
1.93
NA
NA
6.97
NA
NA
7.71
NA
NA
NA
3.97
NA
NA
NA
3.37
2.19
NA
1.90
3.55
NA
7.87
1.55
0.87
0.00
2.83
2.90
3.93
0.00
1.76
2.35
7.01
NA
NA
5.85
NA
NA
2.30
NA
0.62
2.34
3.80
0.00
NA
Facility
PE
RVUs
4.28
1.24
5.07
4.90
5.41
7.11
9.07
9.00
6.79
0.00
1.18
0.42
0.93
1.62
1.87
4.50
1.62
0.32
5.41
6.39
6.27
7.08
4.62
6.24
4.02
4.10
6.27
4.61
0.00
1.72
1.99
1.24
9.45
10.29
2.13
7.21
1.97
2.55
9.14
11.03
5.84
1.75
7.65
7.65
8.04
1.60
1.31
3.78
1.46
2.62
2.35
2.75
1.11
0.71
0.00
1.32
1.79
2.00
0.00
0.41
0.76
4.35
5.99
13.09
3.28
13.05
19.00
0.54
1.34
0.22
0.72
2.01
4.43
15.97
Malpractice
RVUs
0.39
0.06
0.36
0.33
0.37
0.53
0.75
0.75
0.50
0.00
0.06
0.04
0.07
0.09
0.12
0.24
0.09
0.02
0.27
0.44
0.35
0.54
0.24
0.36
0.21
0.22
0.36
0.44
0.00
0.08
0.11
0.05
0.55
0.55
0.23
0.37
0.22
0.18
0.52
0.80
0.32
0.10
0.44
0.52
0.43
0.09
0.06
0.35
0.05
0.10
0.13
0.17
0.06
0.04
0.00
0.12
0.17
0.12
0.00
0.03
0.07
0.30
0.38
0.65
0.21
1.22
1.92
0.06
0.10
0.05
0.07
0.12
0.72
0.85
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00187
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
14.82
6.50
14.46
14.37
15.72
NA
NA
NA
NA
0.00
2.81
1.59
4.51
5.78
8.15
13.51
3.70
1.03
16.45
NA
NA
NA
14.07
NA
12.85
12.29
NA
NA
0.00
7.38
8.31
2.92
NA
NA
11.81
NA
NA
11.55
NA
NA
NA
6.13
NA
NA
NA
5.19
3.62
NA
2.89
5.56
NA
11.25
2.86
1.71
0.00
4.41
5.18
5.54
0.00
2.61
3.27
10.75
NA
NA
8.68
NA
NA
3.13
NA
1.28
3.24
5.32
7.08
NA
Facility
total
10.89
2.63
11.25
10.92
12.35
17.44
22.69
22.59
16.43
0.00
2.62
1.31
2.36
3.48
4.36
9.67
3.55
0.83
11.05
14.19
13.77
15.81
9.69
13.80
8.39
8.68
13.97
9.95
0.00
3.49
4.40
2.23
21.02
21.78
6.97
15.09
6.62
6.39
20.26
25.09
12.76
3.92
17.05
16.80
17.14
3.42
2.73
11.15
2.45
4.62
4.84
6.12
2.42
1.55
0.00
2.90
4.07
3.60
0.00
1.25
1.68
8.09
10.42
21.72
6.11
27.71
41.73
1.37
2.64
0.88
1.62
3.53
11.51
27.61
Global
090
010
090
090
090
090
090
090
090
YYY
010
000
000
010
010
090
010
000
090
090
090
090
090
090
090
090
090
010
YYY
010
010
010
090
090
000
090
000
010
090
090
090
010
090
090
090
010
010
090
010
010
010
010
010
000
YYY
010
010
010
XXX
000
000
090
090
090
090
090
090
000
010
000
000
010
YYY
090
45950
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
69320
69399
69400
69401
69405
69410
69420
69421
69424
69433
69436
69440
69450
69501
69502
69505
69511
69530
69535
69540
69550
69552
69554
69601
69602
69603
69604
69605
69610
69620
69631
69632
69633
69635
69636
69637
69641
69642
69643
69644
69645
69646
69650
69660
69661
69662
69666
69667
69670
69676
69700
69710
69711
69714
69715
69717
69718
69720
69725
69740
69745
69799
69801
69802
69805
69806
69820
69840
69905
69910
69915
69930
69949
69950
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
C
A
Physician
work
RVUs 3
Description
Rebuild outer ear canal ...............................
Outer ear surgery procedure .......................
Inflate middle ear canal ...............................
Inflate middle ear canal ...............................
Catheterize middle ear canal ......................
Inset middle ear (baffle) ..............................
Incision of eardrum ......................................
Incision of eardrum ......................................
Remove ventilating tube ..............................
Create eardrum opening .............................
Create eardrum opening .............................
Exploration of middle ear ............................
Eardrum revision .........................................
Mastoidectomy ............................................
Mastoidectomy ............................................
Remove mastoid structures ........................
Extensive mastoid surgery ..........................
Extensive mastoid surgery ..........................
Remove part of temporal bone ...................
Remove ear lesion ......................................
Remove ear lesion ......................................
Remove ear lesion ......................................
Remove ear lesion ......................................
Mastoid surgery revision .............................
Mastoid surgery revision .............................
Mastoid surgery revision .............................
Mastoid surgery revision .............................
Mastoid surgery revision .............................
Repair of eardrum .......................................
Repair of eardrum .......................................
Repair eardrum structures ..........................
Rebuild eardrum structures .........................
Rebuild eardrum structures .........................
Repair eardrum structures ..........................
Rebuild eardrum structures .........................
Rebuild eardrum structures .........................
Revise middle ear & mastoid ......................
Revise middle ear & mastoid ......................
Revise middle ear & mastoid ......................
Revise middle ear & mastoid ......................
Revise middle ear & mastoid ......................
Revise middle ear & mastoid ......................
Release middle ear bone ............................
Revise middle ear bone ..............................
Revise middle ear bone ..............................
Revise middle ear bone ..............................
Repair middle ear structures .......................
Repair middle ear structures .......................
Remove mastoid air cells ............................
Remove middle ear nerve ...........................
Close mastoid fistula ...................................
Implant/replace hearing aid .........................
Remove/repair hearing aid ..........................
Implant temple bone w/stimul .....................
Temple bne implnt w/stimulat .....................
Temple bone implant revision .....................
Revise temple bone implant ........................
Release facial nerve ....................................
Release facial nerve ....................................
Repair facial nerve ......................................
Repair facial nerve ......................................
Middle ear surgery procedure .....................
Incise inner ear ............................................
Incise inner ear ............................................
Explore inner ear .........................................
Explore inner ear .........................................
Establish inner ear window .........................
Revise inner ear window .............................
Remove inner ear ........................................
Remove inner ear & mastoid ......................
Incise inner ear nerve .................................
Implant cochlear device ..............................
Inner ear surgery procedure .......................
Incise inner ear nerve .................................
16.96
0.00
0.83
0.63
2.64
0.33
1.33
1.73
0.85
1.52
1.96
7.58
5.57
9.08
12.38
13.00
13.53
19.20
36.16
1.20
10.99
19.47
33.18
13.25
13.59
14.03
14.03
18.50
4.43
5.89
9.87
12.76
12.10
13.34
15.23
15.12
12.72
16.84
15.33
16.97
16.39
18.00
9.67
11.90
15.75
15.45
9.76
9.77
11.51
9.53
8.24
0.00
10.44
14.01
18.26
14.99
18.51
14.39
25.39
15.97
16.69
0.00
8.57
13.11
13.83
12.35
10.34
10.26
11.10
13.64
21.24
16.81
0.00
25.65
Nonfacility
PE
RVUs
NA
0.00
2.20
1.27
3.49
2.06
3.12
NA
2.16
3.07
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.69
NA
NA
NA
NA
NA
NA
NA
NA
5.43
10.93
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
Facility
PE
RVUs
21.39
0.00
0.67
0.64
2.26
0.48
1.57
2.10
0.67
1.62
2.22
8.74
7.04
8.89
11.46
16.86
17.13
21.15
31.12
1.93
14.61
20.18
29.40
12.52
13.10
17.92
13.49
20.72
3.19
6.17
11.14
13.35
12.97
16.44
18.98
18.91
12.67
16.10
14.66
20.00
19.64
20.38
9.84
11.04
14.47
13.54
9.90
9.90
11.57
10.65
9.06
0.00
10.65
12.46
14.75
14.01
14.97
14.34
19.77
13.13
14.67
0.00
9.41
12.21
11.70
10.92
11.04
12.73
11.23
11.72
16.16
14.44
0.00
18.47
Malpractice
RVUs
1.37
0.00
0.07
0.05
0.21
0.03
0.11
0.15
0.07
0.13
0.19
0.61
0.45
0.73
1.00
1.05
1.09
1.54
2.92
0.10
0.89
1.59
2.91
1.07
1.10
1.14
1.14
1.50
0.36
0.48
0.80
1.03
0.98
1.08
1.23
1.22
1.03
1.36
1.24
1.37
1.33
1.46
0.78
0.96
1.27
1.25
0.79
0.79
0.93
0.81
0.67
0.00
0.83
1.13
1.48
0.90
3.21
1.16
2.44
1.27
1.14
0.00
0.69
1.06
1.12
1.00
0.90
0.79
0.90
1.07
1.69
1.36
0.00
2.28
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00188
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
0.00
3.11
1.95
6.33
2.42
4.56
NA
3.09
4.72
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.99
NA
NA
NA
NA
NA
NA
NA
NA
10.22
17.30
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
NA
Facility
total
39.72
0.00
1.57
1.32
5.10
0.84
3.01
3.98
1.60
3.27
4.37
16.93
13.06
18.70
24.85
30.90
31.75
41.89
70.20
3.23
26.49
41.23
65.48
26.84
27.79
33.08
28.66
40.71
7.98
12.54
21.81
27.14
26.05
30.86
35.44
35.25
26.41
34.30
31.23
38.35
37.36
39.83
20.29
23.91
31.49
30.24
20.45
20.46
24.01
20.99
17.97
0.00
21.92
27.60
34.49
29.90
36.69
29.89
47.60
30.37
32.50
0.00
18.67
26.37
26.64
24.27
22.28
23.78
23.23
26.42
39.09
32.61
0.00
46.40
Global
090
YYY
000
000
010
000
010
010
000
010
010
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
090
010
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
XXX
090
090
090
090
090
090
090
090
090
YYY
090
090
090
090
090
090
090
090
090
090
YYY
090
45951
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
69955
69960
69970
69979
69990
70010
70010
70010
70015
70015
70015
70030
70030
70030
70100
70100
70100
70110
70110
70110
70120
70120
70120
70130
70130
70130
70134
70134
70134
70140
70140
70140
70150
70150
70150
70160
70160
70160
70170
70170
70170
70190
70190
70190
70200
70200
70200
70210
70210
70210
70220
70220
70220
70240
70240
70240
70250
70250
70250
70260
70260
70260
70300
70300
70300
70310
70310
70310
70320
70320
70320
70328
70328
70328
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
C
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Release facial nerve ....................................
Release inner ear canal ..............................
Remove inner ear lesion .............................
Temporal bone surgery ...............................
Microsurgery add-on ...................................
Contrast x-ray of brain ................................
Contrast x-ray of brain ................................
Contrast x-ray of brain ................................
Contrast x-ray of brain ................................
Contrast x-ray of brain ................................
Contrast x-ray of brain ................................
X-ray eye for foreign body ..........................
X-ray eye for foreign body ..........................
X-ray eye for foreign body ..........................
X-ray exam of jaw .......................................
X-ray exam of jaw .......................................
X-ray exam of jaw .......................................
X-ray exam of jaw .......................................
X-ray exam of jaw .......................................
X-ray exam of jaw .......................................
X-ray exam of mastoids ..............................
X-ray exam of mastoids ..............................
X-ray exam of mastoids ..............................
X-ray exam of mastoids ..............................
X-ray exam of mastoids ..............................
X-ray exam of mastoids ..............................
X-ray exam of middle ear ............................
X-ray exam of middle ear ............................
X-ray exam of middle ear ............................
X-ray exam of facial bones .........................
X-ray exam of facial bones .........................
X-ray exam of facial bones .........................
X-ray exam of facial bones .........................
X-ray exam of facial bones .........................
X-ray exam of facial bones .........................
X-ray exam of nasal bones .........................
X-ray exam of nasal bones .........................
X-ray exam of nasal bones .........................
X-ray exam of tear duct ..............................
X-ray exam of tear duct ..............................
X-ray exam of tear duct ..............................
X-ray exam of eye sockets .........................
X-ray exam of eye sockets .........................
X-ray exam of eye sockets .........................
X-ray exam of eye sockets .........................
X-ray exam of eye sockets .........................
X-ray exam of eye sockets .........................
X-ray exam of sinuses ................................
X-ray exam of sinuses ................................
X-ray exam of sinuses ................................
X-ray exam of sinuses ................................
X-ray exam of sinuses ................................
X-ray exam of sinuses ................................
X-ray exam, pituitary saddle .......................
X-ray exam, pituitary saddle .......................
X-ray exam, pituitary saddle .......................
X-ray exam of skull .....................................
X-ray exam of skull .....................................
X-ray exam of skull .....................................
X-ray exam of skull .....................................
X-ray exam of skull .....................................
X-ray exam of skull .....................................
X-ray exam of teeth .....................................
X-ray exam of teeth .....................................
X-ray exam of teeth .....................................
X-ray exam of teeth .....................................
X-ray exam of teeth .....................................
X-ray exam of teeth .....................................
Full mouth x-ray of teeth .............................
Full mouth x-ray of teeth .............................
Full mouth x-ray of teeth .............................
X-ray exam of jaw joint ...............................
X-ray exam of jaw joint ...............................
X-ray exam of jaw joint ...............................
27.05
27.05
30.05
0.00
3.47
1.19
1.19
0.00
1.19
1.19
0.00
0.17
0.17
0.00
0.18
0.18
0.00
0.25
0.25
0.00
0.18
0.18
0.00
0.34
0.34
0.00
0.34
0.34
0.00
0.19
0.19
0.00
0.26
0.26
0.00
0.17
0.17
0.00
0.30
0.30
0.00
0.21
0.21
0.00
0.28
0.28
0.00
0.17
0.17
0.00
0.25
0.25
0.00
0.19
0.19
0.00
0.24
0.24
0.00
0.34
0.34
0.00
0.10
0.10
0.00
0.16
0.16
0.00
0.22
0.22
0.00
0.18
0.18
0.00
Nonfacility
PE
RVUs
NA
NA
NA
0.00
NA
4.33
0.41
3.92
2.34
0.41
1.94
0.53
0.06
0.47
0.62
0.06
0.56
0.74
0.09
0.66
0.72
0.06
0.66
1.03
0.12
0.91
0.93
0.12
0.81
0.66
0.06
0.60
0.87
0.09
0.78
0.61
0.06
0.55
NA
0.11
NA
0.71
0.07
0.64
0.89
0.10
0.80
0.68
0.06
0.62
0.85
0.09
0.77
0.53
0.06
0.47
0.71
0.08
0.63
0.99
0.12
0.87
0.29
0.05
0.24
0.54
0.08
0.46
0.88
0.08
0.80
0.58
0.06
0.52
Facility
PE
RVUs
20.91
19.59
22.69
0.00
1.74
NA
0.41
NA
NA
0.41
NA
NA
0.06
NA
NA
0.06
NA
NA
0.09
NA
NA
0.06
NA
NA
0.12
NA
NA
0.12
NA
NA
0.06
NA
NA
0.09
NA
NA
0.06
NA
NA
0.11
NA
NA
0.07
NA
NA
0.10
NA
NA
0.06
NA
NA
0.09
NA
NA
0.06
NA
NA
0.08
NA
NA
0.12
NA
NA
0.05
NA
NA
0.08
NA
NA
0.08
NA
NA
0.06
NA
Malpractice
RVUs
2.48
2.17
2.41
0.00
0.89
0.27
0.05
0.22
0.16
0.08
0.08
0.03
0.01
0.02
0.03
0.01
0.02
0.05
0.01
0.04
0.05
0.01
0.04
0.07
0.02
0.05
0.07
0.02
0.05
0.05
0.01
0.04
0.06
0.01
0.05
0.03
0.01
0.02
0.07
0.01
0.06
0.05
0.01
0.04
0.06
0.01
0.05
0.05
0.01
0.04
0.06
0.01
0.05
0.03
0.01
0.02
0.05
0.01
0.04
0.08
0.02
0.06
0.03
0.01
0.02
0.03
0.01
0.02
0.06
0.01
0.05
0.03
0.01
0.02
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00189
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
0.00
NA
5.79
1.65
4.14
3.70
1.68
2.02
0.73
0.24
0.49
0.83
0.25
0.58
1.04
0.35
0.70
0.95
0.25
0.70
1.44
0.48
0.96
1.34
0.48
0.86
0.90
0.26
0.64
1.19
0.36
0.83
0.81
0.24
0.57
NA
0.42
NA
0.97
0.29
0.68
1.23
0.39
0.85
0.90
0.24
0.66
1.16
0.35
0.82
0.75
0.26
0.49
1.00
0.33
0.67
1.41
0.48
0.93
0.42
0.16
0.26
0.73
0.25
0.48
1.16
0.31
0.85
0.79
0.25
0.54
Facility
total
50.45
48.81
55.15
0.00
6.09
NA
1.65
NA
NA
1.68
NA
NA
0.24
NA
NA
0.25
NA
NA
0.35
NA
NA
0.25
NA
NA
0.48
NA
NA
0.48
NA
NA
0.26
NA
NA
0.36
NA
NA
0.24
NA
NA
0.42
NA
NA
0.29
NA
NA
0.39
NA
NA
0.24
NA
NA
0.35
NA
NA
0.26
NA
NA
0.33
NA
NA
0.48
NA
NA
0.16
NA
NA
0.25
NA
NA
0.31
NA
NA
0.25
NA
Global
090
090
090
YYY
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45952
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
70330
70330
70330
70332
70332
70332
70336
70336
70336
70350
70350
70350
70355
70355
70355
70360
70360
70360
70370
70370
70370
70371
70371
70371
70373
70373
70373
70380
70380
70380
70390
70390
70390
70450
70450
70450
70460
70460
70460
70470
70470
70470
70480
70480
70480
70481
70481
70481
70482
70482
70482
70486
70486
70486
70487
70487
70487
70488
70488
70488
70490
70490
70490
70491
70491
70491
70492
70492
70492
70496
70496
70496
70498
70498
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
X-ray exam of jaw joints ..............................
X-ray exam of jaw joints ..............................
X-ray exam of jaw joints ..............................
X-ray exam of jaw joint ...............................
X-ray exam of jaw joint ...............................
X-ray exam of jaw joint ...............................
Magnetic image, jaw joint ............................
Magnetic image, jaw joint ............................
Magnetic image, jaw joint ............................
X-ray head for orthodontia ..........................
X-ray head for orthodontia ..........................
X-ray head for orthodontia ..........................
Panoramic x-ray of jaws ..............................
Panoramic x-ray of jaws ..............................
Panoramic x-ray of jaws ..............................
X-ray exam of neck .....................................
X-ray exam of neck .....................................
X-ray exam of neck .....................................
Throat x-ray & fluoroscopy ..........................
Throat x-ray & fluoroscopy ..........................
Throat x-ray & fluoroscopy ..........................
Speech evaluation, complex .......................
Speech evaluation, complex .......................
Speech evaluation, complex .......................
Contrast x-ray of larynx ...............................
Contrast x-ray of larynx ...............................
Contrast x-ray of larynx ...............................
X-ray exam of salivary gland ......................
X-ray exam of salivary gland ......................
X-ray exam of salivary gland ......................
X-ray exam of salivary duct ........................
X-ray exam of salivary duct ........................
X-ray exam of salivary duct ........................
Ct head/brain w/o dye .................................
Ct head/brain w/o dye .................................
Ct head/brain w/o dye .................................
Ct head/brain w/dye ....................................
Ct head/brain w/dye ....................................
Ct head/brain w/dye ....................................
Ct head/brain w/o & w/dye ..........................
Ct head/brain w/o & w/dye ..........................
Ct head/brain w/o & w/dye ..........................
Ct orbit/ear/fossa w/o dye ...........................
Ct orbit/ear/fossa w/o dye ...........................
Ct orbit/ear/fossa w/o dye ...........................
Ct orbit/ear/fossa w/dye ..............................
Ct orbit/ear/fossa w/dye ..............................
Ct orbit/ear/fossa w/dye ..............................
Ct orbit/ear/fossa w/o&w/dye ......................
Ct orbit/ear/fossa w/o&w/dye ......................
Ct orbit/ear/fossa w/o&w/dye ......................
Ct maxillofacial w/o dye ..............................
Ct maxillofacial w/o dye ..............................
Ct maxillofacial w/o dye ..............................
Ct maxillofacial w/dye ..................................
Ct maxillofacial w/dye ..................................
Ct maxillofacial w/dye ..................................
Ct maxillofacial w/o & w/dye .......................
Ct maxillofacial w/o & w/dye .......................
Ct maxillofacial w/o & w/dye .......................
Ct soft tissue neck w/o dye .........................
Ct soft tissue neck w/o dye .........................
Ct soft tissue neck w/o dye .........................
Ct soft tissue neck w/dye ............................
Ct soft tissue neck w/dye ............................
Ct soft tissue neck w/dye ............................
Ct sft tsue nck w/o & w/dye ........................
Ct sft tsue nck w/o & w/dye ........................
Ct sft tsue nck w/o & w/dye ........................
Ct angiography, head ..................................
Ct angiography, head ..................................
Ct angiography, head ..................................
Ct angiography, neck ..................................
Ct angiography, neck ..................................
0.24
0.24
0.00
0.54
0.54
0.00
1.48
1.48
0.00
0.17
0.17
0.00
0.20
0.20
0.00
0.17
0.17
0.00
0.32
0.32
0.00
0.84
0.84
0.00
0.44
0.44
0.00
0.17
0.17
0.00
0.38
0.38
0.00
0.85
0.85
0.00
1.13
1.13
0.00
1.27
1.27
0.00
1.28
1.28
0.00
1.38
1.38
0.00
1.45
1.45
0.00
1.14
1.14
0.00
1.30
1.30
0.00
1.42
1.42
0.00
1.28
1.28
0.00
1.38
1.38
0.00
1.45
1.45
0.00
1.75
1.75
0.00
1.75
1.75
Nonfacility
PE
RVUs
0.98
0.08
0.89
2.14
0.21
1.94
11.68
0.51
11.16
0.42
0.07
0.35
0.56
0.07
0.48
0.50
0.06
0.44
1.52
0.11
1.42
2.22
0.29
1.93
1.86
0.15
1.71
0.77
0.06
0.71
2.07
0.13
1.94
4.94
0.29
4.65
6.12
0.39
5.74
7.58
0.44
7.14
5.94
0.44
5.50
7.04
0.47
6.57
8.49
0.50
7.99
5.48
0.39
5.09
6.63
0.45
6.18
8.20
0.49
7.72
5.44
0.44
4.99
6.59
0.47
6.12
8.14
0.50
7.64
12.21
0.60
11.62
12.31
0.60
Facility
PE
RVUs
NA
0.08
NA
NA
0.21
NA
NA
0.51
NA
NA
0.07
NA
NA
0.07
NA
NA
0.06
NA
NA
0.11
NA
NA
0.29
NA
NA
0.15
NA
NA
0.06
NA
NA
0.13
NA
NA
0.29
NA
NA
0.39
NA
NA
0.44
NA
NA
0.44
NA
NA
0.47
NA
NA
0.50
NA
NA
0.39
NA
NA
0.45
NA
NA
0.49
NA
NA
0.44
NA
NA
0.47
NA
NA
0.50
NA
NA
0.60
NA
NA
0.60
Malpractice
RVUs
0.06
0.01
0.05
0.14
0.02
0.12
0.66
0.07
0.59
0.03
0.01
0.02
0.05
0.01
0.04
0.03
0.01
0.02
0.08
0.01
0.07
0.16
0.04
0.12
0.13
0.02
0.11
0.05
0.01
0.04
0.13
0.02
0.11
0.29
0.04
0.25
0.35
0.05
0.30
0.43
0.06
0.37
0.31
0.06
0.25
0.36
0.06
0.30
0.43
0.06
0.37
0.30
0.05
0.25
0.36
0.06
0.30
0.43
0.06
0.37
0.31
0.06
0.25
0.36
0.06
0.30
0.43
0.06
0.37
0.66
0.08
0.58
0.66
0.08
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00190
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.28
0.33
0.94
2.83
0.77
2.06
13.82
2.07
11.75
0.62
0.25
0.37
0.81
0.28
0.52
0.70
0.24
0.46
1.92
0.44
1.49
3.22
1.17
2.05
2.43
0.61
1.82
0.99
0.24
0.75
2.58
0.53
2.05
6.09
1.18
4.90
7.61
1.57
6.04
9.28
1.77
7.51
7.53
1.78
5.75
8.78
1.92
6.87
10.38
2.02
8.36
6.93
1.58
5.34
8.30
1.81
6.48
10.06
1.97
8.09
7.03
1.78
5.24
8.33
1.92
6.42
10.02
2.01
8.01
14.63
2.43
12.20
14.73
2.43
Facility
total
NA
0.33
NA
NA
0.77
NA
NA
2.07
NA
NA
0.25
NA
NA
0.28
NA
NA
0.24
NA
NA
0.44
NA
NA
1.17
NA
NA
0.61
NA
NA
0.24
NA
NA
0.53
NA
NA
1.18
NA
NA
1.57
NA
NA
1.77
NA
NA
1.78
NA
NA
1.92
NA
NA
2.02
NA
NA
1.58
NA
NA
1.81
NA
NA
1.97
NA
NA
1.78
NA
NA
1.92
NA
NA
2.01
NA
NA
2.43
NA
NA
2.43
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45953
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
70498
70540
70540
70540
70542
70542
70542
70543
70543
70543
70544
70544
70544
70545
70545
70545
70546
70546
70546
70547
70547
70547
70548
70548
70548
70549
70549
70549
70551
70551
70551
70552
70552
70552
70553
70553
70553
70557
70557
70557
70558
70558
70558
70559
70559
70559
71010
71010
71010
71015
71015
71015
71020
71020
71020
71021
71021
71021
71022
71022
71022
71023
71023
71023
71030
71030
71030
71034
71034
71034
71035
71035
71035
71040
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Ct angiography, neck ..................................
Mri orbit/face/neck w/o dye .........................
Mri orbit/face/neck w/o dye .........................
Mri orbit/face/neck w/o dye .........................
Mri orbit/face/neck w/dye ............................
Mri orbit/face/neck w/dye ............................
Mri orbit/face/neck w/dye ............................
Mri orbt/fac/nck w/o & w/dye .......................
Mri orbt/fac/nck w/o & w/dye .......................
Mri orbt/fac/nck w/o & w/dye .......................
Mr angiography head w/o dye ....................
Mr angiography head w/o dye ....................
Mr angiography head w/o dye ....................
Mr angiography head w/dye ........................
Mr angiography head w/dye ........................
Mr angiography head w/dye ........................
Mr angiograph head w/o&w/dye .................
Mr angiograph head w/o&w/dye .................
Mr angiograph head w/o&w/dye .................
Mr angiography neck w/o dye .....................
Mr angiography neck w/o dye .....................
Mr angiography neck w/o dye .....................
Mr angiography neck w/dye ........................
Mr angiography neck w/dye ........................
Mr angiography neck w/dye ........................
Mr angiograph neck w/o&w/dye ..................
Mr angiograph neck w/o&w/dye ..................
Mr angiograph neck w/o&w/dye ..................
Mri brain w/o dye .........................................
Mri brain w/o dye .........................................
Mri brain w/o dye .........................................
Mri brain w/dye ............................................
Mri brain w/dye ............................................
Mri brain w/dye ............................................
Mri brain w/o & w/dye .................................
Mri brain w/o & w/dye .................................
Mri brain w/o & w/dye .................................
Mri brain w/o dye .........................................
Mri brain w/o dye .........................................
Mri brain w/o dye .........................................
Mri brain w/dye ............................................
Mri brain w/dye ............................................
Mri brain w/dye ............................................
Mri brain w/o & w/dye .................................
Mri brain w/o & w/dye .................................
Mri brain w/o & w/dye .................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray and fluoroscopy .......................
Chest x-ray and fluoroscopy .......................
Chest x-ray and fluoroscopy .......................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray and fluoroscopy .......................
Chest x-ray and fluoroscopy .......................
Chest x-ray and fluoroscopy .......................
Chest x-ray ..................................................
Chest x-ray ..................................................
Chest x-ray ..................................................
Contrast x-ray of bronchi .............................
0.00
1.35
1.35
0.00
1.62
1.62
0.00
2.15
2.15
0.00
1.20
1.20
0.00
1.20
1.20
0.00
1.80
1.80
0.00
1.20
1.20
0.00
1.20
1.20
0.00
1.80
1.80
0.00
1.48
1.48
0.00
1.78
1.78
0.00
2.36
2.36
0.00
0.00
2.91
0.00
0.00
3.21
0.00
0.00
3.21
0.00
0.18
0.18
0.00
0.21
0.21
0.00
0.22
0.22
0.00
0.27
0.27
0.00
0.31
0.31
0.00
0.38
0.38
0.00
0.31
0.31
0.00
0.46
0.46
0.00
0.18
0.18
0.00
0.58
Nonfacility
PE
RVUs
11.71
12.19
0.46
11.73
14.04
0.56
13.48
23.46
0.74
22.71
12.25
0.42
11.83
12.22
0.41
11.81
22.67
0.62
22.05
12.23
0.41
11.82
12.55
0.41
12.13
22.83
0.62
22.21
12.02
0.51
11.51
14.21
0.62
13.59
23.54
0.82
22.72
0.00
1.16
0.00
0.00
1.28
0.00
0.00
1.27
0.00
0.50
0.06
0.44
0.55
0.07
0.48
0.68
0.08
0.60
0.81
0.10
0.72
0.83
0.11
0.73
1.08
0.14
0.94
0.92
0.11
0.82
1.72
0.17
1.55
0.66
0.06
0.59
1.86
Facility
PE
RVUs
NA
NA
0.46
NA
NA
0.56
NA
NA
0.74
NA
NA
0.42
NA
NA
0.41
NA
NA
0.62
NA
NA
0.41
NA
NA
0.41
NA
NA
0.62
NA
NA
0.51
NA
NA
0.62
NA
NA
0.82
NA
0.00
1.16
0.00
0.00
1.28
0.00
0.00
1.27
0.00
NA
0.06
NA
NA
0.07
NA
NA
0.08
NA
NA
0.10
NA
NA
0.11
NA
NA
0.14
NA
NA
0.11
NA
NA
0.17
NA
NA
0.06
NA
NA
Malpractice
RVUs
0.58
0.45
0.06
0.39
0.54
0.07
0.47
0.94
0.10
0.84
0.64
0.05
0.59
0.64
0.05
0.59
0.67
0.08
0.59
0.64
0.05
0.59
0.64
0.05
0.59
0.67
0.08
0.59
0.66
0.07
0.59
0.78
0.08
0.70
1.41
0.10
1.31
0.00
0.08
0.00
0.00
0.10
0.00
0.00
0.12
0.00
0.03
0.01
0.02
0.03
0.01
0.02
0.05
0.01
0.04
0.06
0.01
0.05
0.06
0.01
0.05
0.06
0.01
0.05
0.06
0.01
0.05
0.10
0.02
0.08
0.03
0.01
0.02
0.11
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00191
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
12.29
13.99
1.88
12.12
16.20
2.25
13.95
26.55
3.00
23.55
14.09
1.67
12.42
14.06
1.66
12.40
25.14
2.50
22.64
14.08
1.66
12.41
14.39
1.66
12.72
25.30
2.50
22.80
14.16
2.07
12.10
16.77
2.48
14.29
27.31
3.28
24.03
0.00
4.15
0.00
0.00
4.58
0.00
0.00
4.60
0.00
0.71
0.25
0.46
0.79
0.29
0.50
0.95
0.31
0.64
1.14
0.38
0.77
1.20
0.43
0.78
1.52
0.53
0.99
1.29
0.43
0.87
2.28
0.65
1.63
0.87
0.25
0.61
2.55
Facility
total
NA
NA
1.88
NA
NA
2.25
NA
NA
3.00
NA
NA
1.67
NA
NA
1.66
NA
NA
2.50
NA
NA
1.66
NA
NA
1.66
NA
NA
2.50
NA
NA
2.07
NA
NA
2.48
NA
NA
3.28
NA
0.00
4.15
0.00
0.00
4.58
0.00
0.00
4.60
0.00
NA
0.25
NA
NA
0.29
NA
NA
0.31
NA
NA
0.38
NA
NA
0.43
NA
NA
0.53
NA
NA
0.43
NA
NA
0.65
NA
NA
0.25
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45954
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
71040
71040
71060
71060
71060
71090
71090
71090
71100
71100
71100
71101
71101
71101
71110
71110
71110
71111
71111
71111
71120
71120
71120
71130
71130
71130
71250
71250
71250
71260
71260
71260
71270
71270
71270
71275
71275
71275
71550
71550
71550
71551
71551
71551
71552
71552
71552
71555
71555
71555
72010
72010
72010
72020
72020
72020
72040
72040
72040
72050
72050
72050
72052
72052
72052
72069
72069
72069
72070
72070
72070
72072
72072
72072
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Contrast x-ray of bronchi .............................
Contrast x-ray of bronchi .............................
Contrast x-ray of bronchi .............................
Contrast x-ray of bronchi .............................
Contrast x-ray of bronchi .............................
X-ray & pacemaker insertion .......................
X-ray & pacemaker insertion .......................
X-ray & pacemaker insertion .......................
X-ray exam of ribs .......................................
X-ray exam of ribs .......................................
X-ray exam of ribs .......................................
X-ray exam of ribs/chest .............................
X-ray exam of ribs/chest .............................
X-ray exam of ribs/chest .............................
X-ray exam of ribs .......................................
X-ray exam of ribs .......................................
X-ray exam of ribs .......................................
X-ray exam of ribs/chest .............................
X-ray exam of ribs/chest .............................
X-ray exam of ribs/chest .............................
X-ray exam of breastbone ...........................
X-ray exam of breastbone ...........................
X-ray exam of breastbone ...........................
X-ray exam of breastbone ...........................
X-ray exam of breastbone ...........................
X-ray exam of breastbone ...........................
Ct thorax w/o dye ........................................
Ct thorax w/o dye ........................................
Ct thorax w/o dye ........................................
Ct thorax w/dye ...........................................
Ct thorax w/dye ...........................................
Ct thorax w/dye ...........................................
Ct thorax w/o & w/dye .................................
Ct thorax w/o & w/dye .................................
Ct thorax w/o & w/dye .................................
Ct angiography, chest .................................
Ct angiography, chest .................................
Ct angiography, chest .................................
Mri chest w/o dye ........................................
Mri chest w/o dye ........................................
Mri chest w/o dye ........................................
Mri chest w/dye ...........................................
Mri chest w/dye ...........................................
Mri chest w/dye ...........................................
Mri chest w/o & w/dye .................................
Mri chest w/o & w/dye .................................
Mri chest w/o & w/dye .................................
Mri angio chest w or w/o dye ......................
Mri angio chest w or w/o dye ......................
Mri angio chest w or w/o dye ......................
X-ray exam of spine ....................................
X-ray exam of spine ....................................
X-ray exam of spine ....................................
X-ray exam of spine ....................................
X-ray exam of spine ....................................
X-ray exam of spine ....................................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of neck spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
0.58
0.00
0.74
0.74
0.00
0.54
0.54
0.00
0.22
0.22
0.00
0.27
0.27
0.00
0.27
0.27
0.00
0.32
0.32
0.00
0.20
0.20
0.00
0.22
0.22
0.00
1.16
1.16
0.00
1.24
1.24
0.00
1.38
1.38
0.00
1.92
1.92
0.00
1.46
1.46
0.00
1.73
1.73
0.00
2.26
2.26
0.00
1.81
1.81
0.00
0.45
0.45
0.00
0.15
0.15
0.00
0.22
0.22
0.00
0.31
0.31
0.00
0.36
0.36
0.00
0.22
0.22
0.00
0.22
0.22
0.00
0.22
0.22
0.00
Nonfacility
PE
RVUs
0.20
1.66
2.68
0.25
2.42
NA
0.22
NA
0.65
0.08
0.58
0.78
0.10
0.68
0.87
0.09
0.77
1.03
0.11
0.93
0.72
0.07
0.64
0.79
0.08
0.72
6.29
0.40
5.89
7.63
0.43
7.20
9.45
0.47
8.98
12.83
0.66
12.17
12.57
0.50
12.07
14.97
0.60
14.37
24.34
0.78
23.56
12.49
0.63
11.86
1.29
0.16
1.13
0.48
0.05
0.43
0.71
0.08
0.63
1.04
0.11
0.93
1.32
0.13
1.20
0.64
0.08
0.56
0.72
0.08
0.65
0.82
0.08
0.75
Facility
PE
RVUs
0.20
NA
NA
0.25
NA
NA
0.22
NA
NA
0.08
NA
NA
0.10
NA
NA
0.09
NA
NA
0.11
NA
NA
0.07
NA
NA
0.08
NA
NA
0.40
NA
NA
0.43
NA
NA
0.47
NA
NA
0.66
NA
NA
0.50
NA
NA
0.60
NA
NA
0.78
NA
NA
0.63
NA
NA
0.16
NA
NA
0.05
NA
NA
0.08
NA
NA
0.11
NA
NA
0.13
NA
NA
0.08
NA
NA
0.08
NA
NA
0.08
NA
Malpractice
RVUs
0.03
0.08
0.16
0.03
0.13
0.13
0.02
0.11
0.05
0.01
0.04
0.05
0.01
0.04
0.06
0.01
0.05
0.07
0.01
0.06
0.05
0.01
0.04
0.05
0.01
0.04
0.36
0.05
0.31
0.42
0.05
0.37
0.52
0.06
0.46
0.48
0.09
0.39
0.51
0.06
0.45
0.60
0.08
0.52
0.78
0.10
0.68
0.67
0.08
0.59
0.08
0.02
0.06
0.03
0.01
0.02
0.05
0.01
0.04
0.07
0.01
0.06
0.08
0.02
0.06
0.03
0.01
0.02
0.05
0.01
0.04
0.06
0.01
0.05
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00192
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.81
1.74
3.58
1.02
2.55
NA
0.78
NA
0.92
0.31
0.62
1.10
0.38
0.72
1.20
0.37
0.82
1.43
0.44
0.99
0.97
0.28
0.68
1.06
0.31
0.76
7.81
1.61
6.20
9.30
1.72
7.57
11.35
1.92
9.44
15.23
2.68
12.56
14.55
2.03
12.52
17.30
2.41
14.89
27.38
3.14
24.24
14.97
2.52
12.45
1.82
0.63
1.19
0.66
0.21
0.45
0.98
0.31
0.67
1.42
0.43
0.99
1.76
0.51
1.26
0.89
0.31
0.58
0.99
0.31
0.69
1.10
0.31
0.80
Facility
total
0.81
NA
NA
1.02
NA
NA
0.78
NA
NA
0.31
NA
NA
0.38
NA
NA
0.37
NA
NA
0.44
NA
NA
0.28
NA
NA
0.31
NA
NA
1.61
NA
NA
1.72
NA
NA
1.92
NA
NA
2.68
NA
NA
2.03
NA
NA
2.41
NA
NA
3.14
NA
NA
2.52
NA
NA
0.63
NA
NA
0.21
NA
NA
0.31
NA
NA
0.43
NA
NA
0.51
NA
NA
0.31
NA
NA
0.31
NA
NA
0.31
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45955
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
72074
72074
72074
72080
72080
72080
72090
72090
72090
72100
72100
72100
72110
72110
72110
72114
72114
72114
72120
72120
72120
72125
72125
72125
72126
72126
72126
72127
72127
72127
72128
72128
72128
72129
72129
72129
72130
72130
72130
72131
72131
72131
72132
72132
72132
72133
72133
72133
72141
72141
72141
72142
72142
72142
72146
72146
72146
72147
72147
72147
72148
72148
72148
72149
72149
72149
72156
72156
72156
72157
72157
72157
72158
72158
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
X-ray exam of thoracic spine ......................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of trunk spine ...........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
X-ray exam of lower spine ..........................
Ct neck spine w/o dye .................................
Ct neck spine w/o dye .................................
Ct neck spine w/o dye .................................
Ct neck spine w/dye ....................................
Ct neck spine w/dye ....................................
Ct neck spine w/dye ....................................
Ct neck spine w/o & w/dye .........................
Ct neck spine w/o & w/dye .........................
Ct neck spine w/o & w/dye .........................
Ct chest spine w/o dye ................................
Ct chest spine w/o dye ................................
Ct chest spine w/o dye ................................
Ct chest spine w/dye ...................................
Ct chest spine w/dye ...................................
Ct chest spine w/dye ...................................
Ct chest spine w/o & w/dye ........................
Ct chest spine w/o & w/dye ........................
Ct chest spine w/o & w/dye ........................
Ct lumbar spine w/o dye .............................
Ct lumbar spine w/o dye .............................
Ct lumbar spine w/o dye .............................
Ct lumbar spine w/dye ................................
Ct lumbar spine w/dye ................................
Ct lumbar spine w/dye ................................
Ct lumbar spine w/o & w/dye ......................
Ct lumbar spine w/o & w/dye ......................
Ct lumbar spine w/o & w/dye ......................
Mri neck spine w/o dye ...............................
Mri neck spine w/o dye ...............................
Mri neck spine w/o dye ...............................
Mri neck spine w/dye ..................................
Mri neck spine w/dye ..................................
Mri neck spine w/dye ..................................
Mri chest spine w/o dye ..............................
Mri chest spine w/o dye ..............................
Mri chest spine w/o dye ..............................
Mri chest spine w/dye .................................
Mri chest spine w/dye .................................
Mri chest spine w/dye .................................
Mri lumbar spine w/o dye ............................
Mri lumbar spine w/o dye ............................
Mri lumbar spine w/o dye ............................
Mri lumbar spine w/dye ...............................
Mri lumbar spine w/dye ...............................
Mri lumbar spine w/dye ...............................
Mri neck spine w/o & w/dye ........................
Mri neck spine w/o & w/dye ........................
Mri neck spine w/o & w/dye ........................
Mri chest spine w/o & w/dye .......................
Mri chest spine w/o & w/dye .......................
Mri chest spine w/o & w/dye .......................
Mri lumbar spine w/o & w/dye .....................
Mri lumbar spine w/o & w/dye .....................
0.22
0.22
0.00
0.22
0.22
0.00
0.28
0.28
0.00
0.22
0.22
0.00
0.31
0.31
0.00
0.36
0.36
0.00
0.22
0.22
0.00
1.16
1.16
0.00
1.22
1.22
0.00
1.27
1.27
0.00
1.16
1.16
0.00
1.22
1.22
0.00
1.27
1.27
0.00
1.16
1.16
0.00
1.22
1.22
0.00
1.27
1.27
0.00
1.60
1.60
0.00
1.92
1.92
0.00
1.60
1.60
0.00
1.92
1.92
0.00
1.48
1.48
0.00
1.78
1.78
0.00
2.58
2.58
0.00
2.58
2.58
0.00
2.36
2.36
Nonfacility
PE
RVUs
1.00
0.08
0.93
0.74
0.08
0.67
0.85
0.10
0.76
0.77
0.08
0.70
1.08
0.11
0.97
1.41
0.13
1.29
1.00
0.07
0.93
6.29
0.40
5.89
7.60
0.42
7.18
9.40
0.44
8.96
6.29
0.40
5.89
7.58
0.42
7.15
9.44
0.44
9.00
6.30
0.40
5.90
7.57
0.42
7.15
9.42
0.44
8.98
11.72
0.56
11.17
14.23
0.67
13.56
12.68
0.56
12.12
13.76
0.66
13.10
12.61
0.51
12.10
14.26
0.63
13.63
23.52
0.89
22.63
23.15
0.88
22.27
23.45
0.82
Facility
PE
RVUs
NA
0.08
NA
NA
0.08
NA
NA
0.10
NA
NA
0.08
NA
NA
0.11
NA
NA
0.13
NA
NA
0.07
NA
NA
0.40
NA
NA
0.42
NA
NA
0.44
NA
NA
0.40
NA
NA
0.42
NA
NA
0.44
NA
NA
0.40
NA
NA
0.42
NA
NA
0.44
NA
NA
0.56
NA
NA
0.67
NA
NA
0.56
NA
NA
0.66
NA
NA
0.51
NA
NA
0.63
NA
NA
0.89
NA
NA
0.88
NA
NA
0.82
Malpractice
RVUs
0.07
0.01
0.06
0.05
0.01
0.04
0.05
0.01
0.04
0.05
0.01
0.04
0.07
0.01
0.06
0.08
0.02
0.06
0.07
0.01
0.06
0.36
0.05
0.31
0.42
0.05
0.37
0.52
0.06
0.46
0.36
0.05
0.31
0.42
0.05
0.37
0.52
0.06
0.46
0.36
0.05
0.31
0.42
0.05
0.37
0.52
0.06
0.46
0.66
0.07
0.59
0.79
0.09
0.70
0.71
0.07
0.64
0.79
0.09
0.70
0.71
0.07
0.64
0.78
0.08
0.70
1.42
0.11
1.31
1.42
0.11
1.31
1.41
0.10
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00193
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.29
0.31
0.99
1.01
0.31
0.71
1.18
0.39
0.80
1.04
0.31
0.74
1.46
0.43
1.03
1.85
0.51
1.35
1.29
0.30
0.99
7.81
1.61
6.20
9.25
1.69
7.55
11.19
1.77
9.42
7.81
1.61
6.20
9.22
1.69
7.52
11.23
1.77
9.46
7.82
1.61
6.21
9.22
1.69
7.52
11.22
1.77
9.44
13.99
2.23
11.76
16.94
2.68
14.26
14.99
2.23
12.76
16.48
2.68
13.80
14.80
2.07
12.74
16.82
2.49
14.33
27.52
3.57
23.94
27.15
3.57
23.58
27.22
3.28
Facility
total
NA
0.31
NA
NA
0.31
NA
NA
0.39
NA
NA
0.31
NA
NA
0.43
NA
NA
0.51
NA
NA
0.30
NA
NA
1.61
NA
NA
1.69
NA
NA
1.77
NA
NA
1.61
NA
NA
1.69
NA
NA
1.77
NA
NA
1.61
NA
NA
1.69
NA
NA
1.77
NA
NA
2.23
NA
NA
2.68
NA
NA
2.23
NA
NA
2.68
NA
NA
2.07
NA
NA
2.49
NA
NA
3.57
NA
NA
3.57
NA
NA
3.28
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45956
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
72158
72159
72159
72159
72170
72170
72170
72190
72190
72190
72191
72191
72191
72192
72192
72192
72193
72193
72193
72194
72194
72194
72195
72195
72195
72196
72196
72196
72197
72197
72197
72198
72198
72198
72200
72200
72200
72202
72202
72202
72220
72220
72220
72240
72240
72240
72255
72255
72255
72265
72265
72265
72270
72270
72270
72275
72275
72275
72285
72285
72285
72295
72295
72295
73000
73000
73000
73010
73010
73010
73020
73020
73020
73030
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
N
N
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Mri lumbar spine w/o & w/dye .....................
Mr angio spine w/o&w/dye ..........................
Mr angio spine w/o&w/dye ..........................
Mr angio spine w/o&w/dye ..........................
X-ray exam of pelvis ...................................
X-ray exam of pelvis ...................................
X-ray exam of pelvis ...................................
X-ray exam of pelvis ...................................
X-ray exam of pelvis ...................................
X-ray exam of pelvis ...................................
Ct angiograph pelv w/o&w/dye ...................
Ct angiograph pelv w/o&w/dye ...................
Ct angiograph pelv w/o&w/dye ...................
Ct pelvis w/o dye .........................................
Ct pelvis w/o dye .........................................
Ct pelvis w/o dye .........................................
Ct pelvis w/dye ............................................
Ct pelvis w/dye ............................................
Ct pelvis w/dye ............................................
Ct pelvis w/o & w/dye ..................................
Ct pelvis w/o & w/dye ..................................
Ct pelvis w/o & w/dye ..................................
Mri pelvis w/o dye .......................................
Mri pelvis w/o dye .......................................
Mri pelvis w/o dye .......................................
Mri pelvis w/dye ...........................................
Mri pelvis w/dye ...........................................
Mri pelvis w/dye ...........................................
Mri pelvis w/o & w/dye ................................
Mri pelvis w/o & w/dye ................................
Mri pelvis w/o & w/dye ................................
Mr angio pelvis w/o & w/dye .......................
Mr angio pelvis w/o & w/dye .......................
Mr angio pelvis w/o & w/dye .......................
X-ray exam sacroiliac joints ........................
X-ray exam sacroiliac joints ........................
X-ray exam sacroiliac joints ........................
X-ray exam sacroiliac joints ........................
X-ray exam sacroiliac joints ........................
X-ray exam sacroiliac joints ........................
X-ray exam of tailbone ................................
X-ray exam of tailbone ................................
X-ray exam of tailbone ................................
Contrast x-ray of neck spine .......................
Contrast x-ray of neck spine .......................
Contrast x-ray of neck spine .......................
Contrast x-ray, thorax spine ........................
Contrast x-ray, thorax spine ........................
Contrast x-ray, thorax spine ........................
Contrast x-ray, lower spine .........................
Contrast x-ray, lower spine .........................
Contrast x-ray, lower spine .........................
Contrast x-ray, spine ...................................
Contrast x-ray, spine ...................................
Contrast x-ray, spine ...................................
Epidurography .............................................
Epidurography .............................................
Epidurography .............................................
X-ray c/t spine disk ......................................
X-ray c/t spine disk ......................................
X-ray c/t spine disk ......................................
X-ray of lower spine disk .............................
X-ray of lower spine disk .............................
X-ray of lower spine disk .............................
X-ray exam of collar bone ...........................
X-ray exam of collar bone ...........................
X-ray exam of collar bone ...........................
X-ray exam of shoulder blade .....................
X-ray exam of shoulder blade .....................
X-ray exam of shoulder blade .....................
X-ray exam of shoulder ...............................
X-ray exam of shoulder ...............................
X-ray exam of shoulder ...............................
X-ray exam of shoulder ...............................
0.00
1.80
1.80
0.00
0.17
0.17
0.00
0.21
0.21
0.00
1.81
1.81
0.00
1.09
1.09
0.00
1.16
1.16
0.00
1.22
1.22
0.00
1.46
1.46
0.00
1.73
1.73
0.00
2.26
2.26
0.00
1.80
1.80
0.00
0.17
0.17
0.00
0.19
0.19
0.00
0.17
0.17
0.00
0.91
0.91
0.00
0.91
0.91
0.00
0.83
0.83
0.00
1.33
1.33
0.00
0.76
0.76
0.00
1.16
1.16
0.00
0.83
0.83
0.00
0.16
0.16
0.00
0.17
0.17
0.00
0.15
0.15
0.00
0.18
Nonfacility
PE
RVUs
22.63
13.69
0.69
13.00
0.57
0.06
0.51
0.78
0.07
0.71
12.28
0.62
11.66
6.18
0.38
5.80
7.32
0.40
6.92
9.11
0.42
8.69
12.01
0.50
11.50
14.11
0.60
13.51
23.58
0.78
22.81
12.37
0.62
11.75
0.61
0.06
0.54
0.72
0.06
0.66
0.63
0.06
0.57
4.45
0.30
4.15
4.03
0.28
3.74
3.91
0.26
3.65
5.96
0.44
5.52
2.22
0.20
2.03
7.10
0.37
6.73
6.61
0.28
6.34
0.57
0.05
0.52
0.59
0.06
0.52
0.51
0.05
0.45
0.62
Facility
PE
RVUs
NA
NA
0.69
NA
NA
0.06
NA
NA
0.07
NA
NA
0.62
NA
NA
0.38
NA
NA
0.40
NA
NA
0.42
NA
NA
0.50
NA
NA
0.60
NA
NA
0.78
NA
NA
0.62
NA
NA
0.06
NA
NA
0.06
NA
NA
0.06
NA
NA
0.30
NA
NA
0.28
NA
NA
0.26
NA
NA
0.44
NA
NA
0.20
NA
NA
0.37
NA
NA
0.28
NA
NA
0.05
NA
NA
0.06
NA
NA
0.05
NA
NA
Malpractice
RVUs
1.31
0.74
0.10
0.64
0.03
0.01
0.02
0.05
0.01
0.04
0.47
0.08
0.39
0.36
0.05
0.31
0.41
0.05
0.36
0.48
0.05
0.43
0.51
0.06
0.45
0.60
0.08
0.52
1.02
0.10
0.92
0.67
0.08
0.59
0.03
0.01
0.02
0.05
0.01
0.04
0.05
0.01
0.04
0.29
0.04
0.25
0.26
0.04
0.22
0.26
0.04
0.22
0.39
0.06
0.33
0.26
0.04
0.22
0.50
0.07
0.43
0.46
0.06
0.40
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.05
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00194
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
23.94
16.23
2.59
13.64
0.77
0.24
0.53
1.04
0.29
0.75
14.56
2.52
12.05
7.63
1.52
6.11
8.89
1.61
7.28
10.81
1.69
9.12
13.98
2.03
11.95
16.44
2.41
14.03
26.87
3.14
23.73
14.85
2.50
12.34
0.81
0.24
0.56
0.96
0.26
0.70
0.85
0.24
0.61
5.66
1.25
4.40
5.20
1.23
3.96
5.00
1.13
3.87
7.68
1.83
5.85
3.25
1.00
2.25
8.76
1.60
7.16
7.90
1.17
6.74
0.76
0.22
0.54
0.79
0.24
0.54
0.69
0.21
0.47
0.85
Facility
total
NA
NA
2.59
NA
NA
0.24
NA
NA
0.29
NA
NA
2.52
NA
NA
1.52
NA
NA
1.61
NA
NA
1.69
NA
NA
2.03
NA
NA
2.41
NA
NA
3.14
NA
NA
2.50
NA
NA
0.24
NA
NA
0.26
NA
NA
0.24
NA
NA
1.25
NA
NA
1.23
NA
NA
1.13
NA
NA
1.83
NA
NA
1.00
NA
NA
1.60
NA
NA
1.17
NA
NA
0.22
NA
NA
0.24
NA
NA
0.21
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45957
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
73030
73030
73040
73040
73040
73050
73050
73050
73060
73060
73060
73070
73070
73070
73080
73080
73080
73085
73085
73085
73090
73090
73090
73092
73092
73092
73100
73100
73100
73110
73110
73110
73115
73115
73115
73120
73120
73120
73130
73130
73130
73140
73140
73140
73200
73200
73200
73201
73201
73201
73202
73202
73202
73206
73206
73206
73218
73218
73218
73219
73219
73219
73220
73220
73220
73221
73221
73221
73222
73222
73222
73223
73223
73223
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
X-ray exam of shoulder ...............................
X-ray exam of shoulder ...............................
Contrast x-ray of shoulder ...........................
Contrast x-ray of shoulder ...........................
Contrast x-ray of shoulder ...........................
X-ray exam of shoulders .............................
X-ray exam of shoulders .............................
X-ray exam of shoulders .............................
X-ray exam of humerus ...............................
X-ray exam of humerus ...............................
X-ray exam of humerus ...............................
X-ray exam of elbow ...................................
X-ray exam of elbow ...................................
X-ray exam of elbow ...................................
X-ray exam of elbow ...................................
X-ray exam of elbow ...................................
X-ray exam of elbow ...................................
Contrast x-ray of elbow ...............................
Contrast x-ray of elbow ...............................
Contrast x-ray of elbow ...............................
X-ray exam of forearm ................................
X-ray exam of forearm ................................
X-ray exam of forearm ................................
X-ray exam of arm, infant ...........................
X-ray exam of arm, infant ...........................
X-ray exam of arm, infant ...........................
X-ray exam of wrist .....................................
X-ray exam of wrist .....................................
X-ray exam of wrist .....................................
X-ray exam of wrist .....................................
X-ray exam of wrist .....................................
X-ray exam of wrist .....................................
Contrast x-ray of wrist .................................
Contrast x-ray of wrist .................................
Contrast x-ray of wrist .................................
X-ray exam of hand .....................................
X-ray exam of hand .....................................
X-ray exam of hand .....................................
X-ray exam of hand .....................................
X-ray exam of hand .....................................
X-ray exam of hand .....................................
X-ray exam of finger(s) ...............................
X-ray exam of finger(s) ...............................
X-ray exam of finger(s) ...............................
Ct upper extremity w/o dye .........................
Ct upper extremity w/o dye .........................
Ct upper extremity w/o dye .........................
Ct upper extremity w/dye ............................
Ct upper extremity w/dye ............................
Ct upper extremity w/dye ............................
Ct uppr extremity w/o&w/dye ......................
Ct uppr extremity w/o&w/dye ......................
Ct uppr extremity w/o&w/dye ......................
Ct angio upr extrm w/o&w/dye ....................
Ct angio upr extrm w/o&w/dye ....................
Ct angio upr extrm w/o&w/dye ....................
Mri upper extremity w/o dye ........................
Mri upper extremity w/o dye ........................
Mri upper extremity w/o dye ........................
Mri upper extremity w/dye ...........................
Mri upper extremity w/dye ...........................
Mri upper extremity w/dye ...........................
Mri uppr extremity w/o&w/dye .....................
Mri uppr extremity w/o&w/dye .....................
Mri uppr extremity w/o&w/dye .....................
Mri joint upr extrem w/o dye .......................
Mri joint upr extrem w/o dye .......................
Mri joint upr extrem w/o dye .......................
Mri joint upr extrem w/dye ...........................
Mri joint upr extrem w/dye ...........................
Mri joint upr extrem w/dye ...........................
Mri joint upr extr w/o&w/dye ........................
Mri joint upr extr w/o&w/dye ........................
Mri joint upr extr w/o&w/dye ........................
0.18
0.00
0.54
0.54
0.00
0.20
0.20
0.00
0.17
0.17
0.00
0.15
0.15
0.00
0.17
0.17
0.00
0.54
0.54
0.00
0.16
0.16
0.00
0.16
0.16
0.00
0.16
0.16
0.00
0.17
0.17
0.00
0.54
0.54
0.00
0.16
0.16
0.00
0.17
0.17
0.00
0.13
0.13
0.00
1.09
1.09
0.00
1.16
1.16
0.00
1.22
1.22
0.00
1.81
1.81
0.00
1.35
1.35
0.00
1.62
1.62
0.00
2.15
2.15
0.00
1.35
1.35
0.00
1.62
1.62
0.00
2.15
2.15
0.00
Nonfacility
PE
RVUs
0.06
0.56
2.30
0.19
2.11
0.74
0.07
0.67
0.63
0.06
0.57
0.57
0.05
0.52
0.67
0.06
0.61
2.20
0.19
2.01
0.58
0.05
0.53
0.56
0.05
0.51
0.55
0.05
0.50
0.65
0.06
0.59
1.95
0.19
1.76
0.56
0.05
0.51
0.62
0.06
0.56
0.52
0.04
0.47
5.54
0.38
5.16
6.72
0.40
6.32
8.51
0.42
8.09
11.18
0.62
10.56
11.98
0.46
11.52
14.47
0.56
13.90
23.76
0.75
23.02
11.84
0.46
11.38
13.74
0.56
13.18
23.20
0.74
22.46
Facility
PE
RVUs
0.06
NA
NA
0.19
NA
NA
0.07
NA
NA
0.06
NA
NA
0.05
NA
NA
0.06
NA
NA
0.19
NA
NA
0.05
NA
NA
0.05
NA
NA
0.05
NA
NA
0.06
NA
NA
0.19
NA
NA
0.05
NA
NA
0.06
NA
NA
0.04
NA
NA
0.38
NA
NA
0.40
NA
NA
0.42
NA
NA
0.62
NA
NA
0.46
NA
NA
0.56
NA
NA
0.75
NA
NA
0.46
NA
NA
0.56
NA
NA
0.74
NA
Malpractice
RVUs
0.01
0.04
0.14
0.02
0.12
0.05
0.01
0.04
0.05
0.01
0.04
0.03
0.01
0.02
0.05
0.01
0.04
0.14
0.02
0.12
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.12
0.02
0.10
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.30
0.05
0.25
0.36
0.05
0.31
0.44
0.05
0.39
0.47
0.08
0.39
0.45
0.06
0.39
0.54
0.07
0.47
0.94
0.10
0.84
0.45
0.06
0.39
0.54
0.07
0.47
0.94
0.10
0.84
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00195
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.25
0.60
2.99
0.75
2.23
0.99
0.28
0.71
0.85
0.24
0.61
0.75
0.21
0.54
0.89
0.24
0.65
2.88
0.75
2.13
0.77
0.22
0.55
0.75
0.22
0.53
0.74
0.22
0.52
0.85
0.24
0.61
2.61
0.75
1.86
0.75
0.22
0.53
0.82
0.24
0.58
0.68
0.18
0.49
6.93
1.52
5.41
8.24
1.61
6.63
10.17
1.69
8.48
13.47
2.51
10.95
13.78
1.88
11.91
16.63
2.26
14.37
26.86
3.00
23.86
13.64
1.88
11.77
15.91
2.25
13.65
26.30
3.00
23.30
Facility
total
0.25
NA
NA
0.75
NA
NA
0.28
NA
NA
0.24
NA
NA
0.21
NA
NA
0.24
NA
NA
0.75
NA
NA
0.22
NA
NA
0.22
NA
NA
0.22
NA
NA
0.24
NA
NA
0.75
NA
NA
0.22
NA
NA
0.24
NA
NA
0.18
NA
NA
1.52
NA
NA
1.61
NA
NA
1.69
NA
NA
2.51
NA
NA
1.88
NA
NA
2.26
NA
NA
3.00
NA
NA
1.88
NA
NA
2.25
NA
NA
3.00
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45958
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
73225
73225
73225
73500
73500
73500
73510
73510
73510
73520
73520
73520
73525
73525
73525
73530
73530
73530
73540
73540
73540
73542
73542
73542
73550
73550
73550
73560
73560
73560
73562
73562
73562
73564
73564
73564
73565
73565
73565
73580
73580
73580
73590
73590
73590
73592
73592
73592
73600
73600
73600
73610
73610
73610
73615
73615
73615
73620
73620
73620
73630
73630
73630
73650
73650
73650
73660
73660
73660
73700
73700
73700
73701
73701
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
N
N
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Mr angio upr extr w/o&w/dye ......................
Mr angio upr extr w/o&w/dye ......................
Mr angio upr extr w/o&w/dye ......................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of hips ......................................
X-ray exam of hips ......................................
X-ray exam of hips ......................................
Contrast x-ray of hip ....................................
Contrast x-ray of hip ....................................
Contrast x-ray of hip ....................................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of hip ........................................
X-ray exam of pelvis & hips ........................
X-ray exam of pelvis & hips ........................
X-ray exam of pelvis & hips ........................
X-ray exam, sacroiliac joint .........................
X-ray exam, sacroiliac joint .........................
X-ray exam, sacroiliac joint .........................
X-ray exam of thigh .....................................
X-ray exam of thigh .....................................
X-ray exam of thigh .....................................
X-ray exam of knee, 1 or 2 .........................
X-ray exam of knee, 1 or 2 .........................
X-ray exam of knee, 1 or 2 .........................
X-ray exam of knee, 3 .................................
X-ray exam of knee, 3 .................................
X-ray exam of knee, 3 .................................
X-ray exam, knee, 4 or more ......................
X-ray exam, knee, 4 or more ......................
X-ray exam, knee, 4 or more ......................
X-ray exam of knees ...................................
X-ray exam of knees ...................................
X-ray exam of knees ...................................
Contrast x-ray of knee joint .........................
Contrast x-ray of knee joint .........................
Contrast x-ray of knee joint .........................
X-ray exam of lower leg ..............................
X-ray exam of lower leg ..............................
X-ray exam of lower leg ..............................
X-ray exam of leg, infant .............................
X-ray exam of leg, infant .............................
X-ray exam of leg, infant .............................
X-ray exam of ankle ....................................
X-ray exam of ankle ....................................
X-ray exam of ankle ....................................
X-ray exam of ankle ....................................
X-ray exam of ankle ....................................
X-ray exam of ankle ....................................
Contrast x-ray of ankle ................................
Contrast x-ray of ankle ................................
Contrast x-ray of ankle ................................
X-ray exam of foot .......................................
X-ray exam of foot .......................................
X-ray exam of foot .......................................
X-ray exam of foot .......................................
X-ray exam of foot .......................................
X-ray exam of foot .......................................
X-ray exam of heel ......................................
X-ray exam of heel ......................................
X-ray exam of heel ......................................
X-ray exam of toe(s) ...................................
X-ray exam of toe(s) ...................................
X-ray exam of toe(s) ...................................
Ct lower extremity w/o dye ..........................
Ct lower extremity w/o dye ..........................
Ct lower extremity w/o dye ..........................
Ct lower extremity w/dye .............................
Ct lower extremity w/dye .............................
1.73
1.73
0.00
0.17
0.17
0.00
0.21
0.21
0.00
0.26
0.26
0.00
0.54
0.54
0.00
0.29
0.29
0.00
0.20
0.20
0.00
0.59
0.59
0.00
0.17
0.17
0.00
0.17
0.17
0.00
0.18
0.18
0.00
0.22
0.22
0.00
0.17
0.17
0.00
0.54
0.54
0.00
0.17
0.17
0.00
0.16
0.16
0.00
0.16
0.16
0.00
0.17
0.17
0.00
0.54
0.54
0.00
0.16
0.16
0.00
0.17
0.17
0.00
0.16
0.16
0.00
0.13
0.13
0.00
1.09
1.09
0.00
1.16
1.16
Nonfacility
PE
RVUs
12.75
0.66
12.09
0.52
0.06
0.46
0.69
0.07
0.61
0.78
0.09
0.69
2.24
0.19
2.06
NA
0.10
NA
0.67
0.07
0.60
2.05
0.16
1.89
0.62
0.06
0.56
0.59
0.06
0.52
0.66
0.06
0.59
0.74
0.08
0.67
0.57
0.06
0.50
2.71
0.18
2.53
0.58
0.06
0.52
0.56
0.05
0.51
0.55
0.05
0.50
0.62
0.06
0.56
2.19
0.19
2.01
0.53
0.05
0.48
0.61
0.06
0.54
0.53
0.05
0.48
0.51
0.04
0.47
5.54
0.38
5.16
6.68
0.40
Facility
PE
RVUs
NA
0.66
NA
NA
0.06
NA
NA
0.07
NA
NA
0.09
NA
NA
0.19
NA
NA
0.10
NA
NA
0.07
NA
NA
0.16
NA
NA
0.06
NA
NA
0.06
NA
NA
0.06
NA
NA
0.08
NA
NA
0.06
NA
NA
0.18
NA
NA
0.06
NA
NA
0.05
NA
NA
0.05
NA
NA
0.06
NA
NA
0.19
NA
NA
0.05
NA
NA
0.06
NA
NA
0.05
NA
NA
0.04
NA
NA
0.38
NA
NA
0.40
Malpractice
RVUs
0.69
0.10
0.59
0.03
0.01
0.02
0.05
0.01
0.04
0.05
0.01
0.04
0.15
0.03
0.12
0.03
0.01
0.02
0.05
0.01
0.04
0.15
0.03
0.12
0.05
0.01
0.04
0.03
0.01
0.02
0.05
0.01
0.04
0.05
0.01
0.04
0.03
0.01
0.02
0.17
0.03
0.14
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.15
0.03
0.12
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.30
0.05
0.25
0.36
0.05
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00196
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
15.17
2.50
12.68
0.72
0.24
0.48
0.95
0.29
0.65
1.09
0.36
0.73
2.94
0.76
2.18
NA
0.40
NA
0.92
0.28
0.64
2.79
0.78
2.01
0.84
0.24
0.60
0.79
0.24
0.54
0.89
0.25
0.63
1.01
0.31
0.71
0.77
0.24
0.52
3.42
0.75
2.67
0.78
0.24
0.54
0.75
0.22
0.53
0.74
0.22
0.52
0.82
0.24
0.58
2.89
0.76
2.13
0.72
0.22
0.50
0.81
0.24
0.56
0.72
0.22
0.50
0.67
0.18
0.49
6.93
1.52
5.41
8.20
1.61
Facility
total
NA
2.50
NA
NA
0.24
NA
NA
0.29
NA
NA
0.36
NA
NA
0.76
NA
NA
0.40
NA
NA
0.28
NA
NA
0.78
NA
NA
0.24
NA
NA
0.24
NA
NA
0.25
NA
NA
0.31
NA
NA
0.24
NA
NA
0.75
NA
NA
0.24
NA
NA
0.22
NA
NA
0.22
NA
NA
0.24
NA
NA
0.76
NA
NA
0.22
NA
NA
0.24
NA
NA
0.22
NA
NA
0.18
NA
NA
1.52
NA
NA
1.61
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45959
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
73701
73702
73702
73702
73706
73706
73706
73718
73718
73718
73719
73719
73719
73720
73720
73720
73721
73721
73721
73722
73722
73722
73723
73723
73723
73725
73725
73725
74000
74000
74000
74010
74010
74010
74020
74020
74020
74022
74022
74022
74150
74150
74150
74160
74160
74160
74170
74170
74170
74175
74175
74175
74181
74181
74181
74182
74182
74182
74183
74183
74183
74185
74185
74185
74190
74190
74190
74210
74210
74210
74220
74220
74220
74230
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Ct lower extremity w/dye .............................
Ct lwr extremity w/o&w/dye .........................
Ct lwr extremity w/o&w/dye .........................
Ct lwr extremity w/o&w/dye .........................
Ct angio lwr extr w/o&w/dye .......................
Ct angio lwr extr w/o&w/dye .......................
Ct angio lwr extr w/o&w/dye .......................
Mri lower extremity w/o dye ........................
Mri lower extremity w/o dye ........................
Mri lower extremity w/o dye ........................
Mri lower extremity w/dye ...........................
Mri lower extremity w/dye ...........................
Mri lower extremity w/dye ...........................
Mri lwr extremity w/o&w/dye .......................
Mri lwr extremity w/o&w/dye .......................
Mri lwr extremity w/o&w/dye .......................
Mri jnt of lwr extre w/o dye ..........................
Mri jnt of lwr extre w/o dye ..........................
Mri jnt of lwr extre w/o dye ..........................
Mri joint of lwr extr w/dye ............................
Mri joint of lwr extr w/dye ............................
Mri joint of lwr extr w/dye ............................
Mri joint lwr extr w/o&w/dye ........................
Mri joint lwr extr w/o&w/dye ........................
Mri joint lwr extr w/o&w/dye ........................
Mr ang lwr ext w or w/o dye .......................
Mr ang lwr ext w or w/o dye .......................
Mr ang lwr ext w or w/o dye ........................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam of abdomen ..............................
X-ray exam series, abdomen ......................
X-ray exam series, abdomen ......................
X-ray exam series, abdomen ......................
Ct abdomen w/o dye ...................................
Ct abdomen w/o dye ...................................
Ct abdomen w/o dye ...................................
Ct abdomen w/dye ......................................
Ct abdomen w/dye ......................................
Ct abdomen w/dye ......................................
Ct abdomen w/o & w/dye ............................
Ct abdomen w/o & w/dye ............................
Ct abdomen w/o & w/dye ............................
Ct angio abdom w/o & w/dye ......................
Ct angio abdom w/o & w/dye ......................
Ct angio abdom w/o & w/dye ......................
Mri abdomen w/o dye ..................................
Mri abdomen w/o dye ..................................
Mri abdomen w/o dye ..................................
Mri abdomen w/dye .....................................
Mri abdomen w/dye .....................................
Mri abdomen w/dye .....................................
Mri abdomen w/o & w/dye ..........................
Mri abdomen w/o & w/dye ..........................
Mri abdomen w/o & w/dye ..........................
Mri angio, abdom w orw/o dye ....................
Mri angio, abdom w orw/o dye ....................
Mri angio, abdom w orw/o dye ....................
X-ray exam of peritoneum ...........................
X-ray exam of peritoneum ...........................
X-ray exam of peritoneum ...........................
Contrst x-ray exam of throat .......................
Contrst x-ray exam of throat .......................
Contrst x-ray exam of throat .......................
Contrast x-ray, esophagus ..........................
Contrast x-ray, esophagus ..........................
Contrast x-ray, esophagus ..........................
Cine/vid x-ray, throat/esoph ........................
0.00
1.22
1.22
0.00
1.90
1.90
0.00
1.35
1.35
0.00
1.62
1.62
0.00
2.15
2.15
0.00
1.35
1.35
0.00
1.62
1.62
0.00
2.15
2.15
0.00
1.82
1.82
0.00
0.18
0.18
0.00
0.23
0.23
0.00
0.27
0.27
0.00
0.32
0.32
0.00
1.19
1.19
0.00
1.27
1.27
0.00
1.40
1.40
0.00
1.90
1.90
0.00
1.46
1.46
0.00
1.73
1.73
0.00
2.26
2.26
0.00
1.80
1.80
0.00
0.48
0.48
0.00
0.36
0.36
0.00
0.46
0.46
0.00
0.53
Nonfacility
PE
RVUs
6.28
8.40
0.42
7.98
11.68
0.65
11.03
11.94
0.46
11.48
13.98
0.56
13.43
23.69
0.74
22.96
11.94
0.46
11.48
13.75
0.56
13.19
23.23
0.74
22.48
12.54
0.63
11.91
0.57
0.06
0.50
0.71
0.08
0.63
0.75
0.10
0.65
0.89
0.11
0.78
6.02
0.41
5.61
7.66
0.44
7.22
9.77
0.48
9.29
12.48
0.65
11.83
11.66
0.50
11.15
14.55
0.60
13.96
23.60
0.78
22.82
12.41
0.62
11.79
NA
0.17
NA
1.45
0.13
1.33
1.57
0.16
1.41
1.63
Facility
PE
RVUs
NA
NA
0.42
NA
NA
0.65
NA
NA
0.46
NA
NA
0.56
NA
NA
0.74
NA
NA
0.46
NA
NA
0.56
NA
NA
0.74
NA
NA
0.63
NA
NA
0.06
NA
NA
0.08
NA
NA
0.10
NA
NA
0.11
NA
NA
0.41
NA
NA
0.44
NA
NA
0.48
NA
NA
0.65
NA
NA
0.50
NA
NA
0.60
NA
NA
0.78
NA
NA
0.62
NA
NA
0.17
NA
NA
0.13
NA
NA
0.16
NA
NA
Malpractice
RVUs
0.31
0.44
0.05
0.39
0.47
0.08
0.39
0.45
0.06
0.39
0.54
0.07
0.47
0.94
0.10
0.84
0.45
0.06
0.39
0.54
0.07
0.47
0.94
0.10
0.84
0.67
0.08
0.59
0.03
0.01
0.02
0.05
0.01
0.04
0.05
0.01
0.04
0.06
0.01
0.05
0.35
0.05
0.30
0.42
0.06
0.36
0.49
0.06
0.43
0.47
0.08
0.39
0.51
0.06
0.45
0.60
0.08
0.52
1.02
0.10
0.92
0.67
0.08
0.59
0.09
0.02
0.07
0.08
0.02
0.06
0.08
0.02
0.06
0.09
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00197
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
6.59
10.06
1.69
8.37
14.06
2.64
11.42
13.74
1.88
11.87
16.15
2.25
13.90
26.79
2.99
23.80
13.75
1.88
11.87
15.92
2.25
13.66
26.32
3.00
23.32
15.03
2.53
12.50
0.78
0.25
0.52
0.99
0.32
0.67
1.07
0.38
0.69
1.27
0.44
0.83
7.57
1.65
5.91
9.36
1.77
7.58
11.66
1.95
9.72
14.86
2.64
12.22
13.63
2.03
11.60
16.89
2.41
14.48
26.88
3.14
23.74
14.88
2.50
12.38
NA
0.67
NA
1.89
0.51
1.39
2.11
0.64
1.47
2.25
Facility
total
NA
NA
1.69
NA
NA
2.64
NA
NA
1.88
NA
NA
2.25
NA
NA
2.99
NA
NA
1.88
NA
NA
2.25
NA
NA
3.00
NA
NA
2.53
NA
NA
0.25
NA
NA
0.32
NA
NA
0.38
NA
NA
0.44
NA
NA
1.65
NA
NA
1.77
NA
NA
1.95
NA
NA
2.64
NA
NA
2.03
NA
NA
2.41
NA
NA
3.14
NA
NA
2.50
NA
NA
0.67
NA
NA
0.51
NA
NA
0.64
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45960
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
74230
74230
74235
74235
74235
74240
74240
74240
74241
74241
74241
74245
74245
74245
74246
74246
74246
74247
74247
74247
74249
74249
74249
74250
74250
74250
74251
74251
74251
74260
74260
74260
74270
74270
74270
74280
74280
74280
74283
74283
74283
74290
74290
74290
74291
74291
74291
74300
74300
74300
74301
74301
74301
74305
74305
74305
74320
74320
74320
74327
74327
74327
74328
74328
74328
74329
74329
74329
74330
74330
74330
74340
74340
74340
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Cine/vid x-ray, throat/esoph ........................
Cine/vid x-ray, throat/esoph ........................
Remove esophagus obstruction ..................
Remove esophagus obstruction ..................
Remove esophagus obstruction ..................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
X-ray exam, upper gi tract ..........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
Contrst x-ray uppr gi tract ...........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
X-ray exam of small bowel ..........................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray exam of colon ......................
Contrast x-ray, gallbladder ..........................
Contrast x-ray, gallbladder ..........................
Contrast x-ray, gallbladder ..........................
Contrast x-rays, gallbladder ........................
Contrast x-rays, gallbladder ........................
Contrast x-rays, gallbladder ........................
X-ray bile ducts/pancreas ............................
X-ray bile ducts/pancreas ............................
X-ray bile ducts/pancreas ............................
X-rays at surgery add-on ............................
X-rays at surgery add-on ............................
X-rays at surgery add-on ............................
X-ray bile ducts/pancreas ............................
X-ray bile ducts/pancreas ............................
X-ray bile ducts/pancreas ............................
Contrast x-ray of bile ducts .........................
Contrast x-ray of bile ducts .........................
Contrast x-ray of bile ducts .........................
X-ray bile stone removal .............................
X-ray bile stone removal .............................
X-ray bile stone removal .............................
X-ray bile duct endoscopy ...........................
X-ray bile duct endoscopy ...........................
X-ray bile duct endoscopy ...........................
X-ray for pancreas endoscopy ....................
X-ray for pancreas endoscopy ....................
X-ray for pancreas endoscopy ....................
X-ray bile/panc endoscopy ..........................
X-ray bile/panc endoscopy ..........................
X-ray bile/panc endoscopy ..........................
X-ray guide for GI tube ...............................
X-ray guide for GI tube ...............................
X-ray guide for GI tube ...............................
0.53
0.00
1.19
1.19
0.00
0.69
0.69
0.00
0.69
0.69
0.00
0.91
0.91
0.00
0.69
0.69
0.00
0.69
0.69
0.00
0.91
0.91
0.00
0.47
0.47
0.00
0.69
0.69
0.00
0.50
0.50
0.00
0.69
0.69
0.00
0.99
0.99
0.00
2.02
2.02
0.00
0.32
0.32
0.00
0.20
0.20
0.00
0.00
0.36
0.00
0.00
0.21
0.00
0.42
0.42
0.00
0.54
0.54
0.00
0.70
0.70
0.00
0.70
0.70
0.00
0.70
0.70
0.00
0.90
0.90
0.00
0.54
0.54
0.00
Nonfacility
PE
RVUs
0.18
1.45
NA
0.41
NA
1.89
0.24
1.65
1.98
0.24
1.74
3.16
0.32
2.85
2.16
0.24
1.92
2.30
0.24
2.06
3.38
0.32
3.06
1.83
0.16
1.67
4.38
0.24
4.14
3.97
0.17
3.81
2.44
0.24
2.20
3.35
0.34
3.02
3.31
0.69
2.62
1.08
0.11
0.98
0.83
0.07
0.76
0.00
0.13
0.00
0.00
0.07
0.00
NA
0.15
NA
3.15
0.19
2.96
2.28
0.24
2.03
NA
0.24
NA
NA
0.24
NA
NA
0.31
NA
NA
0.19
NA
Facility
PE
RVUs
0.18
NA
NA
0.41
NA
NA
0.24
NA
NA
0.24
NA
NA
0.32
NA
NA
0.24
NA
NA
0.24
NA
NA
0.32
NA
NA
0.16
NA
NA
0.24
NA
NA
0.17
NA
NA
0.24
NA
NA
0.34
NA
NA
0.69
NA
NA
0.11
NA
NA
0.07
NA
0.00
0.13
0.00
0.00
0.07
0.00
NA
0.15
NA
NA
0.19
NA
NA
0.24
NA
NA
0.24
NA
NA
0.24
NA
NA
0.31
NA
NA
0.19
NA
Malpractice
RVUs
0.02
0.07
0.19
0.05
0.14
0.11
0.03
0.08
0.11
0.03
0.08
0.17
0.04
0.13
0.13
0.03
0.10
0.14
0.03
0.11
0.18
0.04
0.14
0.09
0.02
0.07
0.10
0.03
0.07
0.10
0.02
0.08
0.14
0.03
0.11
0.17
0.04
0.13
0.23
0.09
0.14
0.06
0.01
0.05
0.03
0.01
0.02
0.00
0.02
0.00
0.00
0.01
0.00
0.07
0.02
0.05
0.19
0.02
0.17
0.14
0.03
0.11
0.20
0.03
0.17
0.20
0.03
0.17
0.21
0.04
0.17
0.16
0.02
0.14
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00198
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.73
1.52
NA
1.65
NA
2.69
0.96
1.73
2.78
0.96
1.82
4.24
1.27
2.98
2.98
0.96
2.02
3.13
0.96
2.17
4.47
1.27
3.20
2.39
0.65
1.74
5.17
0.96
4.21
4.57
0.69
3.89
3.27
0.96
2.31
4.51
1.37
3.15
5.57
2.81
2.76
1.47
0.44
1.03
1.06
0.28
0.78
0.00
0.51
0.00
0.00
0.29
0.00
NA
0.59
NA
3.88
0.75
3.13
3.12
0.97
2.14
NA
0.97
NA
NA
0.97
NA
NA
1.25
NA
NA
0.75
NA
Facility
total
0.73
NA
NA
1.65
NA
NA
0.96
NA
NA
0.96
NA
NA
1.27
NA
NA
0.96
NA
NA
0.96
NA
NA
1.27
NA
NA
0.65
NA
NA
0.96
NA
NA
0.69
NA
NA
0.96
NA
NA
1.37
NA
NA
2.81
NA
NA
0.44
NA
NA
0.28
NA
0.00
0.51
0.00
0.00
0.29
0.00
NA
0.59
NA
NA
0.75
NA
NA
0.97
NA
NA
0.97
NA
NA
0.97
NA
NA
1.25
NA
NA
0.75
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45961
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
74350
74350
74350
74355
74355
74355
74360
74360
74360
74363
74363
74363
74400
74400
74400
74410
74410
74410
74415
74415
74415
74420
74420
74420
74425
74425
74425
74430
74430
74430
74440
74440
74440
74445
74445
74445
74450
74450
74450
74455
74455
74455
74470
74470
74470
74475
74475
74475
74480
74480
74480
74485
74485
74485
74710
74710
74710
74740
74740
74740
74742
74742
74742
74775
74775
74775
75552
75552
75552
75553
75553
75553
75554
75554
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
X-ray guide, stomach tube ..........................
X-ray guide, stomach tube ..........................
X-ray guide, stomach tube ..........................
X-ray guide, intestinal tube .........................
X-ray guide, intestinal tube .........................
X-ray guide, intestinal tube .........................
X-ray guide, GI dilation ...............................
X-ray guide, GI dilation ...............................
X-ray guide, GI dilation ...............................
X-ray, bile duct dilation ................................
X-ray, bile duct dilation ................................
X-ray, bile duct dilation ................................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrst x-ray, urinary tract ..........................
Contrast x-ray, bladder ................................
Contrast x-ray, bladder ................................
Contrast x-ray, bladder ................................
X-ray, male genital tract ..............................
X-ray, male genital tract ..............................
X-ray, male genital tract ..............................
X-ray exam of penis ....................................
X-ray exam of penis ....................................
X-ray exam of penis ....................................
X-ray, urethra/bladder .................................
X-ray, urethra/bladder .................................
X-ray, urethra/bladder .................................
X-ray, urethra/bladder .................................
X-ray, urethra/bladder .................................
X-ray, urethra/bladder .................................
X-ray exam of kidney lesion ........................
X-ray exam of kidney lesion ........................
X-ray exam of kidney lesion ........................
X-ray control, cath insert .............................
X-ray control, cath insert .............................
X-ray control, cath insert .............................
X-ray control, cath insert .............................
X-ray control, cath insert .............................
X-ray control, cath insert .............................
X-ray guide, GU dilation ..............................
X-ray guide, GU dilation ..............................
X-ray guide, GU dilation ..............................
X-ray measurement of pelvis ......................
X-ray measurement of pelvis ......................
X-ray measurement of pelvis ......................
X-ray, female genital tract ...........................
X-ray, female genital tract ...........................
X-ray, female genital tract ...........................
X-ray, fallopian tube ....................................
X-ray, fallopian tube ....................................
X-ray, fallopian tube ....................................
X-ray exam of perineum ..............................
X-ray exam of perineum ..............................
X-ray exam of perineum ..............................
Heart mri for morph w/o dye .......................
Heart mri for morph w/o dye .......................
Heart mri for morph w/o dye .......................
Heart mri for morph w/dye ..........................
Heart mri for morph w/dye ..........................
Heart mri for morph w/dye ..........................
Cardiac MRI/function ...................................
Cardiac MRI/function ...................................
0.76
0.76
0.00
0.76
0.76
0.00
0.54
0.54
0.00
0.88
0.88
0.00
0.49
0.49
0.00
0.49
0.49
0.00
0.49
0.49
0.00
0.36
0.36
0.00
0.36
0.36
0.00
0.32
0.32
0.00
0.38
0.38
0.00
1.14
1.14
0.00
0.33
0.33
0.00
0.33
0.33
0.00
0.54
0.54
0.00
0.54
0.54
0.00
0.54
0.54
0.00
0.54
0.54
0.00
0.34
0.34
0.00
0.38
0.38
0.00
0.61
0.61
0.00
0.62
0.62
0.00
1.60
1.60
0.00
2.00
2.00
0.00
1.83
1.83
Nonfacility
PE
RVUs
3.17
0.26
2.90
NA
0.26
NA
NA
0.20
NA
NA
0.31
NA
2.16
0.17
2.00
2.39
0.17
2.22
2.73
0.17
2.56
NA
0.13
NA
NA
0.13
NA
1.46
0.11
1.35
1.37
0.13
1.24
NA
0.41
NA
NA
0.12
NA
1.87
0.12
1.76
NA
0.19
NA
3.97
0.19
3.78
3.72
0.19
3.53
3.17
0.19
2.98
1.05
0.12
0.93
1.55
0.14
1.42
NA
0.21
NA
NA
0.22
NA
13.56
0.56
13.00
13.77
0.68
13.08
17.01
0.68
Facility
PE
RVUs
NA
0.26
NA
NA
0.26
NA
NA
0.20
NA
NA
0.31
NA
NA
0.17
NA
NA
0.17
NA
NA
0.17
NA
NA
0.13
NA
NA
0.13
NA
NA
0.11
NA
NA
0.13
NA
NA
0.41
NA
NA
0.12
NA
NA
0.12
NA
NA
0.19
NA
NA
0.19
NA
NA
0.19
NA
NA
0.19
NA
NA
0.12
NA
NA
0.14
NA
NA
0.21
NA
NA
0.22
NA
NA
0.56
NA
NA
0.68
NA
NA
0.68
Malpractice
RVUs
0.20
0.03
0.17
0.17
0.03
0.14
0.19
0.02
0.17
0.37
0.04
0.33
0.13
0.02
0.11
0.13
0.02
0.11
0.14
0.02
0.12
0.16
0.02
0.14
0.09
0.02
0.07
0.08
0.02
0.06
0.08
0.02
0.06
0.13
0.07
0.06
0.10
0.02
0.08
0.12
0.02
0.10
0.09
0.02
0.07
0.24
0.02
0.22
0.24
0.02
0.22
0.20
0.03
0.17
0.08
0.02
0.06
0.09
0.02
0.07
0.20
0.03
0.17
0.11
0.03
0.08
0.66
0.07
0.59
0.66
0.07
0.59
0.66
0.07
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00199
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
4.13
1.05
3.07
NA
1.05
NA
NA
0.76
NA
NA
1.23
NA
2.79
0.68
2.11
3.01
0.68
2.33
3.36
0.68
2.68
NA
0.51
NA
NA
0.51
NA
1.86
0.45
1.41
1.83
0.53
1.30
NA
1.62
NA
NA
0.47
NA
2.32
0.47
1.86
NA
0.75
NA
4.75
0.75
4.00
4.51
0.75
3.75
3.91
0.76
3.15
1.47
0.48
0.99
2.02
0.54
1.49
NA
0.85
NA
NA
0.87
NA
15.82
2.23
13.59
16.43
2.76
13.67
19.50
2.58
Facility
total
NA
1.05
NA
NA
1.05
NA
NA
0.76
NA
NA
1.23
NA
NA
0.68
NA
NA
0.68
NA
NA
0.68
NA
NA
0.51
NA
NA
0.51
NA
NA
0.45
NA
NA
0.53
NA
NA
1.62
NA
NA
0.47
NA
NA
0.47
NA
NA
0.75
NA
NA
0.75
NA
NA
0.75
NA
NA
0.76
NA
NA
0.48
NA
NA
0.54
NA
NA
0.85
NA
NA
0.87
NA
NA
2.23
NA
NA
2.76
NA
NA
2.58
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45962
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
75554
75555
75555
75555
75556
75600
75600
75600
75605
75605
75605
75625
75625
75625
75630
75630
75630
75635
75635
75635
75650
75650
75650
75658
75658
75658
75660
75660
75660
75662
75662
75662
75665
75665
75665
75671
75671
75671
75676
75676
75676
75680
75680
75680
75685
75685
75685
75705
75705
75705
75710
75710
75710
75716
75716
75716
75722
75722
75722
75724
75724
75724
75726
75726
75726
75731
75731
75731
75733
75733
75733
75736
75736
75736
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Cardiac MRI/function ...................................
Cardiac MRI/limited study ...........................
Cardiac MRI/limited study ...........................
Cardiac MRI/limited study ...........................
Cardiac MRI/flow mapping ..........................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
Contrast x-ray exam of aorta ......................
X-ray aorta, leg arteries ..............................
X-ray aorta, leg arteries ..............................
X-ray aorta, leg arteries ..............................
Ct angio abdominal arteries ........................
Ct angio abdominal arteries ........................
Ct angio abdominal arteries ........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, arm ........................................
Artery x-rays, arm ........................................
Artery x-rays, arm ........................................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, head & neck .........................
Artery x-rays, neck ......................................
Artery x-rays, neck ......................................
Artery x-rays, neck ......................................
Artery x-rays, neck ......................................
Artery x-rays, neck ......................................
Artery x-rays, neck ......................................
Artery x-rays, spine .....................................
Artery x-rays, spine .....................................
Artery x-rays, spine .....................................
Artery x-rays, spine .....................................
Artery x-rays, spine .....................................
Artery x-rays, spine .....................................
Artery x-rays, arm/leg ..................................
Artery x-rays, arm/leg ..................................
Artery x-rays, arm/leg ..................................
Artery x-rays, arms/legs ..............................
Artery x-rays, arms/legs ..............................
Artery x-rays, arms/legs ..............................
Artery x-rays, kidney ...................................
Artery x-rays, kidney ...................................
Artery x-rays, kidney ...................................
Artery x-rays, kidneys ..................................
Artery x-rays, kidneys ..................................
Artery x-rays, kidneys ..................................
Artery x-rays, abdomen ...............................
Artery x-rays, abdomen ...............................
Artery x-rays, abdomen ...............................
Artery x-rays, adrenal gland ........................
Artery x-rays, adrenal gland ........................
Artery x-rays, adrenal gland ........................
Artery x-rays, adrenals ................................
Artery x-rays, adrenals ................................
Artery x-rays, adrenals ................................
Artery x-rays, pelvis .....................................
Artery x-rays, pelvis .....................................
Artery x-rays, pelvis .....................................
0.00
1.74
1.74
0.00
0.00
0.49
0.49
0.00
1.14
1.14
0.00
1.14
1.14
0.00
1.79
1.79
0.00
2.40
2.40
0.00
1.49
1.49
0.00
1.31
1.31
0.00
1.31
1.31
0.00
1.66
1.66
0.00
1.31
1.31
0.00
1.66
1.66
0.00
1.31
1.31
0.00
1.66
1.66
0.00
1.31
1.31
0.00
2.18
2.18
0.00
1.14
1.14
0.00
1.31
1.31
0.00
1.14
1.14
0.00
1.49
1.49
0.00
1.14
1.14
0.00
1.14
1.14
0.00
1.31
1.31
0.00
1.14
1.14
0.00
Nonfacility
PE
RVUs
16.33
15.87
0.67
15.20
0.00
11.90
0.20
11.70
10.80
0.42
10.38
10.87
0.40
10.47
11.50
0.64
10.86
15.78
0.83
14.94
10.92
0.52
10.40
10.93
0.49
10.44
10.89
0.46
10.42
11.28
0.62
10.66
10.88
0.46
10.42
11.32
0.58
10.74
11.00
0.46
10.54
11.21
0.58
10.63
10.92
0.45
10.47
11.26
0.77
10.49
10.90
0.41
10.49
11.30
0.46
10.84
10.99
0.42
10.57
11.60
0.59
11.01
10.86
0.39
10.47
10.63
0.39
10.24
11.21
0.46
10.75
10.89
0.40
10.49
Facility
PE
RVUs
NA
NA
0.67
NA
0.00
NA
0.20
NA
NA
0.42
NA
NA
0.40
NA
NA
0.64
NA
NA
0.83
NA
NA
0.52
NA
NA
0.49
NA
NA
0.46
NA
NA
0.62
NA
NA
0.46
NA
NA
0.58
NA
NA
0.46
NA
NA
0.58
NA
NA
0.45
NA
NA
0.77
NA
NA
0.41
NA
NA
0.46
NA
NA
0.42
NA
NA
0.59
NA
NA
0.39
NA
NA
0.39
NA
NA
0.46
NA
NA
0.40
NA
Malpractice
RVUs
0.59
0.66
0.07
0.59
0.00
0.67
0.02
0.65
0.70
0.05
0.65
0.71
0.06
0.65
0.80
0.11
0.69
0.50
0.11
0.39
0.72
0.07
0.65
0.72
0.07
0.65
0.71
0.06
0.65
0.71
0.06
0.65
0.74
0.09
0.65
0.72
0.07
0.65
0.72
0.07
0.65
0.72
0.07
0.65
0.71
0.06
0.65
0.78
0.13
0.65
0.72
0.07
0.65
0.72
0.07
0.65
0.70
0.05
0.65
0.70
0.05
0.65
0.70
0.05
0.65
0.71
0.06
0.65
0.71
0.06
0.65
0.71
0.06
0.65
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00200
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
16.92
18.27
2.49
15.79
0.00
13.06
0.71
12.35
12.65
1.61
11.03
12.73
1.60
11.12
14.09
2.54
11.55
18.68
3.35
15.33
13.13
2.08
11.05
12.96
1.87
11.09
12.91
1.84
11.07
13.65
2.34
11.31
12.93
1.86
11.07
13.70
2.31
11.39
13.03
1.84
11.19
13.60
2.31
11.28
12.94
1.83
11.12
14.22
3.08
11.14
12.76
1.62
11.14
13.33
1.84
11.49
12.84
1.61
11.22
13.79
2.13
11.66
12.70
1.58
11.12
12.49
1.60
10.89
13.24
1.84
11.40
12.74
1.60
11.14
Facility
total
NA
NA
2.49
NA
0.00
NA
0.71
NA
NA
1.61
NA
NA
1.60
NA
NA
2.54
NA
NA
3.35
NA
NA
2.08
NA
NA
1.87
NA
NA
1.84
NA
NA
2.34
NA
NA
1.86
NA
NA
2.31
NA
NA
1.84
NA
NA
2.31
NA
NA
1.83
NA
NA
3.08
NA
NA
1.62
NA
NA
1.84
NA
NA
1.61
NA
NA
2.13
NA
NA
1.58
NA
NA
1.60
NA
NA
1.84
NA
NA
1.60
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45963
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
75741
75741
75741
75743
75743
75743
75746
75746
75746
75756
75756
75756
75774
75774
75774
75790
75790
75790
75801
75801
75801
75803
75803
75803
75805
75805
75805
75807
75807
75807
75809
75809
75809
75810
75810
75810
75820
75820
75820
75822
75822
75822
75825
75825
75825
75827
75827
75827
75831
75831
75831
75833
75833
75833
75840
75840
75840
75842
75842
75842
75860
75860
75860
75870
75870
75870
75872
75872
75872
75880
75880
75880
75885
75885
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Artery x-rays, lung .......................................
Artery x-rays, lung .......................................
Artery x-rays, lung .......................................
Artery x-rays, lungs .....................................
Artery x-rays, lungs .....................................
Artery x-rays, lungs .....................................
Artery x-rays, lung .......................................
Artery x-rays, lung .......................................
Artery x-rays, lung .......................................
Artery x-rays, chest .....................................
Artery x-rays, chest .....................................
Artery x-rays, chest .....................................
Artery x-ray, each vessel ............................
Artery x-ray, each vessel ............................
Artery x-ray, each vessel ............................
Visualize A-V shunt .....................................
Visualize A-V shunt .....................................
Visualize A-V shunt .....................................
Lymph vessel x-ray, arm/leg .......................
Lymph vessel x-ray, arm/leg .......................
Lymph vessel x-ray, arm/leg .......................
Lymph vessel x-ray,arms/legs .....................
Lymph vessel x-ray,arms/legs .....................
Lymph vessel x-ray,arms/legs .....................
Lymph vessel x-ray, trunk ...........................
Lymph vessel x-ray, trunk ...........................
Lymph vessel x-ray, trunk ...........................
Lymph vessel x-ray, trunk ...........................
Lymph vessel x-ray, trunk ...........................
Lymph vessel x-ray, trunk ...........................
Nonvascular shunt, x-ray ............................
Nonvascular shunt, x-ray ............................
Nonvascular shunt, x-ray ............................
Vein x-ray, spleen/liver ................................
Vein x-ray, spleen/liver ................................
Vein x-ray, spleen/liver ................................
Vein x-ray, arm/leg ......................................
Vein x-ray, arm/leg ......................................
Vein x-ray, arm/leg ......................................
Vein x-ray, arms/legs ..................................
Vein x-ray, arms/legs ..................................
Vein x-ray, arms/legs ..................................
Vein x-ray, trunk ..........................................
Vein x-ray, trunk ..........................................
Vein x-ray, trunk ..........................................
Vein x-ray, chest .........................................
Vein x-ray, chest .........................................
Vein x-ray, chest .........................................
Vein x-ray, kidney ........................................
Vein x-ray, kidney ........................................
Vein x-ray, kidney ........................................
Vein x-ray, kidneys ......................................
Vein x-ray, kidneys ......................................
Vein x-ray, kidneys ......................................
Vein x-ray, adrenal gland ............................
Vein x-ray, adrenal gland ............................
Vein x-ray, adrenal gland ............................
Vein x-ray, adrenal glands ..........................
Vein x-ray, adrenal glands ..........................
Vein x-ray, adrenal glands ..........................
Vein x-ray, neck ..........................................
Vein x-ray, neck ..........................................
Vein x-ray, neck ..........................................
Vein x-ray, skull ...........................................
Vein x-ray, skull ...........................................
Vein x-ray, skull ...........................................
Vein x-ray, skull ...........................................
Vein x-ray, skull ...........................................
Vein x-ray, skull ...........................................
Vein x-ray, eye socket .................................
Vein x-ray, eye socket .................................
Vein x-ray, eye socket .................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
1.31
1.31
0.00
1.66
1.66
0.00
1.14
1.14
0.00
1.14
1.14
0.00
0.36
0.36
0.00
1.84
1.84
0.00
0.81
0.81
0.00
1.17
1.17
0.00
0.81
0.81
0.00
1.17
1.17
0.00
0.47
0.47
0.00
1.14
1.14
0.00
0.70
0.70
0.00
1.06
1.06
0.00
1.14
1.14
0.00
1.14
1.14
0.00
1.14
1.14
0.00
1.49
1.49
0.00
1.14
1.14
0.00
1.49
1.49
0.00
1.14
1.14
0.00
1.14
1.14
0.00
1.14
1.14
0.00
0.70
0.70
0.00
1.44
1.44
Nonfacility
PE
RVUs
10.77
0.46
10.32
10.97
0.57
10.40
10.87
0.40
10.47
11.30
0.47
10.82
10.44
0.13
10.31
2.36
0.63
1.73
NA
0.28
NA
NA
0.40
NA
NA
0.28
NA
NA
0.40
NA
1.26
0.16
1.10
NA
0.39
NA
1.67
0.24
1.43
2.25
0.37
1.88
10.64
0.39
10.25
10.67
0.39
10.28
10.64
0.39
10.25
10.96
0.52
10.43
10.79
0.39
10.40
10.98
0.51
10.47
10.70
0.41
10.29
10.60
0.41
10.20
10.61
0.39
10.22
1.65
0.24
1.41
11.06
0.50
Facility
PE
RVUs
NA
0.46
NA
NA
0.57
NA
NA
0.40
NA
NA
0.47
NA
NA
0.13
NA
NA
0.63
NA
NA
0.28
NA
NA
0.40
NA
NA
0.28
NA
NA
0.40
NA
NA
0.16
NA
NA
0.39
NA
NA
0.24
NA
NA
0.37
NA
NA
0.39
NA
NA
0.39
NA
NA
0.39
NA
NA
0.52
NA
NA
0.39
NA
NA
0.51
NA
NA
0.41
NA
NA
0.41
NA
NA
0.39
NA
NA
0.24
NA
NA
0.50
Malpractice
RVUs
0.71
0.06
0.65
0.72
0.07
0.65
0.70
0.05
0.65
0.69
0.04
0.65
0.67
0.02
0.65
0.17
0.09
0.08
0.37
0.08
0.29
0.34
0.05
0.29
0.38
0.05
0.33
0.38
0.05
0.33
0.07
0.02
0.05
0.70
0.05
0.65
0.09
0.03
0.06
0.13
0.05
0.08
0.72
0.07
0.65
0.70
0.05
0.65
0.71
0.06
0.65
0.74
0.09
0.65
0.72
0.07
0.65
0.72
0.07
0.65
0.69
0.04
0.65
0.70
0.05
0.65
0.79
0.14
0.65
0.09
0.03
0.06
0.71
0.06
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00201
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
12.79
1.83
10.97
13.36
2.31
11.05
12.72
1.59
11.12
13.13
1.65
11.47
11.47
0.51
10.96
4.38
2.56
1.81
NA
1.17
NA
NA
1.62
NA
NA
1.14
NA
NA
1.63
NA
1.80
0.65
1.15
NA
1.58
NA
2.46
0.97
1.49
3.44
1.48
1.96
12.50
1.60
10.90
12.51
1.58
10.93
12.49
1.59
10.90
13.19
2.10
11.08
12.66
1.61
11.05
13.19
2.07
11.12
12.53
1.59
10.94
12.45
1.60
10.85
12.54
1.67
10.87
2.44
0.97
1.47
13.21
2.00
Facility
total
NA
1.83
NA
NA
2.31
NA
NA
1.59
NA
NA
1.65
NA
NA
0.51
NA
NA
2.56
NA
NA
1.17
NA
NA
1.62
NA
NA
1.14
NA
NA
1.63
NA
NA
0.65
NA
NA
1.58
NA
NA
0.97
NA
NA
1.48
NA
NA
1.60
NA
NA
1.58
NA
NA
1.59
NA
NA
2.10
NA
NA
1.61
NA
NA
2.07
NA
NA
1.59
NA
NA
1.60
NA
NA
1.67
NA
NA
0.97
NA
NA
2.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45964
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
75885
75887
75887
75887
75889
75889
75889
75891
75891
75891
75893
75893
75893
75894
75894
75894
75896
75896
75896
75898
75898
75898
75900
75900
75900
75901
75901
75901
75902
75902
75902
75940
75940
75940
75945
75945
75945
75946
75946
75946
75952
75952
75952
75953
75953
75953
75954
75954
75954
75960
75960
75960
75961
75961
75961
75962
75962
75962
75964
75964
75964
75966
75966
75966
75968
75968
75968
75970
75970
75970
75978
75978
75978
75980
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Vein x-ray, liver ...........................................
Venous sampling by catheter ......................
Venous sampling by catheter ......................
Venous sampling by catheter ......................
X-rays, transcath therapy ............................
X-rays, transcath therapy ............................
X-rays, transcath therapy ............................
X-rays, transcath therapy ............................
X-rays, transcath therapy ............................
X-rays, transcath therapy ............................
Follow-up angiography ................................
Follow-up angiography ................................
Follow-up angiography ................................
Arterial catheter exchange ..........................
Arterial catheter exchange ..........................
Arterial catheter exchange ..........................
Remove cva device obstruct .......................
Remove cva device obstruct .......................
Remove cva device obstruct .......................
Remove cva lumen obstruct .......................
Remove cva lumen obstruct .......................
Remove cva lumen obstruct .......................
X-ray placement, vein filter .........................
X-ray placement, vein filter .........................
X-ray placement, vein filter .........................
Intravascular us ...........................................
Intravascular us ...........................................
Intravascular us ...........................................
Intravascular us add-on ...............................
Intravascular us add-on ...............................
Intravascular us add-on ...............................
Endovasc repair abdom aorta .....................
Endovasc repair abdom aorta .....................
Endovasc repair abdom aorta .....................
Abdom aneurysm endovas rpr ....................
Abdom aneurysm endovas rpr ....................
Abdom aneurysm endovas rpr ....................
Iliac aneurysm endovas rpr .........................
Iliac aneurysm endovas rpr .........................
Iliac aneurysm endovas rpr .........................
Transcath iv stent rs&i ................................
Transcath iv stent rs&i ................................
Transcath iv stent rs&i ................................
Retrieval, broken catheter ...........................
Retrieval, broken catheter ...........................
Retrieval, broken catheter ...........................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair artery blockage, each ......................
Repair artery blockage, each ......................
Repair artery blockage, each ......................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair arterial blockage ..............................
Repair artery blockage, each ......................
Repair artery blockage, each ......................
Repair artery blockage, each ......................
Vascular biopsy ...........................................
Vascular biopsy ...........................................
Vascular biopsy ...........................................
Repair venous blockage ..............................
Repair venous blockage ..............................
Repair venous blockage ..............................
Contrast xray exam bile duct ......................
0.00
1.44
1.44
0.00
1.14
1.14
0.00
1.14
1.14
0.00
0.54
0.54
0.00
1.31
1.31
0.00
1.31
1.31
0.00
1.65
1.65
0.00
0.49
0.49
0.00
0.49
0.49
0.00
0.39
0.39
0.00
0.54
0.54
0.00
0.40
0.40
0.00
0.40
0.40
0.00
0.00
4.50
0.00
0.00
1.36
0.00
0.00
2.25
0.00
0.82
0.82
0.00
4.25
4.25
0.00
0.54
0.54
0.00
0.36
0.36
0.00
1.31
1.31
0.00
0.36
0.36
0.00
0.83
0.83
0.00
0.54
0.54
0.00
1.44
Nonfacility
PE
RVUs
10.56
11.75
0.50
11.25
10.77
0.39
10.38
10.56
0.39
10.17
11.08
0.19
10.89
NA
0.45
NA
NA
0.47
NA
NA
0.58
NA
NA
0.17
NA
2.30
0.17
2.13
1.56
0.14
1.43
NA
0.19
NA
NA
0.14
NA
NA
0.14
NA
0.00
1.51
0.00
0.00
0.46
0.00
0.00
0.81
0.00
NA
0.30
NA
10.29
1.47
8.82
13.03
0.19
12.84
7.07
0.13
6.94
13.24
0.48
12.75
7.01
0.14
6.87
NA
0.30
NA
13.02
0.19
12.83
NA
Facility
PE
RVUs
NA
NA
0.50
NA
NA
0.39
NA
NA
0.39
NA
NA
0.19
NA
NA
0.45
NA
NA
0.47
NA
NA
0.58
NA
NA
0.17
NA
NA
0.17
NA
NA
0.14
NA
NA
0.19
NA
NA
0.14
NA
NA
0.14
NA
0.00
1.51
0.00
0.00
0.46
0.00
0.00
0.81
0.00
NA
0.30
NA
NA
1.47
NA
NA
0.19
NA
NA
0.13
NA
NA
0.48
NA
NA
0.14
NA
NA
0.30
NA
NA
0.19
NA
NA
Malpractice
RVUs
0.65
0.71
0.06
0.65
0.70
0.05
0.65
0.70
0.05
0.65
0.67
0.02
0.65
1.35
0.08
1.27
1.15
0.05
1.10
0.13
0.07
0.06
1.14
0.03
1.11
0.85
0.02
0.83
0.85
0.02
0.83
0.69
0.04
0.65
0.28
0.04
0.24
0.18
0.05
0.13
0.00
0.43
0.00
0.00
0.13
0.00
0.00
0.15
0.00
0.82
0.05
0.77
0.73
0.18
0.55
0.86
0.03
0.83
0.46
0.03
0.43
0.89
0.06
0.83
0.45
0.02
0.43
0.64
0.04
0.60
0.85
0.02
0.83
0.35
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00202
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
11.21
13.90
2.00
11.90
12.61
1.58
11.03
12.40
1.58
10.82
12.30
0.75
11.54
NA
1.85
NA
NA
1.84
NA
NA
2.30
NA
NA
0.69
NA
3.64
0.68
2.96
2.80
0.55
2.26
NA
0.77
NA
NA
0.58
NA
NA
0.59
NA
0.00
6.44
0.00
0.00
1.95
0.00
0.00
3.22
0.00
NA
1.17
NA
15.27
5.90
9.37
14.43
0.76
13.67
7.89
0.52
7.37
15.44
1.86
13.58
7.82
0.52
7.30
NA
1.17
NA
14.41
0.75
13.66
NA
Facility
total
NA
NA
2.00
NA
NA
1.58
NA
NA
1.58
NA
NA
0.75
NA
NA
1.85
NA
NA
1.84
NA
NA
2.30
NA
NA
0.69
NA
NA
0.68
NA
NA
0.55
NA
NA
0.77
NA
NA
0.58
NA
NA
0.59
NA
0.00
6.44
0.00
0.00
1.95
0.00
0.00
3.22
0.00
NA
1.17
NA
NA
5.90
NA
NA
0.76
NA
NA
0.52
NA
NA
1.86
NA
NA
0.52
NA
NA
1.17
NA
NA
0.75
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45965
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
75980
75980
75982
75982
75982
75984
75984
75984
75989
75989
75989
75992
75992
75992
75993
75993
75993
75994
75994
75994
75995
75995
75995
75996
75996
75996
75998
75998
75998
76000
76000
76000
76001
76001
76001
76003
76003
76003
76005
76005
76005
76006
76010
76010
76010
76012
76012
76012
76013
76013
76013
76020
76020
76020
76040
76040
76040
76061
76061
76061
76062
76062
76062
76065
76065
76065
76066
76066
76066
76070
76070
76070
76071
76071
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Contrast xray exam bile duct ......................
Contrast xray exam bile duct ......................
Contrast xray exam bile duct ......................
Contrast xray exam bile duct ......................
Contrast xray exam bile duct ......................
Xray control catheter change ......................
Xray control catheter change ......................
Xray control catheter change ......................
Abscess drainage under x-ray ....................
Abscess drainage under x-ray ....................
Abscess drainage under x-ray ....................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Atherectomy, x-ray exam ............................
Fluoroguide for vein device .........................
Fluoroguide for vein device .........................
Fluoroguide for vein device .........................
Fluoroscope examination ............................
Fluoroscope examination ............................
Fluoroscope examination ............................
Fluoroscope exam, extensive .....................
Fluoroscope exam, extensive .....................
Fluoroscope exam, extensive .....................
Needle localization by x-ray ........................
Needle localization by x-ray ........................
Needle localization by x-ray ........................
Fluoroguide for spine inject .........................
Fluoroguide for spine inject .........................
Fluoroguide for spine inject .........................
X-ray stress view .........................................
X-ray, nose to rectum ..................................
X-ray, nose to rectum ..................................
X-ray, nose to rectum ..................................
Percut vertebroplasty fluor ..........................
Percut vertebroplasty fluor ..........................
Percut vertebroplasty fluor ..........................
Percut vertebroplasty, ct .............................
Percut vertebroplasty, ct .............................
Percut vertebroplasty, ct .............................
X-rays for bone age ....................................
X-rays for bone age ....................................
X-rays for bone age ....................................
X-rays, bone evaluation ..............................
X-rays, bone evaluation ..............................
X-rays, bone evaluation ..............................
X-rays, bone survey ....................................
X-rays, bone survey ....................................
X-rays, bone survey ....................................
X-rays, bone survey ....................................
X-rays, bone survey ....................................
X-rays, bone survey ....................................
X-rays, bone evaluation ..............................
X-rays, bone evaluation ..............................
X-rays, bone evaluation ..............................
Joint survey, single view .............................
Joint survey, single view .............................
Joint survey, single view .............................
Ct bone density, axial ..................................
Ct bone density, axial ..................................
Ct bone density, axial ..................................
Ct bone density, peripheral .........................
Ct bone density, peripheral .........................
1.44
0.00
1.44
1.44
0.00
0.72
0.72
0.00
1.19
1.19
0.00
0.54
0.54
0.00
0.36
0.36
0.00
1.31
1.31
0.00
1.31
1.31
0.00
0.36
0.36
0.00
0.38
0.38
0.00
0.17
0.17
0.00
0.67
0.67
0.00
0.54
0.54
0.00
0.60
0.60
0.00
0.41
0.18
0.18
0.00
0.00
1.31
0.00
0.00
1.38
0.00
0.19
0.19
0.00
0.27
0.27
0.00
0.45
0.45
0.00
0.54
0.54
0.00
0.70
0.70
0.00
0.31
0.31
0.00
0.25
0.25
0.00
0.22
0.22
Nonfacility
PE
RVUs
0.50
NA
NA
0.50
NA
2.31
0.25
2.07
3.31
0.41
2.90
NA
0.20
NA
NA
0.14
NA
NA
0.48
NA
NA
0.50
NA
NA
0.12
NA
1.88
0.14
1.75
1.78
0.05
1.72
NA
0.23
NA
1.47
0.18
1.30
1.34
0.15
1.19
0.32
0.58
0.06
0.52
0.00
0.49
0.00
0.00
0.50
0.00
0.55
0.06
0.49
0.82
0.09
0.73
1.31
0.16
1.15
1.93
0.19
1.74
1.27
0.24
1.03
1.06
0.11
0.96
3.37
0.09
3.29
2.43
0.07
Facility
PE
RVUs
0.50
NA
NA
0.50
NA
NA
0.25
NA
NA
0.41
NA
NA
0.20
NA
NA
0.14
NA
NA
0.48
NA
NA
0.50
NA
NA
0.12
NA
NA
0.14
NA
NA
0.05
NA
NA
0.23
NA
NA
0.18
NA
NA
0.15
NA
0.17
NA
0.06
NA
0.00
0.49
0.00
0.00
0.50
0.00
NA
0.06
NA
NA
0.09
NA
NA
0.16
NA
NA
0.19
NA
NA
0.24
NA
NA
0.11
NA
NA
0.09
NA
NA
0.07
Malpractice
RVUs
0.06
0.29
0.39
0.06
0.33
0.14
0.03
0.11
0.22
0.05
0.17
0.86
0.03
0.83
0.45
0.02
0.43
0.90
0.07
0.83
0.88
0.05
0.83
0.45
0.02
0.43
0.11
0.01
0.10
0.08
0.01
0.07
0.19
0.05
0.14
0.09
0.02
0.07
0.10
0.03
0.07
0.06
0.03
0.01
0.02
0.00
0.10
0.00
0.00
0.07
0.00
0.03
0.01
0.02
0.06
0.01
0.05
0.08
0.02
0.06
0.10
0.02
0.08
0.08
0.03
0.05
0.08
0.02
0.06
0.17
0.01
0.16
0.06
0.01
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00203
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
2.00
NA
NA
2.00
NA
3.18
1.00
2.18
4.72
1.65
3.07
NA
0.77
NA
NA
0.52
NA
NA
1.86
NA
NA
1.86
NA
NA
0.50
NA
2.37
0.53
1.85
2.03
0.23
1.79
NA
0.95
NA
2.10
0.74
1.37
2.04
0.78
1.26
0.79
0.79
0.25
0.54
0.00
1.90
0.00
0.00
1.96
0.00
0.77
0.26
0.51
1.15
0.37
0.78
1.84
0.63
1.21
2.57
0.75
1.82
2.05
0.97
1.08
1.45
0.44
1.02
3.79
0.35
3.45
2.71
0.30
Facility
total
2.00
NA
NA
2.00
NA
NA
1.00
NA
NA
1.65
NA
NA
0.77
NA
NA
0.52
NA
NA
1.86
NA
NA
1.86
NA
NA
0.50
NA
NA
0.53
NA
NA
0.23
NA
NA
0.95
NA
NA
0.74
NA
NA
0.78
NA
0.64
NA
0.25
NA
0.00
1.90
0.00
0.00
1.96
0.00
NA
0.26
NA
NA
0.37
NA
NA
0.63
NA
NA
0.75
NA
NA
0.97
NA
NA
0.44
NA
NA
0.35
NA
NA
0.30
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45966
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
76071
76075
76075
76075
76076
76076
76076
76077
76077
76077
76078
76078
76078
76080
76080
76080
76082
76082
76082
76083
76083
76083
76086
76086
76086
76088
76088
76088
76090
76090
76090
76091
76091
76091
76092
76092
76092
76093
76093
76093
76094
76094
76094
76095
76095
76095
76096
76096
76096
76098
76098
76098
76100
76100
76100
76101
76101
76101
76102
76102
76102
76120
76120
76120
76125
76125
76125
76140
76150
76350
76355
76355
76355
76360
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
I
A
C
A
A
A
A
Physician
work
RVUs 3
Description
Ct bone density, peripheral .........................
Dxa bone density, axial ...............................
Dxa bone density, axial ...............................
Dxa bone density, axial ...............................
Dxa bone density/peripheral .......................
Dxa bone density/peripheral .......................
Dxa bone density/peripheral .......................
Dxa bone density/v-fracture ........................
Dxa bone density/v-fracture ........................
Dxa bone density/v-fracture ........................
Radiographic absorptiometry ......................
Radiographic absorptiometry ......................
Radiographic absorptiometry ......................
X-ray exam of fistula ...................................
X-ray exam of fistula ...................................
X-ray exam of fistula ...................................
Computer mammogram add-on ..................
Computer mammogram add-on ..................
Computer mammogram add-on ..................
Computer mammogram add-on ..................
Computer mammogram add-on ..................
Computer mammogram add-on ..................
X-ray of mammary duct ...............................
X-ray of mammary duct ...............................
X-ray of mammary duct ...............................
X-ray of mammary ducts .............................
X-ray of mammary ducts .............................
X-ray of mammary ducts .............................
Mammogram, one breast ............................
Mammogram, one breast ............................
Mammogram, one breast ............................
Mammogram, both breasts .........................
Mammogram, both breasts .........................
Mammogram, both breasts .........................
Mammogram, screening ..............................
Mammogram, screening ..............................
Mammogram, screening ..............................
Magnetic image, breast ...............................
Magnetic image, breast ...............................
Magnetic image, breast ...............................
Magnetic image, both breasts .....................
Magnetic image, both breasts .....................
Magnetic image, both breasts .....................
Stereotactic breast biopsy ...........................
Stereotactic breast biopsy ...........................
Stereotactic breast biopsy ...........................
X-ray of needle wire, breast ........................
X-ray of needle wire, breast ........................
X-ray of needle wire, breast ........................
X-ray exam, breast specimen .....................
X-ray exam, breast specimen .....................
X-ray exam, breast specimen .....................
X-ray exam of body section ........................
X-ray exam of body section ........................
X-ray exam of body section ........................
Complex body section x-ray ........................
Complex body section x-ray ........................
Complex body section x-ray ........................
Complex body section x-rays ......................
Complex body section x-rays ......................
Complex body section x-rays ......................
Cine/video x-rays .........................................
Cine/video x-rays .........................................
Cine/video x-rays .........................................
Cine/video x-rays add-on ............................
Cine/video x-rays add-on ............................
Cine/video x-rays add-on ............................
X-ray consultation ........................................
X-ray exam, dry process .............................
Special x-ray contrast study ........................
Ct scan for localization ................................
Ct scan for localization ................................
Ct scan for localization ................................
Ct scan for needle biopsy ...........................
0.00
0.30
0.30
0.00
0.22
0.22
0.00
0.17
0.17
0.00
0.20
0.20
0.00
0.54
0.54
0.00
0.06
0.06
0.00
0.06
0.06
0.00
0.36
0.36
0.00
0.45
0.45
0.00
0.70
0.70
0.00
0.87
0.87
0.00
0.70
0.70
0.00
1.63
1.63
0.00
1.63
1.63
0.00
1.59
1.59
0.00
0.56
0.56
0.00
0.16
0.16
0.00
0.58
0.58
0.00
0.58
0.58
0.00
0.58
0.58
0.00
0.38
0.38
0.00
0.27
0.27
0.00
0.00
0.00
0.00
1.21
1.21
0.00
1.16
Nonfacility
PE
RVUs
2.36
2.58
0.11
2.47
0.75
0.08
0.67
0.71
0.06
0.65
0.70
0.07
0.63
1.23
0.19
1.05
0.39
0.02
0.37
0.39
0.02
0.37
2.40
0.13
2.28
3.32
0.16
3.17
1.44
0.24
1.20
1.82
0.30
1.52
1.51
0.24
1.27
18.79
0.56
18.23
23.36
0.56
22.81
6.38
0.54
5.84
1.37
0.19
1.17
0.46
0.05
0.40
2.02
0.20
1.82
2.53
0.20
2.32
3.39
0.20
3.19
1.78
0.14
1.65
NA
0.10
NA
0.00
0.45
0.00
12.79
0.42
12.37
7.23
Facility
PE
RVUs
NA
NA
0.11
NA
NA
0.08
NA
NA
0.06
NA
NA
0.07
NA
NA
0.19
NA
NA
0.02
NA
NA
0.02
NA
NA
0.13
NA
NA
0.16
NA
NA
0.24
NA
NA
0.30
NA
NA
0.24
NA
NA
0.56
NA
NA
0.56
NA
NA
0.54
NA
NA
0.19
NA
NA
0.05
NA
NA
0.20
NA
NA
0.20
NA
NA
0.20
NA
NA
0.14
NA
NA
0.10
NA
0.00
NA
0.00
NA
0.42
NA
NA
Malpractice
RVUs
0.05
0.18
0.01
0.17
0.06
0.01
0.05
0.06
0.01
0.05
0.06
0.01
0.05
0.08
0.02
0.06
0.02
0.01
0.01
0.02
0.01
0.01
0.16
0.02
0.14
0.21
0.02
0.19
0.09
0.03
0.06
0.11
0.04
0.07
0.10
0.03
0.07
0.99
0.07
0.92
1.31
0.07
1.24
0.46
0.09
0.37
0.09
0.02
0.07
0.03
0.01
0.02
0.10
0.03
0.07
0.11
0.03
0.08
0.14
0.03
0.11
0.08
0.02
0.06
0.06
0.01
0.05
0.00
0.02
0.00
0.47
0.05
0.42
0.47
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00204
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
2.41
3.06
0.42
2.64
1.03
0.31
0.72
0.94
0.24
0.70
0.96
0.28
0.68
1.86
0.75
1.11
0.47
0.09
0.38
0.47
0.09
0.38
2.92
0.51
2.42
3.99
0.63
3.36
2.23
0.97
1.26
2.80
1.21
1.59
2.31
0.97
1.34
21.41
2.26
19.15
26.31
2.26
24.05
8.43
2.22
6.21
2.02
0.77
1.24
0.65
0.22
0.42
2.70
0.81
1.89
3.22
0.81
2.40
4.11
0.81
3.30
2.24
0.54
1.71
NA
0.38
NA
0.00
0.47
0.00
14.47
1.68
12.79
8.86
Facility
total
NA
NA
0.42
NA
NA
0.31
NA
NA
0.24
NA
NA
0.28
NA
NA
0.75
NA
NA
0.09
NA
NA
0.09
NA
NA
0.51
NA
NA
0.63
NA
NA
0.97
NA
NA
1.21
NA
NA
0.97
NA
NA
2.26
NA
NA
2.26
NA
NA
2.22
NA
NA
0.77
NA
NA
0.22
NA
NA
0.81
NA
NA
0.81
NA
NA
0.81
NA
NA
0.54
NA
NA
0.38
NA
0.00
NA
0.00
NA
1.68
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45967
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
76360
76360
76362
76362
76362
76370
76370
76370
76375
76375
76375
76380
76380
76380
76390
76390
76390
76393
76393
76393
76394
76394
76394
76400
76400
76400
76496
76496
76496
76497
76497
76497
76498
76498
76498
76499
76499
76499
76506
76506
76506
76510
76510
76510
76511
76511
76511
76512
76512
76512
76513
76513
76513
76514
76514
76514
76516
76516
76516
76519
76519
76519
76529
76529
76529
76536
76536
76536
76604
76604
76604
76645
76645
76645
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
N
N
A
A
A
A
A
A
A
A
A
C
C
C
C
C
C
C
C
C
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Ct scan for needle biopsy ...........................
Ct scan for needle biopsy ...........................
Ct guide for tissue ablation .........................
Ct guide for tissue ablation .........................
Ct guide for tissue ablation .........................
Ct scan for therapy guide ............................
Ct scan for therapy guide ............................
Ct scan for therapy guide ............................
3d/holograph reconstr add-on .....................
3d/holograph reconstr add-on .....................
3d/holograph reconstr add-on .....................
CAT scan follow-up study ...........................
CAT scan follow-up study ...........................
CAT scan follow-up study ...........................
Mr spectroscopy ..........................................
Mr spectroscopy ..........................................
Mr spectroscopy ..........................................
Mr guidance for needle place .....................
Mr guidance for needle place .....................
Mr guidance for needle place .....................
Mri for tissue ablation ..................................
Mri for tissue ablation ..................................
Mri for tissue ablation ..................................
Magnetic image, bone marrow ....................
Magnetic image, bone marrow ....................
Magnetic image, bone marrow ....................
Fluoroscopic procedure ...............................
Fluoroscopic procedure ...............................
Fluoroscopic procedure ...............................
Ct procedure ................................................
Ct procedure ................................................
Ct procedure ................................................
Mri procedure ..............................................
Mri procedure ..............................................
Mri procedure ..............................................
Radiographic procedure ..............................
Radiographic procedure ..............................
Radiographic procedure ..............................
Echo exam of head .....................................
Echo exam of head .....................................
Echo exam of head .....................................
Ophth us, b & quant a .................................
Ophth us, b & quant a .................................
Ophth us, b & quant a .................................
Ophth us, quant a only ................................
Ophth us, quant a only ................................
Ophth us, quant a only ................................
Ophth us, b w/non-quant a .........................
Ophth us, b w/non-quant a .........................
Ophth us, b w/non-quant a .........................
Echo exam of eye, water bath ....................
Echo exam of eye, water bath ....................
Echo exam of eye, water bath ....................
Echo exam of eye, thickness ......................
Echo exam of eye, thickness ......................
Echo exam of eye, thickness ......................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Echo exam of eye .......................................
Us exam of head and neck .........................
Us exam of head and neck .........................
Us exam of head and neck .........................
Us exam, chest, b-scan ..............................
Us exam, chest, b-scan ..............................
Us exam, chest, b-scan ..............................
Us exam, breast(s) ......................................
Us exam, breast(s) ......................................
Us exam, breast(s) ......................................
1.16
0.00
4.00
4.00
0.00
0.85
0.85
0.00
0.16
0.16
0.00
0.98
0.98
0.00
1.40
1.40
0.00
1.50
1.50
0.00
4.25
4.25
0.00
1.60
1.60
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.63
0.63
0.00
1.55
1.55
0.00
0.94
0.94
0.00
0.94
0.94
0.00
0.66
0.66
0.00
0.17
0.17
0.00
0.54
0.54
0.00
0.54
0.54
0.00
0.57
0.57
0.00
0.56
0.56
0.00
0.55
0.55
0.00
0.54
0.54
0.00
Nonfacility
PE
RVUs
0.40
6.83
NA
1.37
NA
3.57
0.29
3.28
2.92
0.05
2.87
4.06
0.34
3.73
10.86
0.49
10.37
11.11
0.52
10.59
NA
1.45
NA
12.18
0.55
11.63
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.95
0.24
1.71
2.73
0.67
2.06
2.24
0.40
1.85
2.05
0.41
1.64
1.73
0.28
1.45
0.13
0.08
0.05
1.39
0.24
1.16
1.48
0.24
1.25
1.33
0.24
1.09
1.90
0.19
1.71
1.66
0.19
1.47
1.47
0.19
1.29
Facility
PE
RVUs
0.40
NA
NA
1.37
NA
NA
0.29
NA
NA
0.05
NA
NA
0.34
NA
NA
0.49
NA
NA
0.52
NA
NA
1.45
NA
NA
0.55
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.24
NA
NA
0.67
NA
NA
0.40
NA
NA
0.41
NA
NA
0.28
NA
NA
0.08
NA
NA
0.24
NA
NA
0.24
NA
NA
0.24
NA
NA
0.19
NA
NA
0.19
NA
NA
0.19
NA
Malpractice
RVUs
0.05
0.42
1.65
0.18
1.46
0.20
0.04
0.16
0.19
0.01
0.18
0.22
0.04
0.18
0.66
0.07
0.59
0.64
0.09
0.55
1.81
0.24
1.57
0.66
0.07
0.59
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.14
0.06
0.08
0.10
0.03
0.07
0.10
0.03
0.07
0.12
0.02
0.10
0.12
0.02
0.10
0.02
0.01
0.01
0.08
0.01
0.07
0.08
0.01
0.07
0.10
0.02
0.08
0.10
0.02
0.08
0.09
0.02
0.07
0.08
0.02
0.06
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00205
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.61
7.25
NA
5.55
NA
4.63
1.18
3.44
3.27
0.22
3.05
5.27
1.36
3.91
12.92
1.96
10.96
13.25
2.11
11.14
NA
5.94
NA
14.45
2.22
12.22
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.72
0.93
1.79
4.38
2.25
2.13
3.28
1.37
1.92
3.11
1.37
1.74
2.51
0.96
1.55
0.32
0.26
0.06
2.01
0.79
1.23
2.10
0.79
1.32
2.00
0.83
1.17
2.56
0.77
1.79
2.30
0.76
1.54
2.09
0.75
1.35
Facility
total
1.61
NA
NA
5.55
NA
NA
1.18
NA
NA
0.22
NA
NA
1.36
NA
NA
1.96
NA
NA
2.11
NA
NA
5.94
NA
NA
2.22
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.93
NA
NA
2.25
NA
NA
1.37
NA
NA
1.37
NA
NA
0.96
NA
NA
0.26
NA
NA
0.79
NA
NA
0.79
NA
NA
0.83
NA
NA
0.77
NA
NA
0.76
NA
NA
0.75
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45968
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
76700
76700
76700
76705
76705
76705
76770
76770
76770
76775
76775
76775
76778
76778
76778
76800
76800
76800
76801
76801
76801
76802
76802
76802
76805
76805
76805
76810
76810
76810
76811
76811
76811
76812
76812
76812
76815
76815
76815
76816
76816
76816
76817
76817
76817
76818
76818
76818
76819
76819
76819
76820
76820
76820
76821
76821
76821
76825
76825
76825
76826
76826
76826
76827
76827
76827
76828
76828
76828
76830
76830
76830
76831
76831
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Us exam, abdom, complete ........................
Us exam, abdom, complete ........................
Us exam, abdom, complete ........................
Echo exam of abdomen ..............................
Echo exam of abdomen ..............................
Echo exam of abdomen ..............................
Us exam abdo back wall, comp ..................
Us exam abdo back wall, comp ..................
Us exam abdo back wall, comp ..................
Us exam abdo back wall, lim ......................
Us exam abdo back wall, lim ......................
Us exam abdo back wall, lim ......................
Us exam kidney transplant ..........................
Us exam kidney transplant ..........................
Us exam kidney transplant ..........................
Us exam, spinal canal .................................
Us exam, spinal canal .................................
Us exam, spinal canal .................................
Ob us < 14 wks, single fetus ......................
Ob us < 14 wks, single fetus ......................
Ob us < 14 wks, single fetus ......................
Ob us < 14 wks, add’l fetus ........................
Ob us < 14 wks, add’l fetus ........................
Ob us < 14 wks, add’l fetus ........................
Ob us >/= 14 wks, sngl fetus ......................
Ob us >/= 14 wks, sngl fetus ......................
Ob us >/= 14 wks, sngl fetus ......................
Ob us >/= 14 wks, addl fetus ......................
Ob us >/= 14 wks, addl fetus ......................
Ob us >/= 14 wks, addl fetus ......................
Ob us, detailed, sngl fetus ..........................
Ob us, detailed, sngl fetus ..........................
Ob us, detailed, sngl fetus ..........................
Ob us, detailed, addl fetus ..........................
Ob us, detailed, addl fetus ..........................
Ob us, detailed, addl fetus ..........................
Ob us, limited, fetus(s) ................................
Ob us, limited, fetus(s) ................................
Ob us, limited, fetus(s) ................................
Ob us, follow-up, per fetus ..........................
Ob us, follow-up, per fetus ..........................
Ob us, follow-up, per fetus ..........................
Transvaginal us, obstetric ...........................
Transvaginal us, obstetric ...........................
Transvaginal us, obstetric ...........................
Fetal biophys profile w/nst ..........................
Fetal biophys profile w/nst ..........................
Fetal biophys profile w/nst ..........................
Fetal biophys profil w/o nst .........................
Fetal biophys profil w/o nst .........................
Fetal biophys profil w/o nst .........................
Umbilical artery echo ...................................
Umbilical artery echo ...................................
Umbilical artery echo ...................................
Middle cerebral artery echo ........................
Middle cerebral artery echo ........................
Middle cerebral artery echo ........................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Echo exam of fetal heart .............................
Transvaginal us, non-ob ..............................
Transvaginal us, non-ob ..............................
Transvaginal us, non-ob ..............................
Echo exam, uterus ......................................
Echo exam, uterus ......................................
0.81
0.81
0.00
0.59
0.59
0.00
0.74
0.74
0.00
0.58
0.58
0.00
0.74
0.74
0.00
1.13
1.13
0.00
0.99
0.99
0.00
0.83
0.83
0.00
0.99
0.99
0.00
0.98
0.98
0.00
1.90
1.90
0.00
1.78
1.78
0.00
0.65
0.65
0.00
0.85
0.85
0.00
0.75
0.75
0.00
1.05
1.05
0.00
0.77
0.77
0.00
0.50
0.50
0.00
0.70
0.70
0.00
1.67
1.67
0.00
0.83
0.83
0.00
0.58
0.58
0.00
0.56
0.56
0.00
0.69
0.69
0.00
0.72
0.72
Nonfacility
PE
RVUs
2.52
0.28
2.24
1.91
0.20
1.71
2.52
0.25
2.27
1.89
0.20
1.69
2.52
0.25
2.27
1.98
0.34
1.64
2.44
0.35
2.09
1.26
0.30
0.96
2.57
0.35
2.22
1.46
0.35
1.11
3.92
0.71
3.21
2.26
0.66
1.60
1.67
0.23
1.44
1.64
0.32
1.32
1.83
0.27
1.56
2.03
0.39
1.64
1.82
0.28
1.54
1.50
0.19
1.32
1.88
0.26
1.61
3.06
0.60
2.46
1.47
0.29
1.17
1.73
0.21
1.52
1.16
0.22
0.95
2.01
0.24
1.77
1.98
0.26
Facility
PE
RVUs
NA
0.28
NA
NA
0.20
NA
NA
0.25
NA
NA
0.20
NA
NA
0.25
NA
NA
0.34
NA
NA
0.35
NA
NA
0.30
NA
NA
0.35
NA
NA
0.35
NA
NA
0.71
NA
NA
0.66
NA
NA
0.23
NA
NA
0.32
NA
NA
0.27
NA
NA
0.39
NA
NA
0.28
NA
NA
0.19
NA
NA
0.26
NA
NA
0.60
NA
NA
0.29
NA
NA
0.21
NA
NA
0.22
NA
NA
0.24
NA
NA
0.26
Malpractice
RVUs
0.15
0.04
0.11
0.11
0.03
0.08
0.14
0.03
0.11
0.11
0.03
0.08
0.14
0.03
0.11
0.13
0.05
0.08
0.16
0.04
0.12
0.16
0.04
0.12
0.16
0.04
0.12
0.26
0.04
0.22
0.52
0.09
0.43
0.49
0.08
0.41
0.11
0.03
0.08
0.10
0.04
0.06
0.09
0.03
0.06
0.15
0.05
0.10
0.13
0.03
0.10
0.15
0.03
0.12
0.15
0.03
0.12
0.18
0.07
0.11
0.08
0.03
0.05
0.14
0.02
0.12
0.11
0.03
0.08
0.13
0.03
0.10
0.13
0.03
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00206
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
3.48
1.13
2.35
2.61
0.82
1.79
3.40
1.02
2.38
2.58
0.81
1.77
3.40
1.02
2.38
3.24
1.52
1.72
3.59
1.38
2.21
2.25
1.17
1.08
3.72
1.38
2.34
2.70
1.37
1.33
6.34
2.71
3.64
4.54
2.53
2.01
2.43
0.91
1.52
2.59
1.21
1.38
2.67
1.05
1.62
3.24
1.49
1.74
2.73
1.08
1.64
2.15
0.72
1.44
2.73
0.99
1.73
4.91
2.34
2.57
2.38
1.15
1.22
2.45
0.81
1.64
1.84
0.81
1.03
2.83
0.96
1.87
2.84
1.01
Facility
total
NA
1.13
NA
NA
0.82
NA
NA
1.02
NA
NA
0.81
NA
NA
1.02
NA
NA
1.52
NA
NA
1.38
NA
NA
1.17
NA
NA
1.38
NA
NA
1.37
NA
NA
2.71
NA
NA
2.53
NA
NA
0.91
NA
NA
1.21
NA
NA
1.05
NA
NA
1.49
NA
NA
1.08
NA
NA
0.72
NA
NA
0.99
NA
NA
2.34
NA
NA
1.15
NA
NA
0.81
NA
NA
0.81
NA
NA
0.96
NA
NA
1.01
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45969
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
76831
76856
76856
76856
76857
76857
76857
76870
76870
76870
76872
76872
76872
76873
76873
76873
76880
76880
76880
76885
76885
76885
76886
76886
76886
76930
76930
76930
76932
76932
76932
76936
76936
76936
76937
76937
76937
76940
76940
76940
76941
76941
76941
76942
76942
76942
76945
76945
76945
76946
76946
76946
76948
76948
76948
76950
76950
76950
76965
76965
76965
76970
76970
76970
76975
76975
76975
76977
76977
76977
76986
76986
76986
76999
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
Physician
work
RVUs 3
Description
Echo exam, uterus ......................................
Us exam, pelvic, complete ..........................
Us exam, pelvic, complete ..........................
Us exam, pelvic, complete ..........................
Us exam, pelvic, limited ..............................
Us exam, pelvic, limited ..............................
Us exam, pelvic, limited ..............................
Us exam, scrotum .......................................
Us exam, scrotum .......................................
Us exam, scrotum .......................................
Us, transrectal .............................................
Us, transrectal .............................................
Us, transrectal .............................................
Echograp trans r, pros study .......................
Echograp trans r, pros study .......................
Echograp trans r, pros study .......................
Us exam, extremity .....................................
Us exam, extremity .....................................
Us exam, extremity .....................................
Us exam infant hips, dynamic .....................
Us exam infant hips, dynamic .....................
Us exam infant hips, dynamic .....................
Us exam infant hips, static ..........................
Us exam infant hips, static ..........................
Us exam infant hips, static ..........................
Echo guide, cardiocentesis .........................
Echo guide, cardiocentesis .........................
Echo guide, cardiocentesis .........................
Echo guide for heart biopsy ........................
Echo guide for heart biopsy ........................
Echo guide for heart biopsy ........................
Echo guide for artery repair ........................
Echo guide for artery repair ........................
Echo guide for artery repair ........................
Us guide, vascular access ..........................
Us guide, vascular access ..........................
Us guide, vascular access ..........................
Us guide, tissue ablation .............................
Us guide, tissue ablation .............................
Us guide, tissue ablation .............................
Echo guide for transfusion ..........................
Echo guide for transfusion ..........................
Echo guide for transfusion ..........................
Echo guide for biopsy .................................
Echo guide for biopsy .................................
Echo guide for biopsy .................................
Echo guide, villus sampling .........................
Echo guide, villus sampling .........................
Echo guide, villus sampling .........................
Echo guide for amniocentesis .....................
Echo guide for amniocentesis .....................
Echo guide for amniocentesis .....................
Echo guide, ova aspiration ..........................
Echo guide, ova aspiration ..........................
Echo guide, ova aspiration ..........................
Echo guidance radiotherapy .......................
Echo guidance radiotherapy .......................
Echo guidance radiotherapy .......................
Echo guidance radiotherapy .......................
Echo guidance radiotherapy .......................
Echo guidance radiotherapy .......................
Ultrasound exam follow-up ..........................
Ultrasound exam follow-up ..........................
Ultrasound exam follow-up ..........................
GI endoscopic ultrasound ...........................
GI endoscopic ultrasound ...........................
GI endoscopic ultrasound ...........................
Us bone density measure ...........................
Us bone density measure ...........................
Us bone density measure ...........................
Ultrasound guide intraoper ..........................
Ultrasound guide intraoper ..........................
Ultrasound guide intraoper ..........................
Echo examination procedure ......................
0.00
0.69
0.69
0.00
0.38
0.38
0.00
0.64
0.64
0.00
0.69
0.69
0.00
1.55
1.55
0.00
0.59
0.59
0.00
0.74
0.74
0.00
0.62
0.62
0.00
0.67
0.67
0.00
0.67
0.67
0.00
1.99
1.99
0.00
0.30
0.30
0.00
2.00
2.00
0.00
1.34
1.34
0.00
0.67
0.67
0.00
0.67
0.67
0.00
0.38
0.38
0.00
0.38
0.38
0.00
0.58
0.58
0.00
1.34
1.34
0.00
0.40
0.40
0.00
0.81
0.81
0.00
0.05
0.05
0.00
1.20
1.20
0.00
0.00
Nonfacility
PE
RVUs
1.73
2.10
0.24
1.86
2.08
0.13
1.95
2.12
0.22
1.90
2.59
0.25
2.35
3.05
0.55
2.50
2.06
0.20
1.86
2.21
0.25
1.96
1.82
0.21
1.61
1.69
0.26
1.43
NA
0.26
NA
6.80
0.68
6.11
0.58
0.11
0.47
NA
0.67
NA
NA
0.48
NA
3.73
0.24
3.49
NA
0.23
NA
1.36
0.14
1.21
1.39
0.14
1.25
1.55
0.20
1.35
4.86
0.49
4.38
1.43
0.14
1.29
3.41
0.30
3.12
0.65
0.02
0.63
NA
0.41
NA
0.00
Facility
PE
RVUs
NA
NA
0.24
NA
NA
0.13
NA
NA
0.22
NA
NA
0.25
NA
NA
0.55
NA
NA
0.20
NA
NA
0.25
NA
NA
0.21
NA
NA
0.26
NA
NA
0.26
NA
NA
0.68
NA
NA
0.11
NA
NA
0.67
NA
NA
0.48
NA
NA
0.24
NA
NA
0.23
NA
NA
0.14
NA
NA
0.14
NA
NA
0.20
NA
NA
0.49
NA
NA
0.14
NA
NA
0.30
NA
NA
0.02
NA
NA
0.41
NA
0.00
Malpractice
RVUs
0.10
0.13
0.03
0.10
0.08
0.02
0.06
0.13
0.03
0.10
0.14
0.04
0.10
0.25
0.09
0.16
0.11
0.03
0.08
0.13
0.03
0.10
0.11
0.03
0.08
0.12
0.02
0.10
0.12
0.02
0.10
0.47
0.13
0.34
0.13
0.03
0.10
0.60
0.31
0.29
0.15
0.07
0.08
0.13
0.03
0.10
0.11
0.03
0.08
0.12
0.02
0.10
0.12
0.02
0.10
0.10
0.03
0.07
0.37
0.08
0.29
0.08
0.02
0.06
0.14
0.04
0.10
0.06
0.01
0.05
0.27
0.13
0.14
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00207
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.83
2.92
0.96
1.96
2.54
0.53
2.01
2.89
0.89
2.00
3.42
0.98
2.45
4.85
2.19
2.66
2.77
0.82
1.94
3.09
1.02
2.06
2.55
0.86
1.69
2.48
0.95
1.53
NA
0.95
NA
9.26
2.81
6.45
1.01
0.44
0.57
NA
2.98
NA
NA
1.90
NA
4.53
0.94
3.59
NA
0.93
NA
1.86
0.54
1.31
1.89
0.54
1.35
2.23
0.81
1.42
6.57
1.91
4.67
1.91
0.56
1.35
4.37
1.15
3.22
0.76
0.08
0.68
NA
1.75
NA
0.00
Facility
total
NA
NA
0.96
NA
NA
0.53
NA
NA
0.89
NA
NA
0.98
NA
NA
2.19
NA
NA
0.82
NA
NA
1.02
NA
NA
0.86
NA
NA
0.95
NA
NA
0.95
NA
NA
2.81
NA
NA
0.44
NA
NA
2.98
NA
NA
1.90
NA
NA
0.94
NA
NA
0.93
NA
NA
0.54
NA
NA
0.54
NA
NA
0.81
NA
NA
1.91
NA
NA
0.56
NA
NA
1.15
NA
NA
0.08
NA
NA
1.75
NA
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45970
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
Mod
76999 ..........
76999 ..........
77261 ..........
77262 ..........
77263 ..........
77280 ..........
77280 ..........
77280 ..........
77285 ..........
77285 ..........
77285 ..........
77290 ..........
77290 ..........
77290 ..........
77295 ..........
77295 ..........
77295 ..........
77299 ..........
77299 ..........
77299 ..........
77300 ..........
77300 ..........
77300 ..........
77301 ..........
77301 ..........
77301 ..........
77305 ..........
77305 ..........
77305 ..........
77310 ..........
77310 ..........
77310 ..........
77315 ..........
77315 ..........
77315 ..........
7321 ............
77321 ..........
77321 ..........
77326 ..........
77326 ..........
77326 ..........
77327 ..........
77327 ..........
77327 ..........
77328 ..........
77328 ..........
77328 ..........
77331 ..........
77331 ..........
77331 ..........
77332 ..........
77332 ..........
77332 ..........
77333 ..........
77333 ..........
77333 ..........
77334 ..........
77334 ..........
77334 ..........
77336 ..........
77370 ..........
77399 ..........
77399 ..........
77399 ..........
77401 ..........
77402 ..........
77403 ..........
77404 ..........
77406 ..........
77407 ..........
77408 ..........
77409 ..........
77411 ..........
77412 ..........
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
Status
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Echo examination procedure ......................
Echo examination procedure ......................
Radiation therapy planning .........................
Radiation therapy planning .........................
Radiation therapy planning .........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Set radiation therapy field ...........................
Radiation therapy planning .........................
Radiation therapy planning .........................
Radiation therapy planning .........................
Radiation therapy dose plan .......................
Radiation therapy dose plan .......................
Radiation therapy dose plan .......................
Radiotherapy dose plan, imrt ......................
Radiotherapy dose plan, imrt ......................
Radiotherapy dose plan, imrt ......................
Teletx isodose plan simple ..........................
Teletx isodose plan simple ..........................
Teletx isodose plan simple ..........................
Teletx isodose plan intermed ......................
Teletx isodose plan intermed ......................
Teletx isodose plan intermed ......................
Teletx isodose plan complex .......................
Teletx isodose plan complex .......................
Teletx isodose plan complex .......................
Special teletx port plan ................................
Special teletx port plan ................................
Special teletx port plan ................................
Brachytx isodose calc simp .........................
Brachytx isodose calc simp .........................
Brachytx isodose calc simp .........................
Brachytx isodose calc interm ......................
Brachytx isodose calc interm ......................
Brachytx isodose calc interm ......................
Brachytx isodose plan compl ......................
Brachytx isodose plan compl ......................
Brachytx isodose plan compl ......................
Special radiation dosimetry .........................
Special radiation dosimetry .........................
Special radiation dosimetry .........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation treatment aid(s) ...........................
Radiation physics consult ............................
Radiation physics consult ............................
External radiation dosimetry ........................
External radiation dosimetry ........................
External radiation dosimetry ........................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
0.00
0.00
1.39
2.11
3.15
0.70
0.70
0.00
1.05
1.05
0.00
1.56
1.56
0.00
4.57
4.57
0.00
0.00
0.00
0.00
0.62
0.62
0.00
8.01
8.01
0.00
0.70
0.70
0.00
1.05
1.05
0.00
1.56
1.56
0.00
0.95
0.95
0.00
0.93
0.93
0.00
1.39
1.39
0.00
2.09
2.09
0.00
0.87
0.87
0.00
0.54
0.54
0.00
0.84
0.84
0.00
1.24
1.24
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.00
0.00
0.53
0.77
1.12
3.85
0.23
3.62
6.38
0.35
6.03
8.57
0.52
8.05
24.31
1.51
22.80
0.00
0.00
0.00
1.49
0.21
1.28
38.62
2.66
35.96
1.83
0.24
1.59
2.36
0.35
2.01
2.97
0.52
2.45
3.68
0.31
3.37
2.90
0.31
2.59
4.19
0.46
3.73
5.81
0.69
5.12
0.81
0.29
0.52
1.59
0.18
1.41
1.79
0.28
1.51
3.55
0.41
3.14
2.57
3.45
0.00
0.00
0.00
1.53
2.26
2.14
2.26
2.24
2.84
2.69
2.81
2.79
3.24
Facility
PE
RVUs
0.00
0.00
0.52
0.76
1.12
NA
0.23
NA
NA
0.35
NA
NA
0.52
NA
NA
1.51
NA
0.00
0.00
0.00
NA
0.21
NA
NA
2.66
NA
NA
0.24
NA
NA
0.35
NA
NA
0.52
NA
NA
0.31
NA
NA
0.31
NA
NA
0.46
NA
NA
0.69
NA
NA
0.29
NA
NA
0.18
NA
NA
0.28
NA
NA
0.41
NA
NA
NA
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Malpractice
RVUs
0.00
0.00
0.07
0.11
0.16
0.22
0.04
0.18
0.35
0.05
0.30
0.43
0.08
0.35
1.72
0.23
1.48
0.00
0.00
0.00
0.10
0.03
0.07
1.89
0.40
1.48
0.15
0.04
0.11
0.18
0.05
0.13
0.22
0.08
0.14
0.26
0.05
0.21
0.18
0.05
0.13
0.25
0.07
0.18
0.36
0.11
0.25
0.06
0.04
0.02
0.10
0.03
0.07
0.15
0.04
0.11
0.23
0.06
0.17
0.16
0.18
0.00
0.00
0.00
0.11
0.11
0.11
0.11
0.11
0.12
0.12
0.12
0.12
0.13
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00208
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
1.99
2.99
4.43
4.77
0.97
3.80
7.78
1.45
6.33
10.56
2.16
8.40
30.60
6.30
24.28
0.00
0.00
0.00
2.21
0.86
1.35
48.51
11.06
37.44
2.68
0.98
1.70
3.59
1.45
2.14
4.75
2.16
2.59
4.89
1.31
3.58
4.01
1.29
2.72
5.83
1.92
3.91
8.27
2.90
5.37
1.74
1.20
0.54
2.23
0.75
1.48
2.78
1.16
1.62
5.02
1.71
3.31
2.73
3.63
0.00
0.00
0.00
1.64
2.37
2.25
2.37
2.35
2.96
2.81
2.93
2.91
3.37
Facility
total
0.00
0.00
1.98
2.99
4.43
NA
0.97
NA
NA
1.45
NA
NA
2.16
NA
NA
6.30
NA
0.00
0.00
0.00
NA
0.86
NA
NA
11.06
NA
NA
0.98
NA
NA
1.45
NA
NA
2.16
NA
NA
1.31
NA
NA
1.29
NA
NA
1.92
NA
NA
2.90
NA
NA
1.20
NA
NA
0.75
NA
NA
1.16
NA
NA
1.71
NA
NA
NA
0.00
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45971
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
77413
77414
77416
77417
77418
77427
77431
77432
77470
77470
77470
77499
77499
77499
77520
77522
77523
77525
77600
77600
77600
77605
77605
77605
77610
77610
77610
77615
77615
77615
77620
77620
77620
77750
77750
77750
77761
77761
77761
77762
77762
77762
77763
77763
77763
77776
77776
77776
77777
77777
77777
77778
77778
77778
77781
77781
77781
77782
77782
77782
77783
77783
77783
77784
77784
77784
77789
77789
77789
77790
77790
77790
77799
77799
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
C
C
C
C
C
C
C
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
Physician
work
RVUs 3
Description
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiation treatment delivery .......................
Radiology port film(s) ..................................
Radiation tx delivery, imrt ............................
Radiation tx management, x5 .....................
Radiation therapy management ..................
Stereotactic radiation trmt ...........................
Special radiation treatment .........................
Special radiation treatment .........................
Special radiation treatment .........................
Radiation therapy management ..................
Radiation therapy management ..................
Radiation therapy management ..................
Proton trmt, simple w/o comp .....................
Proton trmt, simple w/comp ........................
Proton trmt, intermediate .............................
Proton treatment, complex ..........................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Hyperthermia treatment ...............................
Infuse radioactive materials ........................
Infuse radioactive materials ........................
Infuse radioactive materials ........................
Apply intrcav radiat simple ..........................
Apply intrcav radiat simple ..........................
Apply intrcav radiat simple ..........................
Apply intrcav radiat interm ..........................
Apply intrcav radiat interm ..........................
Apply intrcav radiat interm ..........................
Apply intrcav radiat compl ...........................
Apply intrcav radiat compl ...........................
Apply intrcav radiat compl ...........................
Apply interstit radiat simpl ...........................
Apply interstit radiat simpl ...........................
Apply interstit radiat simpl ...........................
Apply interstit radiat inter ............................
Apply interstit radiat inter ............................
Apply interstit radiat inter ............................
Apply interstit radiat compl ..........................
Apply interstit radiat compl ..........................
Apply interstit radiat compl ..........................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
High intensity brachytherapy .......................
Apply surface radiation ................................
Apply surface radiation ................................
Apply surface radiation ................................
Radiation handling .......................................
Radiation handling .......................................
Radiation handling .......................................
Radium/radioisotope therapy ......................
Radium/radioisotope therapy ......................
0.00
0.00
0.00
0.00
0.00
3.32
1.81
7.94
2.09
2.09
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.56
1.56
0.00
2.09
2.09
0.00
1.56
1.56
0.00
2.09
2.09
0.00
1.56
1.56
0.00
4.91
4.91
0.00
3.81
3.81
0.00
5.72
5.72
0.00
8.58
8.58
0.00
4.66
4.66
0.00
7.48
7.48
0.00
11.19
11.19
0.00
1.66
1.66
0.00
2.49
2.49
0.00
3.73
3.73
0.00
5.61
5.61
0.00
1.12
1.12
0.00
1.05
1.05
0.00
0.00
0.00
Nonfacility
PE
RVUs
3.22
3.39
3.36
0.56
16.71
1.16
0.79
2.92
9.53
0.69
8.84
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.57
0.52
5.06
8.40
0.68
7.71
7.34
0.53
6.81
11.06
0.69
10.37
4.94
0.54
4.40
3.28
1.63
1.65
4.43
1.10
3.32
6.33
1.86
4.47
8.26
2.80
5.46
4.34
0.94
3.40
6.94
2.48
4.45
9.63
3.71
5.92
16.99
0.54
16.45
19.56
0.82
18.73
23.47
1.23
22.24
29.75
1.85
27.90
1.18
0.38
0.80
1.02
0.35
0.67
0.00
0.00
Facility
PE
RVUs
NA
NA
NA
NA
NA
1.09
0.68
2.92
NA
0.69
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.52
NA
NA
0.68
NA
NA
0.53
NA
NA
0.69
NA
NA
0.54
NA
NA
1.63
NA
NA
1.10
NA
NA
1.86
NA
NA
2.80
NA
NA
0.94
NA
NA
2.48
NA
NA
3.71
NA
NA
0.54
NA
NA
0.82
NA
NA
1.23
NA
NA
1.85
NA
NA
0.38
NA
NA
0.35
NA
0.00
0.00
Malpractice
RVUs
0.13
0.13
0.13
0.04
0.13
0.17
0.09
0.41
0.70
0.11
0.59
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.24
0.08
0.16
0.38
0.16
0.22
0.24
0.08
0.16
0.33
0.11
0.22
0.36
0.20
0.16
0.32
0.25
0.07
0.33
0.19
0.14
0.48
0.29
0.19
0.66
0.43
0.23
0.57
0.44
0.13
0.61
0.39
0.22
0.84
0.57
0.27
1.14
0.08
1.06
1.19
0.13
1.06
1.25
0.19
1.06
1.35
0.29
1.06
0.08
0.06
0.02
0.07
0.05
0.02
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00209
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
3.35
3.52
3.49
0.60
16.84
4.65
2.70
11.27
12.32
2.90
9.43
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7.38
2.16
5.22
10.87
2.94
7.93
9.14
2.17
6.97
13.49
2.89
10.59
6.87
2.30
4.56
8.51
6.79
1.72
8.57
5.10
3.46
12.53
7.88
4.66
17.50
11.81
5.69
9.57
6.04
3.53
15.04
10.36
4.67
21.67
15.47
6.19
19.79
2.29
17.51
23.24
3.45
19.79
28.45
5.14
23.30
36.71
7.75
28.96
2.38
1.56
0.82
2.14
1.45
0.69
0.00
0.00
Facility
total
NA
NA
NA
NA
NA
4.58
2.58
11.27
NA
2.90
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
2.16
NA
NA
2.94
NA
NA
2.17
NA
NA
2.89
NA
NA
2.30
NA
NA
6.79
NA
NA
5.10
NA
NA
7.88
NA
NA
11.81
NA
NA
6.04
NA
NA
10.36
NA
NA
15.47
NA
NA
2.29
NA
NA
3.45
NA
NA
5.14
NA
NA
7.75
NA
NA
1.56
NA
NA
1.45
NA
0.00
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
090
000
000
000
XXX
XXX
XXX
XXX
XXX
45972
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
Mod
77799 ..........
78000 ..........
78000 ..........
78000 ..........
78001 ..........
78001 ..........
001 ..............
78003 ..........
78003 ..........
78003 ..........
78006 ..........
78006 ..........
78006 ..........
78007 ..........
78007 ..........
78007 ..........
78010 ..........
78010 ..........
78010 ..........
78011 ..........
78011 ..........
78011 ..........
78015 ..........
78015 ..........
78015 ..........
78016 ..........
78016 ..........
78016 ..........
78018 ..........
78018 ..........
78018 ..........
78020 ..........
78020 ..........
78020 ..........
78070 ..........
78070 ..........
78070 ..........
78075 ..........
78075 ..........
78075 ..........
78099 ..........
78099 ..........
78099 ..........
78102 ..........
78102 ..........
78102 ..........
78103 ..........
78103 ..........
78103 ..........
78104 ..........
78104 ..........
78104 ..........
78110 ..........
78110 ..........
78110 ..........
78111 ..........
78111 ..........
78111 ..........
78120 ..........
78120 ..........
78120 ..........
78121 ..........
78121 ..........
78121 ..........
78122 ..........
78122 ..........
78122 ..........
78130 ..........
78130 ..........
78130 ..........
78135 ..........
78135 ..........
78135 ..........
78140 ..........
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Radium/radioisotope therapy ......................
Thyroid, single uptake .................................
Thyroid, single uptake .................................
Thyroid, single uptake .................................
Thyroid, multiple uptakes ............................
Thyroid, multiple uptakes ............................
Thyroid, multiple uptakes ............................
Thyroid suppress/stimul ..............................
Thyroid suppress/stimul ..............................
Thyroid suppress/stimul ..............................
Thyroid imaging with uptake .......................
Thyroid imaging with uptake .......................
Thyroid imaging with uptake .......................
Thyroid image, mult uptakes .......................
Thyroid image, mult uptakes .......................
Thyroid image, mult uptakes .......................
Thyroid imaging ...........................................
Thyroid imaging ...........................................
Thyroid imaging ...........................................
Thyroid imaging with flow ............................
Thyroid imaging with flow ............................
Thyroid imaging with flow ............................
Thyroid met imaging ....................................
Thyroid met imaging ....................................
Thyroid met imaging ....................................
Thyroid met imaging/studies .......................
Thyroid met imaging/studies .......................
Thyroid met imaging/studies .......................
Thyroid met imaging, body ..........................
Thyroid met imaging, body ..........................
Thyroid met imaging, body ..........................
Thyroid met uptake .....................................
Thyroid met uptake .....................................
Thyroid met uptake .....................................
Parathyroid nuclear imaging .......................
Parathyroid nuclear imaging .......................
Parathyroid nuclear imaging .......................
Adrenal nuclear imaging .............................
Adrenal nuclear imaging .............................
Adrenal nuclear imaging .............................
Endocrine nuclear procedure ......................
Endocrine nuclear procedure ......................
Endocrine nuclear procedure ......................
Bone marrow imaging, ltd ...........................
Bone marrow imaging, ltd ...........................
Bone marrow imaging, ltd ...........................
Bone marrow imaging, mult ........................
Bone marrow imaging, mult ........................
Bone marrow imaging, mult ........................
Bone marrow imaging, body .......................
Bone marrow imaging, body .......................
Bone marrow imaging, body .......................
Plasma volume, single ................................
Plasma volume, single ................................
Plasma volume, single ................................
Plasma volume, multiple .............................
Plasma volume, multiple .............................
Plasma volume, multiple .............................
Red cell mass, single ..................................
Red cell mass, single ..................................
Red cell mass, single ..................................
Red cell mass, multiple ...............................
Red cell mass, multiple ...............................
Red cell mass, multiple ...............................
Blood volume ...............................................
Blood volume ...............................................
Blood volume ...............................................
Red cell survival study ................................
Red cell survival study ................................
Red cell survival study ................................
Red cell survival kinetics .............................
Red cell survival kinetics .............................
Red cell survival kinetics .............................
Red cell sequestration .................................
0.00
0.19
0.19
0.00
0.26
0.26
0.00
0.33
0.33
0.00
0.49
0.49
0.00
0.50
0.50
0.00
0.39
0.39
0.00
0.45
0.45
0.00
0.67
0.67
0.00
0.82
0.82
0.00
0.86
0.86
0.00
0.60
0.60
0.00
0.82
0.82
0.00
0.74
0.74
0.00
0.00
0.00
0.00
0.55
0.55
0.00
0.75
0.75
0.00
0.80
0.80
0.00
0.19
0.19
0.00
0.22
0.22
0.00
0.23
0.23
0.00
0.32
0.32
0.00
0.45
0.45
0.00
0.61
0.61
0.00
0.64
0.64
0.00
0.61
Nonfacility
PE
RVUs
0.00
1.18
0.06
1.12
1.60
0.09
1.51
1.31
0.12
1.19
3.24
0.17
3.07
2.88
0.18
2.70
2.41
0.14
2.27
2.97
0.16
2.81
3.19
0.24
2.95
4.61
0.30
4.32
5.95
0.31
5.64
1.61
0.22
1.39
4.32
0.29
4.03
6.80
0.27
6.53
0.00
0.00
0.00
2.64
0.20
2.43
3.81
0.27
3.54
4.58
0.28
4.29
1.22
0.07
1.15
2.38
0.08
2.30
1.74
0.08
1.65
2.69
0.12
2.58
4.15
0.17
3.98
2.95
0.22
2.73
5.59
0.23
5.36
3.79
Facility
PE
RVUs
0.00
NA
0.06
NA
NA
0.09
NA
NA
0.12
NA
NA
0.17
NA
NA
0.18
NA
NA
0.14
NA
NA
0.16
NA
NA
0.24
NA
NA
0.30
NA
NA
0.31
NA
NA
0.22
NA
NA
0.29
NA
NA
0.27
NA
0.00
0.00
0.00
NA
0.20
NA
NA
0.27
NA
NA
0.28
NA
NA
0.07
NA
NA
0.08
NA
NA
0.08
NA
NA
0.12
NA
NA
0.17
NA
NA
0.22
NA
NA
0.23
NA
NA
Malpractice
RVUs
0.00
0.07
0.01
0.06
0.08
0.01
0.07
0.07
0.01
0.06
0.15
0.02
0.13
0.16
0.02
0.14
0.13
0.02
0.11
0.15
0.02
0.13
0.17
0.03
0.14
0.21
0.03
0.18
0.33
0.04
0.29
0.16
0.02
0.14
0.15
0.04
0.11
0.32
0.03
0.29
0.00
0.00
0.00
0.14
0.02
0.12
0.20
0.03
0.17
0.25
0.03
0.22
0.07
0.01
0.06
0.15
0.01
0.14
0.12
0.01
0.11
0.15
0.01
0.14
0.26
0.02
0.24
0.17
0.03
0.14
0.28
0.03
0.25
0.24
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00210
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
1.44
0.26
1.18
1.94
0.36
1.58
1.71
0.46
1.25
3.88
0.68
3.20
3.54
0.70
2.84
2.93
0.55
2.38
3.57
0.63
2.94
4.04
0.94
3.09
5.64
1.15
4.50
7.14
1.21
5.93
2.37
0.84
1.53
5.30
1.15
4.14
7.87
1.04
6.82
0.00
0.00
0.00
3.33
0.77
2.55
4.76
1.05
3.71
5.63
1.11
4.51
1.48
0.27
1.21
2.75
0.31
2.44
2.09
0.32
1.76
3.16
0.45
2.72
4.86
0.64
4.22
3.73
0.86
2.87
6.51
0.90
5.61
4.64
Facility
total
0.00
NA
0.26
NA
NA
0.36
NA
NA
0.46
NA
NA
0.68
NA
NA
0.70
NA
NA
0.55
NA
NA
0.63
NA
NA
0.94
NA
NA
1.15
NA
NA
1.21
NA
NA
0.84
NA
NA
1.15
NA
NA
1.04
NA
0.00
0.00
0.00
NA
0.77
NA
NA
1.05
NA
NA
1.11
NA
NA
0.27
NA
NA
0.31
NA
NA
0.32
NA
NA
0.45
NA
NA
0.64
NA
NA
0.86
NA
NA
0.90
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45973
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
78140
78140
78160
78160
78160
78162
78162
78162
78170
78170
78170
78172
78172
78172
78185
78185
78185
78190
78190
78190
78191
78191
78191
78195
78195
78195
78199
78199
78199
78201
78201
78201
78202
78202
78202
78205
78205
78205
78206
78206
78206
78215
78215
78215
78216
78216
78216
78220
78220
78220
78223
78223
78223
78230
78230
78230
78231
78231
78231
78232
78232
78232
78258
78258
78258
78261
78261
78261
78262
78262
78262
78264
78264
78264
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Red cell sequestration .................................
Red cell sequestration .................................
Plasma iron turnover ...................................
Plasma iron turnover ...................................
Plasma iron turnover ...................................
Radioiron absorption exam .........................
Radioiron absorption exam .........................
Radioiron absorption exam .........................
Red cell iron utilization ................................
Red cell iron utilization ................................
Red cell iron utilization ................................
Total body iron estimation ...........................
Total body iron estimation ...........................
Total body iron estimation ...........................
Spleen imaging ............................................
Spleen imaging ............................................
Spleen imaging ............................................
Platelet survival, kinetics .............................
Platelet survival, kinetics .............................
Platelet survival, kinetics .............................
Platelet survival ...........................................
Platelet survival ...........................................
Platelet survival ...........................................
Lymph system imaging ...............................
Lymph system imaging ...............................
Lymph system imaging ...............................
Blood/lymph nuclear exam ..........................
Blood/lymph nuclear exam ..........................
Blood/lymph nuclear exam ..........................
Liver imaging ...............................................
Liver imaging ...............................................
Liver imaging ...............................................
Liver imaging with flow ................................
Liver imaging with flow ................................
Liver imaging with flow ................................
Liver imaging (3D) .......................................
Liver imaging (3D) .......................................
Liver imaging (3D) .......................................
Liver image (3d) with flow ...........................
Liver image (3d) with flow ...........................
Liver image (3d) with flow ...........................
Liver and spleen imaging ............................
Liver and spleen imaging ............................
Liver and spleen imaging ............................
Liver & spleen image/flow ...........................
Liver & spleen image/flow ...........................
Liver & spleen image/flow ...........................
Liver function study .....................................
Liver function study .....................................
Liver function study .....................................
Hepatobiliary imaging ..................................
Hepatobiliary imaging ..................................
Hepatobiliary imaging ..................................
Salivary gland imaging ................................
Salivary gland imaging ................................
Salivary gland imaging ................................
Serial salivary imaging ................................
Serial salivary imaging ................................
Serial salivary imaging ................................
Salivary gland function exam ......................
Salivary gland function exam ......................
Salivary gland function exam ......................
Esophageal motility study ...........................
Esophageal motility study ...........................
Esophageal motility study ...........................
Gastric mucosa imaging ..............................
Gastric mucosa imaging ..............................
Gastric mucosa imaging ..............................
Gastroesophageal reflux exam ...................
Gastroesophageal reflux exam ...................
Gastroesophageal reflux exam ...................
Gastric emptying study ................................
Gastric emptying study ................................
Gastric emptying study ................................
0.61
0.00
0.33
0.33
0.00
0.45
0.45
0.00
0.41
0.41
0.00
0.00
0.53
0.00
0.40
0.40
0.00
1.09
1.09
0.00
0.61
0.61
0.00
1.20
1.20
0.00
0.00
0.00
0.00
0.44
0.44
0.00
0.51
0.51
0.00
0.71
0.71
0.00
0.96
0.96
0.00
0.49
0.49
0.00
0.57
0.57
0.00
0.49
0.49
0.00
0.84
0.84
0.00
0.45
0.45
0.00
0.52
0.52
0.00
0.47
0.47
0.00
0.74
0.74
0.00
0.69
0.69
0.00
0.68
0.68
0.00
0.78
0.78
0.00
Nonfacility
PE
RVUs
0.21
3.58
3.04
0.12
2.92
2.73
0.19
2.54
4.36
0.15
4.22
0.00
0.18
0.00
2.96
0.15
2.81
6.43
0.41
6.02
6.53
0.21
6.32
5.19
0.43
4.76
0.00
0.00
0.00
2.96
0.16
2.80
3.44
0.18
3.26
5.87
0.25
5.61
8.15
0.34
7.80
3.48
0.17
3.31
3.49
0.20
3.29
3.67
0.17
3.50
4.79
0.29
4.49
2.74
0.15
2.58
3.14
0.19
2.96
3.47
0.17
3.30
3.70
0.26
3.44
4.56
0.25
4.31
4.57
0.24
4.33
4.86
0.27
4.59
Facility
PE
RVUs
0.21
NA
NA
0.12
NA
NA
0.19
NA
NA
0.15
NA
0.00
0.18
0.00
NA
0.15
NA
NA
0.41
NA
NA
0.21
NA
NA
0.43
NA
0.00
0.00
0.00
NA
0.16
NA
NA
0.18
NA
NA
0.25
NA
NA
0.34
NA
NA
0.17
NA
NA
0.20
NA
NA
0.17
NA
NA
0.29
NA
NA
0.15
NA
NA
0.19
NA
NA
0.17
NA
NA
0.26
NA
NA
0.25
NA
NA
0.24
NA
NA
0.27
NA
Malpractice
RVUs
0.03
0.21
0.23
0.04
0.19
0.19
0.02
0.17
0.30
0.02
0.28
0.00
0.02
0.00
0.15
0.02
0.13
0.38
0.08
0.30
0.40
0.03
0.37
0.28
0.06
0.22
0.00
0.00
0.00
0.15
0.02
0.13
0.16
0.02
0.14
0.34
0.03
0.31
0.15
0.04
0.11
0.16
0.02
0.14
0.20
0.02
0.18
0.21
0.02
0.19
0.23
0.04
0.19
0.15
0.02
0.13
0.19
0.02
0.17
0.20
0.02
0.18
0.17
0.03
0.14
0.25
0.03
0.22
0.25
0.03
0.22
0.25
0.03
0.22
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00211
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.85
3.79
3.60
0.49
3.11
3.37
0.66
2.71
5.07
0.58
4.50
0.00
0.73
0.00
3.51
0.57
2.94
7.90
1.58
6.32
7.54
0.85
6.69
6.68
1.69
4.98
0.00
0.00
0.00
3.55
0.62
2.93
4.11
0.71
3.40
6.92
0.99
5.92
9.26
1.35
7.91
4.13
0.68
3.45
4.26
0.79
3.47
4.37
0.68
3.69
5.86
1.17
4.68
3.34
0.62
2.71
3.85
0.73
3.13
4.14
0.66
3.48
4.61
1.03
3.58
5.51
0.97
4.53
5.50
0.95
4.55
5.89
1.08
4.81
Facility
total
0.85
NA
NA
0.49
NA
NA
0.66
NA
NA
0.58
NA
0.00
0.73
0.00
NA
0.57
NA
NA
1.58
NA
NA
0.85
NA
NA
1.69
NA
0.00
0.00
0.00
NA
0.62
NA
NA
0.71
NA
NA
0.99
NA
NA
1.35
NA
NA
0.68
NA
NA
0.79
NA
NA
0.68
NA
NA
1.17
NA
NA
0.62
NA
NA
0.73
NA
NA
0.66
NA
NA
1.03
NA
NA
0.97
NA
NA
0.95
NA
NA
1.08
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45974
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
78270
78270
78270
78271
78271
78271
78272
78272
78272
78278
78278
78278
78282
78282
78282
78290
78290
78290
78291
78291
78291
78299
78299
78299
78300
78300
78300
78305
78305
78305
78306
78306
78306
78315
78315
78315
78320
78320
78320
78350
78350
78350
78351
78399
78399
78399
78414
78414
78414
78428
78428
78428
78445
78445
78445
78455
78455
78455
78456
78456
78456
78457
78457
78457
78458
78458
78458
78459
78459
78459
78460
78460
78460
78461
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
C
C
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
Physician
work
RVUs 3
Description
Vit B-12 absorption exam ............................
Vit B-12 absorption exam ............................
Vit B-12 absorption exam ............................
Vit b-12 absrp exam, int fac ........................
Vit b-12 absrp exam, int fac ........................
Vit b-12 absrp exam, int fac ........................
Vit B-12 absorp, combined ..........................
Vit B-12 absorp, combined ..........................
Vit B-12 absorp, combined ..........................
Acute GI blood loss imaging .......................
Acute GI blood loss imaging .......................
Acute GI blood loss imaging .......................
GI protein loss exam ...................................
GI protein loss exam ...................................
GI protein loss exam ...................................
Meckel’s divert exam ...................................
Meckel’s divert exam ...................................
Meckel’s divert exam ...................................
Leveen/shunt patency exam .......................
Leveen/shunt patency exam .......................
Leveen/shunt patency exam .......................
GI nuclear procedure ..................................
GI nuclear procedure ..................................
GI nuclear procedure ..................................
Bone imaging, limited area .........................
Bone imaging, limited area .........................
Bone imaging, limited area .........................
Bone imaging, multiple areas ......................
Bone imaging, multiple areas ......................
Bone imaging, multiple areas ......................
Bone imaging, whole body ..........................
Bone imaging, whole body ..........................
Bone imaging, whole body ..........................
Bone imaging, 3 phase ...............................
Bone imaging, 3 phase ...............................
Bone imaging, 3 phase ...............................
Bone imaging (3D) ......................................
Bone imaging (3D) ......................................
Bone imaging (3D) ......................................
Bone mineral, single photon .......................
Bone mineral, single photon .......................
Bone mineral, single photon .......................
Bone mineral, dual photon ..........................
Musculoskeletal nuclear exam ....................
Musculoskeletal nuclear exam ....................
Musculoskeletal nuclear exam ....................
Non-imaging heart function .........................
Non-imaging heart function .........................
Non-imaging heart function .........................
Cardiac shunt imaging ................................
Cardiac shunt imaging ................................
Cardiac shunt imaging ................................
Vascular flow imaging .................................
Vascular flow imaging .................................
Vascular flow imaging .................................
Venous thrombosis study ............................
Venous thrombosis study ............................
Venous thrombosis study ............................
Acute venous thrombus image ...................
Acute venous thrombus image ...................
Acute venous thrombus image ...................
Venous thrombosis imaging ........................
Venous thrombosis imaging ........................
Venous thrombosis imaging ........................
Ven thrombosis images, bilat ......................
Ven thrombosis images, bilat ......................
Ven thrombosis images, bilat ......................
Heart muscle imaging (PET) .......................
Heart muscle imaging (PET) .......................
Heart muscle imaging (PET) .......................
Heart muscle blood, single ..........................
Heart muscle blood, single ..........................
Heart muscle blood, single ..........................
Heart muscle blood, multiple .......................
0.20
0.20
0.00
0.20
0.20
0.00
0.27
0.27
0.00
0.99
0.99
0.00
0.00
0.38
0.00
0.68
0.68
0.00
0.88
0.88
0.00
0.00
0.00
0.00
0.62
0.62
0.00
0.83
0.83
0.00
0.86
0.86
0.00
1.02
1.02
0.00
1.04
1.04
0.00
0.22
0.22
0.00
0.30
0.00
0.00
0.00
0.00
0.45
0.00
0.78
0.78
0.00
0.49
0.49
0.00
0.73
0.73
0.00
1.00
1.00
0.00
0.77
0.77
0.00
0.90
0.90
0.00
0.00
1.50
0.00
0.86
0.86
0.00
1.23
Nonfacility
PE
RVUs
1.55
0.07
1.48
1.64
0.07
1.56
2.15
0.10
2.06
6.10
0.35
5.75
0.00
0.14
0.00
4.32
0.24
4.08
4.00
0.31
3.68
0.00
0.00
0.00
2.97
0.22
2.75
4.16
0.29
3.87
4.77
0.30
4.47
5.69
0.36
5.33
5.89
0.38
5.51
1.00
0.07
0.93
1.86
0.00
0.00
0.00
0.00
0.17
0.00
3.31
0.30
3.00
2.74
0.18
2.57
4.31
0.26
4.05
5.25
0.36
4.89
3.11
0.27
2.85
4.31
0.33
3.98
0.00
0.59
0.00
3.23
0.30
2.93
5.17
Facility
PE
RVUs
NA
0.07
NA
NA
0.07
NA
NA
0.10
NA
NA
0.35
NA
0.00
0.14
0.00
NA
0.24
NA
NA
0.31
NA
0.00
0.00
0.00
NA
0.22
NA
NA
0.29
NA
NA
0.30
NA
NA
0.36
NA
NA
0.38
NA
NA
0.07
NA
0.12
0.00
0.00
0.00
0.00
0.17
0.00
NA
0.30
NA
NA
0.18
NA
NA
0.26
NA
NA
0.36
NA
NA
0.27
NA
NA
0.33
NA
0.00
0.59
0.00
NA
0.30
NA
NA
Malpractice
RVUs
0.11
0.01
0.10
0.11
0.01
0.10
0.14
0.01
0.13
0.29
0.04
0.25
0.00
0.02
0.00
0.19
0.03
0.16
0.20
0.04
0.16
0.00
0.00
0.00
0.17
0.03
0.14
0.23
0.04
0.19
0.26
0.04
0.22
0.29
0.04
0.25
0.35
0.04
0.31
0.06
0.01
0.05
0.01
0.00
0.00
0.00
0.00
0.02
0.00
0.16
0.03
0.13
0.13
0.02
0.11
0.24
0.03
0.21
0.33
0.04
0.29
0.17
0.03
0.14
0.25
0.04
0.21
0.00
0.05
0.00
0.17
0.04
0.13
0.30
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00212
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.86
0.28
1.58
1.95
0.28
1.66
2.56
0.38
2.19
7.38
1.38
6.00
0.00
0.54
0.00
5.19
0.95
4.24
5.08
1.23
3.84
0.00
0.00
0.00
3.76
0.87
2.89
5.22
1.16
4.06
5.89
1.20
4.69
7.00
1.42
5.58
7.28
1.46
5.82
1.28
0.30
0.98
2.17
0.00
0.00
0.00
0.00
0.64
0.00
4.25
1.11
3.13
3.36
0.69
2.68
5.28
1.02
4.26
6.58
1.40
5.18
4.06
1.07
2.99
5.46
1.27
4.19
0.00
2.15
0.00
4.27
1.20
3.06
6.70
Facility
total
NA
0.28
NA
NA
0.28
NA
NA
0.38
NA
NA
1.38
NA
0.00
0.54
0.00
NA
0.95
NA
NA
1.23
NA
0.00
0.00
0.00
NA
0.87
NA
NA
1.16
NA
NA
1.20
NA
NA
1.42
NA
NA
1.46
NA
NA
0.30
NA
0.43
0.00
0.00
0.00
0.00
0.64
0.00
NA
1.11
NA
NA
0.69
NA
NA
1.02
NA
NA
1.40
NA
NA
1.07
NA
NA
1.27
NA
0.00
2.15
0.00
NA
1.20
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45975
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
78461
78461
78464
78464
78464
78465
78465
78465
78466
78466
78466
78468
78468
78468
78469
78469
78469
78472
78472
78472
78473
78473
78473
78478
78478
78478
78480
78480
78480
78481
78481
78481
78483
78483
78483
78491
78491
78491
78492
78492
78492
78494
78494
78494
78496
78496
78496
78499
78499
78499
78580
78580
78580
78584
78584
78584
78585
78585
78585
78586
78586
78586
78587
78587
78587
78588
78588
78588
78591
78591
78591
78593
78593
78593
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Heart muscle blood, multiple .......................
Heart muscle blood, multiple .......................
Heart image (3d), single ..............................
Heart image (3d), single ..............................
Heart image (3d), single ..............................
Heart image (3d), multiple ...........................
Heart image (3d), multiple ...........................
Heart image (3d), multiple ...........................
Heart infarct image ......................................
Heart infarct image ......................................
Heart infarct image ......................................
Heart infarct image (ef) ...............................
Heart infarct image (ef) ...............................
Heart infarct image (ef) ...............................
Heart infarct image (3D) ..............................
Heart infarct image (3D) ..............................
Heart infarct image (3D) ..............................
Gated heart, planar, single ..........................
Gated heart, planar, single ..........................
Gated heart, planar, single ..........................
Gated heart, multiple ...................................
Gated heart, multiple ...................................
Gated heart, multiple ...................................
Heart wall motion add-on ............................
Heart wall motion add-on ............................
Heart wall motion add-on ............................
Heart function add-on ..................................
Heart function add-on ..................................
Heart function add-on ..................................
Heart first pass, single ................................
Heart first pass, single ................................
Heart first pass, single ................................
Heart first pass, multiple .............................
Heart first pass, multiple .............................
Heart first pass, multiple .............................
Heart image (pet), single .............................
Heart image (pet), single .............................
Heart image (pet), single .............................
Heart image (pet), multiple ..........................
Heart image (pet), multiple ..........................
Heart image (pet), multiple ..........................
Heart image, spect ......................................
Heart image, spect ......................................
Heart image, spect ......................................
Heart first pass add-on ................................
Heart first pass add-on ................................
Heart first pass add-on ................................
Cardiovascular nuclear exam ......................
Cardiovascular nuclear exam ......................
Cardiovascular nuclear exam ......................
Lung perfusion imaging ...............................
Lung perfusion imaging ...............................
Lung perfusion imaging ...............................
Lung V/Q image single breath ....................
Lung V/Q image single breath ....................
Lung V/Q image single breath ....................
Lung V/Q imaging .......................................
Lung V/Q imaging .......................................
Lung V/Q imaging .......................................
Aerosol lung image, single ..........................
Aerosol lung image, single ..........................
Aerosol lung image, single ..........................
Aerosol lung image, multiple .......................
Aerosol lung image, multiple .......................
Aerosol lung image, multiple .......................
Perfusion lung image ..................................
Perfusion lung image ..................................
Perfusion lung image ..................................
Vent image, 1 breath, 1 proj .......................
Vent image, 1 breath, 1 proj .......................
Vent image, 1 breath, 1 proj .......................
Vent image, 1 proj, gas ...............................
Vent image, 1 proj, gas ...............................
Vent image, 1 proj, gas ...............................
1.23
0.00
1.09
1.09
0.00
1.46
1.46
0.00
0.69
0.69
0.00
0.80
0.80
0.00
0.92
0.92
0.00
0.98
0.98
0.00
1.47
1.47
0.00
0.62
0.62
0.00
0.62
0.62
0.00
0.98
0.98
0.00
1.47
1.47
0.00
0.00
1.50
0.00
0.00
1.87
0.00
1.19
1.19
0.00
0.50
0.50
0.00
0.00
0.00
0.00
0.74
0.74
0.00
0.99
0.99
0.00
1.09
1.09
0.00
0.40
0.40
0.00
0.49
0.49
0.00
1.09
1.09
0.00
0.40
0.40
0.00
0.49
0.49
0.00
Nonfacility
PE
RVUs
0.45
4.72
7.18
0.40
6.78
12.23
0.54
11.69
3.35
0.25
3.10
4.53
0.29
4.25
5.38
0.32
5.06
5.73
0.36
5.38
7.69
0.53
7.15
1.58
0.24
1.34
1.57
0.23
1.34
4.47
0.38
4.10
6.69
0.56
6.13
0.00
0.00
0.00
0.00
0.00
0.00
7.24
0.44
6.80
5.71
0.19
5.52
0.00
0.00
0.00
4.07
0.26
3.81
3.50
0.35
3.15
6.36
0.38
5.98
3.04
0.14
2.90
3.41
0.18
3.23
4.60
0.38
4.23
3.12
0.14
2.98
3.76
0.17
3.59
Facility
PE
RVUs
0.45
NA
NA
0.40
NA
NA
0.54
NA
NA
0.25
NA
NA
0.29
NA
NA
0.32
NA
NA
0.36
NA
NA
0.53
NA
NA
0.24
NA
NA
0.23
NA
NA
0.38
NA
NA
0.56
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.44
NA
NA
0.19
NA
0.00
0.00
0.00
NA
0.26
NA
NA
0.35
NA
NA
0.38
NA
NA
0.14
NA
NA
0.18
NA
NA
0.38
NA
NA
0.14
NA
NA
0.17
NA
Malpractice
RVUs
0.05
0.25
0.41
0.04
0.37
0.67
0.05
0.62
0.17
0.03
0.14
0.22
0.03
0.19
0.31
0.03
0.28
0.34
0.04
0.30
0.48
0.06
0.42
0.12
0.02
0.10
0.12
0.02
0.10
0.31
0.03
0.28
0.46
0.05
0.41
0.00
0.06
0.00
0.00
0.07
0.00
0.35
0.05
0.30
0.32
0.02
0.30
0.00
0.00
0.00
0.21
0.03
0.18
0.21
0.04
0.17
0.35
0.05
0.30
0.16
0.02
0.14
0.16
0.02
0.14
0.23
0.05
0.18
0.16
0.02
0.14
0.20
0.02
0.18
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00213
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.73
4.97
8.68
1.53
7.15
14.37
2.06
12.31
4.22
0.97
3.24
5.55
1.12
4.44
6.61
1.27
5.34
7.06
1.38
5.68
9.64
2.07
7.57
2.32
0.88
1.44
2.31
0.87
1.44
5.76
1.39
4.38
8.62
2.08
6.54
0.00
1.56
0.00
0.00
1.94
0.00
8.78
1.68
7.10
6.53
0.71
5.82
0.00
0.00
0.00
5.02
1.03
3.99
4.70
1.38
3.32
7.80
1.52
6.28
3.60
0.56
3.04
4.06
0.69
3.37
5.93
1.52
4.41
3.68
0.56
3.12
4.45
0.68
3.77
Facility
total
1.73
NA
NA
1.53
NA
NA
2.06
NA
NA
0.97
NA
NA
1.12
NA
NA
1.27
NA
NA
1.38
NA
NA
2.07
NA
NA
0.88
NA
NA
0.87
NA
NA
1.39
NA
NA
2.08
NA
0.00
1.56
0.00
0.00
1.94
0.00
NA
1.68
NA
NA
0.71
NA
0.00
0.00
0.00
NA
1.03
NA
NA
1.38
NA
NA
1.52
NA
NA
0.56
NA
NA
0.69
NA
NA
1.52
NA
NA
0.56
NA
NA
0.68
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45976
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
78594
78594
78594
78596
78596
78596
78599
78599
78599
78600
78600
78600
78601
78601
78601
78605
78605
78605
78606
78606
78606
78607
78607
78607
78608
78608
78608
78609
78609
78609
78610
78610
78610
78615
78615
78615
78630
78630
78630
78635
78635
78635
78645
78645
78645
78647
78647
78647
78650
78650
78650
78660
78660
78660
78699
78699
78699
78700
78700
78700
78701
78701
78701
78704
78704
78704
78707
78707
78707
78708
78708
78708
78709
78709
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Vent image, mult proj, gas ..........................
Vent image, mult proj, gas ..........................
Vent image, mult proj, gas ..........................
Lung differential function .............................
Lung differential function .............................
Lung differential function .............................
Respiratory nuclear exam ...........................
Respiratory nuclear exam ...........................
Respiratory nuclear exam ...........................
Brain imaging, ltd static ...............................
Brain imaging, ltd static ...............................
Brain imaging, ltd static ...............................
Brain imaging, ltd w/flow .............................
Brain imaging, ltd w/flow .............................
Brain imaging, ltd w/flow .............................
Brain imaging, complete ..............................
Brain imaging, complete ..............................
Brain imaging, complete ..............................
Brain imaging, compl w/flow .......................
Brain imaging, compl w/flow .......................
Brain imaging, compl w/flow .......................
Brain imaging (3D) ......................................
Brain imaging (3D) ......................................
Brain imaging (3D) ......................................
Brain imaging (PET) ....................................
Brain imaging (PET) ....................................
Brain imaging (PET) ....................................
Brain imaging (PET) ....................................
Brain imaging (PET) ....................................
Brain imaging (PET) ....................................
Brain flow imaging only ...............................
Brain flow imaging only ...............................
Brain flow imaging only ...............................
Cerebral vascular flow image ......................
Cerebral vascular flow image ......................
Cerebral vascular flow image ......................
Cerebrospinal fluid scan ..............................
Cerebrospinal fluid scan ..............................
Cerebrospinal fluid scan ..............................
CSF ventriculography ..................................
CSF ventriculography ..................................
CSF ventriculography ..................................
CSF shunt evaluation ..................................
CSF shunt evaluation ..................................
CSF shunt evaluation ..................................
Cerebrospinal fluid scan ..............................
Cerebrospinal fluid scan ..............................
Cerebrospinal fluid scan ..............................
CSF leakage imaging ..................................
CSF leakage imaging ..................................
CSF leakage imaging ..................................
Nuclear exam of tear flow ...........................
Nuclear exam of tear flow ...........................
Nuclear exam of tear flow ...........................
Nervous system nuclear exam ....................
Nervous system nuclear exam ....................
Nervous system nuclear exam ....................
Kidney imaging, static .................................
Kidney imaging, static .................................
Kidney imaging, static .................................
Kidney imaging with flow .............................
Kidney imaging with flow .............................
Kidney imaging with flow .............................
Imaging renogram .......................................
Imaging renogram .......................................
Imaging renogram .......................................
Kidney flow/function image .........................
Kidney flow/function image .........................
Kidney flow/function image .........................
Kidney flow/function image .........................
Kidney flow/function image .........................
Kidney flow/function image .........................
Kidney flow/function image .........................
Kidney flow/function image .........................
0.53
0.53
0.00
1.27
1.27
0.00
0.00
0.00
0.00
0.44
0.44
0.00
0.51
0.51
0.00
0.53
0.53
0.00
0.64
0.64
0.00
1.23
1.23
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.30
0.30
0.00
0.42
0.42
0.00
0.68
0.68
0.00
0.61
0.61
0.00
0.57
0.57
0.00
0.90
0.90
0.00
0.61
0.61
0.00
0.53
0.53
0.00
0.00
0.00
0.00
0.45
0.45
0.00
0.49
0.49
0.00
0.74
0.74
0.00
0.96
0.96
0.00
1.21
1.21
0.00
1.41
1.41
Nonfacility
PE
RVUs
5.09
0.19
4.90
7.35
0.44
6.92
0.00
0.00
0.00
3.50
0.16
3.35
3.91
0.18
3.73
3.77
0.19
3.58
4.79
0.22
4.57
8.26
0.45
7.82
0.00
0.00
0.00
0.00
0.00
0.00
2.15
0.11
2.03
4.07
0.16
3.91
5.67
0.24
5.43
3.91
0.24
3.66
4.91
0.20
4.71
8.47
0.32
8.15
5.35
0.22
5.13
2.68
0.19
2.49
0.00
0.00
0.00
3.42
0.16
3.26
3.93
0.17
3.76
4.35
0.26
4.09
4.89
0.34
4.56
4.63
0.43
4.20
5.73
0.49
Facility
PE
RVUs
NA
0.19
NA
NA
0.44
NA
0.00
0.00
0.00
NA
0.16
NA
NA
0.18
NA
NA
0.19
NA
NA
0.22
NA
NA
0.45
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.11
NA
NA
0.16
NA
NA
0.24
NA
NA
0.24
NA
NA
0.20
NA
NA
0.32
NA
NA
0.22
NA
NA
0.19
NA
0.00
0.00
0.00
NA
0.16
NA
NA
0.17
NA
NA
0.26
NA
NA
0.34
NA
NA
0.43
NA
NA
0.49
Malpractice
RVUs
0.27
0.02
0.25
0.42
0.05
0.37
0.00
0.00
0.00
0.16
0.02
0.14
0.20
0.02
0.18
0.20
0.02
0.18
0.24
0.03
0.21
0.40
0.05
0.35
0.00
0.06
0.00
0.00
0.06
0.00
0.11
0.01
0.10
0.23
0.02
0.21
0.30
0.03
0.27
0.16
0.02
0.14
0.20
0.02
0.18
0.35
0.04
0.31
0.27
0.03
0.24
0.14
0.02
0.12
0.00
0.00
0.00
0.18
0.02
0.16
0.20
0.02
0.18
0.24
0.03
0.21
0.27
0.04
0.23
0.28
0.05
0.23
0.29
0.06
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00214
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
5.89
0.74
5.15
9.05
1.76
7.29
0.00
0.00
0.00
4.11
0.62
3.49
4.62
0.71
3.91
4.50
0.74
3.76
5.67
0.89
4.78
9.90
1.73
8.17
0.00
1.56
0.00
0.00
1.56
0.00
2.56
0.42
2.13
4.72
0.60
4.12
6.65
0.95
5.70
4.68
0.87
3.80
5.68
0.79
4.89
9.73
1.26
8.46
6.23
0.86
5.37
3.35
0.74
2.61
0.00
0.00
0.00
4.05
0.63
3.42
4.62
0.68
3.94
5.34
1.03
4.30
6.12
1.34
4.79
6.12
1.69
4.43
7.43
1.97
Facility
total
NA
0.74
NA
NA
1.76
NA
0.00
0.00
0.00
NA
0.62
NA
NA
0.71
NA
NA
0.74
NA
NA
0.89
NA
NA
1.73
NA
0.00
1.56
0.00
0.00
1.56
0.00
NA
0.42
NA
NA
0.60
NA
NA
0.95
NA
NA
0.87
NA
NA
0.79
NA
NA
1.26
NA
NA
0.86
NA
NA
0.74
NA
0.00
0.00
0.00
NA
0.63
NA
NA
0.68
NA
NA
1.03
NA
NA
1.34
NA
NA
1.69
NA
NA
1.97
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45977
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
78709
78710
78710
78710
78715
78715
78715
78725
78725
78725
78730
78730
78730
78740
78740
78740
78760
78760
78760
78761
78761
78761
78799
78799
78799
78800
78800
78800
78801
78801
78801
78802
78802
78802
78803
78803
78803
78804
78804
78804
78805
78805
78805
78806
78806
78806
78807
78807
78807
78811
78811
78811
78812
78812
78812
78813
78813
78813
78814
78814
78814
78815
78815
78815
78816
78816
78816
78890
78890
78890
78891
78891
78891
78999
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
C
A
C
C
A
C
C
A
C
C
A
C
B
B
B
B
B
B
C
Physician
work
RVUs 3
Description
Kidney flow/function image .........................
Kidney imaging (3D) ....................................
Kidney imaging (3D) ....................................
Kidney imaging (3D) ....................................
Renal vascular flow exam ...........................
Renal vascular flow exam ...........................
Renal vascular flow exam ...........................
Kidney function study ..................................
Kidney function study ..................................
Kidney function study ..................................
Urinary bladder retention .............................
Urinary bladder retention .............................
Urinary bladder retention .............................
Ureteral reflux study ....................................
Ureteral reflux study ....................................
Ureteral reflux study ....................................
Testicular imaging .......................................
Testicular imaging .......................................
Testicular imaging .......................................
Testicular imaging/flow ................................
Testicular imaging/flow ................................
Testicular imaging/flow ................................
Genitourinary nuclear exam ........................
Genitourinary nuclear exam ........................
Genitourinary nuclear exam ........................
Tumor imaging, limited area .......................
Tumor imaging, limited area .......................
Tumor imaging, limited area .......................
Tumor imaging, mult areas .........................
Tumor imaging, mult areas .........................
Tumor imaging, mult areas .........................
Tumor imaging, whole body ........................
Tumor imaging, whole body ........................
Tumor imaging, whole body ........................
Tumor imaging (3D) ....................................
Tumor imaging (3D) ....................................
Tumor imaging (3D) ....................................
Tumor imaging, whole body ........................
Tumor imaging, whole body ........................
Tumor imaging, whole body ........................
Abscess imaging, ltd area ...........................
Abscess imaging, ltd area ...........................
Abscess imaging, ltd area ...........................
Abscess imaging, whole body .....................
Abscess imaging, whole body .....................
Abscess imaging, whole body .....................
Nuclear localization/abscess .......................
Nuclear localization/abscess .......................
Nuclear localization/abscess .......................
Tumor imaging (pet), limited .......................
Tumor imaging (pet), limited .......................
Tumor imaging (pet), limited .......................
Tumor image (pet)/skul-thigh ......................
Tumor image (pet)/skul-thigh ......................
Tumor image (pet)/skul-thigh ......................
Tumor image (pet) full body ........................
Tumor image (pet) full body ........................
Tumor image (pet) full body ........................
Tumor image pet/ct, limited .........................
Tumor image pet/ct, limited .........................
Tumor image pet/ct, limited .........................
Tumorimage pet/ct skul-thigh ......................
Tumorimage pet/ct skul-thigh ......................
Tumorimage pet/ct skul-thigh ......................
Tumor image pet/ct full body ......................
Tumor image pet/ct full body ......................
Tumor image pet/ct full body ......................
Nuclear medicine data proc ........................
Nuclear medicine data proc ........................
Nuclear medicine data proc ........................
Nuclear med data proc ................................
Nuclear med data proc ................................
Nuclear med data proc ................................
Nuclear diagnostic exam .............................
0.00
0.66
0.66
0.00
0.30
0.30
0.00
0.38
0.38
0.00
0.36
0.36
0.00
0.57
0.57
0.00
0.66
0.66
0.00
0.71
0.71
0.00
0.00
0.00
0.00
0.66
0.66
0.00
0.79
0.79
0.00
0.86
0.86
0.00
1.09
1.09
0.00
1.07
1.07
0.00
0.73
0.73
0.00
0.86
0.86
0.00
1.09
1.09
0.00
0.00
1.54
0.00
0.00
1.93
0.00
0.00
2.00
0.00
0.00
2.20
0.00
0.00
2.44
0.00
0.00
2.50
0.00
0.05
0.05
0.00
0.10
0.10
0.00
0.00
Nonfacility
PE
RVUs
5.24
5.79
0.23
5.55
2.36
0.11
2.25
1.93
0.14
1.79
2.27
0.13
2.13
2.79
0.20
2.59
3.08
0.23
2.85
3.69
0.25
3.44
0.00
0.00
0.00
3.68
0.23
3.45
4.81
0.28
4.53
6.11
0.30
5.81
8.16
0.40
7.77
11.45
0.39
11.06
3.72
0.26
3.46
6.80
0.30
6.49
7.96
0.41
7.56
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.08
0.02
1.06
2.15
0.04
2.11
0.00
Facility
PE
RVUs
NA
NA
0.23
NA
NA
0.11
NA
NA
0.14
NA
NA
0.13
NA
NA
0.20
NA
NA
0.23
NA
NA
0.25
NA
0.00
0.00
0.00
NA
0.23
NA
NA
0.28
NA
NA
0.30
NA
NA
0.40
NA
NA
0.39
NA
NA
0.26
NA
NA
0.30
NA
NA
0.41
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.02
NA
NA
0.04
NA
0.00
Malpractice
RVUs
0.23
0.34
0.03
0.31
0.11
0.01
0.10
0.13
0.02
0.11
0.10
0.02
0.08
0.15
0.03
0.12
0.17
0.03
0.14
0.20
0.03
0.17
0.00
0.00
0.00
0.22
0.04
0.18
0.27
0.05
0.22
0.34
0.04
0.30
0.40
0.05
0.35
0.34
0.04
0.30
0.21
0.03
0.18
0.39
0.04
0.35
0.39
0.04
0.35
0.00
0.11
0.00
0.00
0.11
0.00
0.00
0.11
0.00
0.00
0.11
0.00
0.00
0.11
0.00
0.00
0.11
0.00
0.07
0.01
0.06
0.14
0.01
0.13
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00215
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
5.47
6.79
0.92
5.86
2.78
0.42
2.35
2.44
0.54
1.90
2.73
0.51
2.21
3.51
0.80
2.71
3.91
0.92
2.99
4.60
0.99
3.61
0.00
0.00
0.00
4.56
0.93
3.63
5.87
1.12
4.75
7.31
1.20
6.11
9.65
1.54
8.12
12.87
1.50
11.36
4.66
1.02
3.64
8.05
1.20
6.84
9.44
1.54
7.91
0.00
1.65
0.00
0.00
2.04
0.00
0.00
2.11
0.00
0.00
2.31
0.00
0.00
2.55
0.00
0.00
2.61
0.00
1.20
0.08
1.12
2.39
0.15
2.24
0.00
Facility
total
NA
NA
0.92
NA
NA
0.42
NA
NA
0.54
NA
NA
0.51
NA
NA
0.80
NA
NA
0.92
NA
NA
0.99
NA
0.00
0.00
0.00
NA
0.93
NA
NA
1.12
NA
NA
1.20
NA
NA
1.54
NA
NA
1.50
NA
NA
1.02
NA
NA
1.20
NA
NA
1.54
NA
0.00
1.65
0.00
0.00
2.04
0.00
0.00
2.11
0.00
0.00
2.31
0.00
0.00
2.55
0.00
0.00
2.61
0.00
NA
0.08
NA
NA
0.15
NA
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45978
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
78999
78999
79005
79005
79005
79101
79101
79101
79200
79200
79200
79300
79300
79300
79403
79403
79403
79440
79440
79440
79445
79445
79445
79999
79999
79999
80500
80502
83020
83912
84165
84166
84181
84182
85060
85097
85390
85396
85576
86077
86078
86079
86255
86256
86320
86325
86327
86334
86335
86485
86490
86510
86580
86585
86586
87164
87207
88104
88104
88104
88106
88106
88106
88107
88107
88107
88108
88108
88108
88112
88112
88112
88125
88125
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
26 .......
26 .......
26 .......
26 .......
26 .......
............
............
26 .......
............
26 .......
............
............
............
26 .......
26 .......
26 .......
26 .......
26 .......
26 .......
26 .......
............
............
............
............
............
............
26 .......
26 .......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
C
C
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Nuclear diagnostic exam .............................
Nuclear diagnostic exam .............................
Nuclear rx, oral admin .................................
Nuclear rx, oral admin .................................
Nuclear rx, oral admin .................................
Nuclear rx, iv admin ....................................
Nuclear rx, iv admin ....................................
Nuclear rx, iv admin ....................................
Nuclear rx, intracav admin ..........................
Nuclear rx, intracav admin ..........................
Nuclear rx, intracav admin ..........................
Nuclr rx, interstit colloid ...............................
Nuclr rx, interstit colloid ...............................
Nuclr rx, interstit colloid ...............................
Hematopoietic nuclear tx .............................
Hematopoietic nuclear tx .............................
Hematopoietic nuclear tx .............................
Nuclear rx, intra-articular .............................
Nuclear rx, intra-articular .............................
Nuclear rx, intra-articular .............................
Nuclear rx, intra-arterial ...............................
Nuclear rx, intra-arterial ...............................
Nuclear rx, intra-arterial ...............................
Nuclear medicine therapy ...........................
Nuclear medicine therapy ...........................
Nuclear medicine therapy ...........................
Lab pathology consultation .........................
Lab pathology consultation .........................
Hemoglobin electrophoresis ........................
Genetic examination ....................................
Protein e-phoresis, serum ...........................
Protein e-phoresis/urine/csf .........................
Western blot test .........................................
Protein, western blot test ............................
Blood smear interpretation ..........................
Bone marrow interpretation .........................
Fibrinolysins screen .....................................
Clotting assay, whole blood ........................
Blood platelet aggregation ..........................
Physician blood bank service ......................
Physician blood bank service ......................
Physician blood bank service ......................
Fluorescent antibody, screen ......................
Fluorescent antibody, titer ...........................
Serum immunoelectrophoresis ....................
Other immunoelectrophoresis .....................
Immunoelectrophoresis assay .....................
Immunofix e-phoresis, serum ......................
Immunfix e-phorsis/urine/csf .......................
Skin test, candida ........................................
Coccidioidomycosis skin test ......................
Histoplasmosis skin test ..............................
TB intradermal test ......................................
TB tine test ..................................................
Skin test, unlisted ........................................
Dark field examination .................................
Smear, special stain ....................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopathology, fluids ...................................
Cytopath, concentrate tech .........................
Cytopath, concentrate tech .........................
Cytopath, concentrate tech .........................
Cytopath, cell enhance tech ........................
Cytopath, cell enhance tech ........................
Cytopath, cell enhance tech ........................
Forensic cytopathology ...............................
Forensic cytopathology ...............................
0.00
0.00
1.80
1.80
0.00
1.96
1.96
0.00
1.99
1.99
0.00
0.00
1.60
0.00
2.25
2.25
0.00
1.99
1.99
0.00
2.40
2.40
0.00
0.00
0.00
0.00
0.37
1.33
0.37
0.37
0.37
0.37
0.37
0.37
0.45
0.94
0.37
0.37
0.37
0.94
0.94
0.94
0.37
0.37
0.37
0.37
0.42
0.37
0.37
0.00
0.00
0.00
0.00
0.00
0.00
0.37
0.37
0.56
0.56
0.00
0.56
0.56
0.00
0.76
0.76
0.00
0.56
0.56
0.00
1.18
1.18
0.00
0.26
0.26
Nonfacility
PE
RVUs
0.00
0.00
2.82
0.62
2.20
2.98
0.70
2.28
3.18
0.71
2.47
0.00
0.59
0.00
5.17
0.92
4.25
2.95
0.75
2.20
NA
0.86
NA
0.00
0.00
0.00
0.20
0.53
0.15
0.12
0.14
0.14
0.14
0.16
0.18
1.82
0.13
NA
0.16
0.38
0.45
0.44
0.15
0.15
0.15
0.13
0.18
0.15
0.14
0.00
0.28
0.30
0.22
0.21
0.00
0.12
0.17
0.87
0.23
0.64
1.35
0.23
1.11
1.54
0.32
1.21
1.22
0.23
0.99
1.91
0.50
1.42
0.25
0.11
Facility
PE
RVUs
0.00
0.00
NA
0.62
NA
NA
0.70
NA
NA
0.71
NA
0.00
0.59
0.00
NA
0.92
NA
NA
0.75
NA
NA
0.86
NA
0.00
0.00
0.00
0.16
0.53
0.15
0.12
0.14
0.14
0.14
0.16
0.18
0.40
0.13
0.16
0.16
0.38
0.39
0.40
0.15
0.15
0.15
0.13
0.18
0.15
0.14
0.00
NA
NA
NA
NA
0.00
0.12
0.16
NA
0.23
NA
NA
0.23
NA
NA
0.32
NA
NA
0.23
NA
NA
0.50
NA
NA
0.11
Malpractice
RVUs
0.00
0.00
0.22
0.08
0.14
0.22
0.08
0.14
0.23
0.09
0.14
0.00
0.13
0.00
0.24
0.10
0.14
0.22
0.08
0.14
0.28
0.12
0.16
0.00
0.00
0.00
0.01
0.04
0.01
0.01
0.01
0.01
0.01
0.02
0.02
0.04
0.01
0.04
0.01
0.03
0.03
0.03
0.01
0.01
0.01
0.01
0.02
0.01
0.01
0.00
0.02
0.02
0.02
0.01
0.00
0.01
0.01
0.04
0.02
0.02
0.04
0.02
0.02
0.05
0.03
0.02
0.04
0.02
0.02
0.04
0.02
0.02
0.02
0.01
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00216
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
4.85
2.51
2.34
5.16
2.75
2.42
5.41
2.79
2.61
0.00
2.32
0.00
7.66
3.28
4.39
5.16
2.82
2.34
NA
3.39
NA
0.00
0.00
0.00
0.58
1.90
0.53
0.50
0.52
0.52
0.52
0.55
0.65
2.80
0.51
NA
0.54
1.35
1.42
1.41
0.53
0.53
0.53
0.51
0.62
0.53
0.52
0.00
0.30
0.32
0.24
0.22
0.00
0.50
0.55
1.47
0.81
0.66
1.95
0.81
1.13
2.35
1.11
1.23
1.82
0.81
1.01
3.14
1.70
1.44
0.53
0.38
Facility
total
0.00
0.00
NA
2.51
NA
NA
2.75
NA
NA
2.79
NA
0.00
2.32
0.00
NA
3.28
NA
NA
2.82
NA
NA
3.39
NA
0.00
0.00
0.00
0.54
1.90
0.53
0.50
0.52
0.52
0.52
0.55
0.65
1.38
0.51
0.57
0.54
1.35
1.36
1.37
0.53
0.53
0.53
0.51
0.62
0.53
0.52
0.00
NA
NA
NA
NA
0.00
0.50
0.54
NA
0.81
NA
NA
0.81
NA
NA
1.11
NA
NA
0.81
NA
NA
1.70
NA
NA
0.38
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45979
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
88125
88141
88160
88160
88160
88161
88161
88161
88162
88162
88162
88172
88172
88172
88173
88173
88173
88182
88182
88182
88184
88185
88187
88188
88189
88199
88199
88199
88291
88299
88300
88300
88300
88302
88302
88302
88304
88304
88304
88305
88305
88305
88307
88307
88307
88309
88309
88309
88311
88311
88311
88312
88312
88312
88313
88313
88313
88314
88314
88314
88318
88318
88318
88319
88319
88319
88321
88323
88323
88323
88325
88329
88331
88331
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
26 .......
TC ......
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
............
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Forensic cytopathology ...............................
Cytopath, c/v, interpret ................................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopath smear, other source .....................
Cytopathology eval of fna ...........................
Cytopathology eval of fna ...........................
Cytopathology eval of fna ...........................
Cytopath eval, fna, report ............................
Cytopath eval, fna, report ............................
Cytopath eval, fna, report ............................
Cell marker study ........................................
Cell marker study ........................................
Cell marker study ........................................
Flowcytometry/ tc, 1 marker ........................
Flowcytometry/tc, add-on ............................
Flowcytometry/read, 2-8 ..............................
Flowcytometry/read, 9-15 ............................
Flowcytometry/read, 16 & > ........................
Cytopathology procedure ............................
Cytopathology procedure ............................
Cytopathology procedure ............................
Cyto/molecular report ..................................
Cytogenetic study ........................................
Surgical path, gross ....................................
Surgical path, gross ....................................
Surgical path, gross ....................................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Tissue exam by pathologist ........................
Decalcify tissue ...........................................
Decalcify tissue ...........................................
Decalcify tissue ...........................................
Special stains ..............................................
Special stains ..............................................
Special stains ..............................................
Special stains ..............................................
Special stains ..............................................
Special stains ..............................................
Histochemical stain .....................................
Histochemical stain .....................................
Histochemical stain .....................................
Chemical histochemistry .............................
Chemical histochemistry .............................
Chemical histochemistry .............................
Enzyme histochemistry ...............................
Enzyme histochemistry ...............................
Enzyme histochemistry ...............................
Microslide consultation ................................
Microslide consultation ................................
Microslide consultation ................................
Microslide consultation ................................
Comprehensive review of data ...................
Path consult introp ......................................
Path consult intraop, 1 bloc ........................
Path consult intraop, 1 bloc ........................
0.00
0.42
0.50
0.50
0.00
0.50
0.50
0.00
0.76
0.76
0.00
0.60
0.60
0.00
1.39
1.39
0.00
0.77
0.77
0.00
0.00
0.00
1.36
1.69
2.23
0.00
0.00
0.00
0.52
0.00
0.08
0.08
0.00
0.13
0.13
0.00
0.22
0.22
0.00
0.75
0.75
0.00
1.59
1.59
0.00
2.28
2.28
0.00
0.24
0.24
0.00
0.54
0.54
0.00
0.24
0.24
0.00
0.45
0.45
0.00
0.42
0.42
0.00
0.53
0.53
0.00
1.30
1.35
1.35
0.00
2.22
0.67
1.19
1.19
Nonfacility
PE
RVUs
0.14
0.23
0.83
0.21
0.63
0.93
0.21
0.73
1.03
0.32
0.71
0.73
0.25
0.47
2.11
0.58
1.53
2.00
0.32
1.67
1.62
0.86
0.42
0.53
0.69
0.00
0.00
0.00
0.21
0.00
0.45
0.03
0.42
1.03
0.06
0.98
1.43
0.09
1.34
2.09
0.33
1.76
3.27
0.66
2.60
4.52
0.95
3.57
0.23
0.10
0.13
1.66
0.23
1.44
1.35
0.10
1.25
2.06
0.19
1.88
1.77
0.18
1.60
3.39
0.22
3.17
0.80
1.84
0.56
1.28
2.87
0.64
1.12
0.50
Facility
PE
RVUs
NA
0.15
NA
0.21
NA
NA
0.21
NA
NA
0.32
NA
NA
0.25
NA
NA
0.58
NA
NA
0.32
NA
NA
NA
0.42
0.53
0.69
0.00
0.00
0.00
0.18
0.00
NA
0.03
NA
NA
0.06
NA
NA
0.09
NA
NA
0.33
NA
NA
0.66
NA
NA
0.95
NA
NA
0.10
NA
NA
0.23
NA
NA
0.10
NA
NA
0.19
NA
NA
0.18
NA
NA
0.22
NA
0.55
NA
0.56
NA
0.93
0.28
NA
0.50
Malpractice
RVUs
0.01
0.02
0.04
0.02
0.02
0.04
0.02
0.02
0.05
0.03
0.02
0.04
0.02
0.02
0.07
0.05
0.02
0.07
0.03
0.04
0.02
0.02
0.01
0.01
0.01
0.00
0.00
0.00
0.02
0.00
0.02
0.01
0.01
0.03
0.01
0.02
0.03
0.01
0.02
0.07
0.03
0.04
0.12
0.06
0.06
0.14
0.08
0.06
0.02
0.01
0.01
0.03
0.02
0.01
0.02
0.01
0.01
0.04
0.02
0.02
0.03
0.02
0.01
0.04
0.02
0.02
0.05
0.07
0.05
0.02
0.07
0.02
0.08
0.04
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00217
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.15
0.67
1.38
0.73
0.65
1.47
0.73
0.75
1.84
1.11
0.73
1.37
0.87
0.49
3.57
2.02
1.55
2.84
1.12
1.71
1.64
0.88
1.79
2.23
2.94
0.00
0.00
0.00
0.75
0.00
0.55
0.12
0.43
1.19
0.20
1.00
1.68
0.32
1.36
2.91
1.11
1.80
4.98
2.32
2.66
6.95
3.31
3.63
0.49
0.35
0.14
2.23
0.79
1.45
1.61
0.35
1.26
2.55
0.66
1.90
2.22
0.62
1.61
3.96
0.77
3.19
2.15
3.26
1.96
1.30
5.16
1.34
2.40
1.73
Facility
total
NA
0.59
NA
0.73
NA
NA
0.73
NA
NA
1.11
NA
NA
0.87
NA
NA
2.02
NA
NA
1.12
NA
NA
NA
1.79
2.23
2.94
0.00
0.00
0.00
0.72
0.00
NA
0.12
NA
NA
0.20
NA
NA
0.32
NA
NA
1.11
NA
NA
2.32
NA
NA
3.31
NA
NA
0.35
NA
NA
0.79
NA
NA
0.35
NA
NA
0.66
NA
NA
0.62
NA
NA
0.77
NA
1.90
NA
1.96
NA
3.22
0.97
NA
1.73
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45980
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
88331
88332
88332
88332
88342
88342
88342
88346
88346
88346
88347
88347
88347
88348
88348
88348
88349
88349
88349
88355
88355
88355
88356
88356
88356
88358
88358
88358
88360
88360
88360
88361
88361
88361
88362
88362
88362
88365
88365
88365
88367
88367
88367
88368
88368
88368
88371
88372
88380
88380
88380
88399
88399
88399
89060
89100
89105
89130
89132
89135
89136
89140
89141
89220
89230
89240
90281
90283
90287
90288
90291
90296
90371
90375
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
26 .......
26 .......
............
26 .......
TC ......
............
26 .......
TC ......
26 .......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
C
C
C
A
A
A
A
A
A
A
A
A
A
A
C
I
I
I
I
I
E
E
E
Physician
work
RVUs 3
Description
Path consult intraop, 1 bloc ........................
Path consult intraop, add’l ...........................
Path consult intraop, add’l ...........................
Path consult intraop, add’l ...........................
Immunohistochemistry .................................
Immunohistochemistry .................................
Immunohistochemistry .................................
Immunofluorescent study ............................
Immunofluorescent study ............................
Immunofluorescent study ............................
Immunofluorescent study ............................
Immunofluorescent study ............................
Immunofluorescent study ............................
Electron microscopy ....................................
Electron microscopy ....................................
Electron microscopy ....................................
Scanning electron microscopy ....................
Scanning electron microscopy ....................
Scanning electron microscopy ....................
Analysis, skeletal muscle ............................
Analysis, skeletal muscle ............................
Analysis, skeletal muscle ............................
Analysis, nerve ............................................
Analysis, nerve ............................................
Analysis, nerve ............................................
Analysis, tumor ............................................
Analysis, tumor ............................................
Analysis, tumor ............................................
Tumor immunohistochem/manual ...............
Tumor immunohistochem/manual ...............
Tumor immunohistochem/manual ...............
Tumor immunohistochem/comput ...............
Tumor immunohistochem/comput ...............
Tumor immunohistochem/comput ...............
Nerve teasing preparations .........................
Nerve teasing preparations .........................
Nerve teasing preparations .........................
Insitu hybridization (fish) .............................
Insitu hybridization (fish) .............................
Insitu hybridization (fish) .............................
Insitu hybridization, auto .............................
Insitu hybridization, auto .............................
Insitu hybridization, auto .............................
Insitu hybridization, manual .........................
Insitu hybridization, manual .........................
Insitu hybridization, manual .........................
Protein, western blot tissue .........................
Protein analysis w/probe .............................
Microdissection ............................................
Microdissection ............................................
Microdissection ............................................
Surgical pathology procedure .....................
Surgical pathology procedure .....................
Surgical pathology procedure .....................
Exam,synovial fluid crystals ........................
Sample intestinal contents ..........................
Sample intestinal contents ..........................
Sample stomach contents ...........................
Sample stomach contents ...........................
Sample stomach contents ...........................
Sample stomach contents ...........................
Sample stomach contents ...........................
Sample stomach contents ...........................
Sputum specimen collection .......................
Collect sweat for test ...................................
Pathology lab procedure .............................
Human ig, im ...............................................
Human ig, iv ................................................
Botulinum antitoxin ......................................
Botulism ig, iv ..............................................
Cmv ig, iv ....................................................
Diphtheria antitoxin ......................................
Hep b ig, im .................................................
Rabies ig, im/sc ...........................................
0.00
0.59
0.59
0.00
0.85
0.85
0.00
0.86
0.86
0.00
0.86
0.86
0.00
1.51
1.51
0.00
0.76
0.76
0.00
1.85
1.85
0.00
3.03
3.03
0.00
0.95
0.95
0.00
1.10
1.10
0.00
1.18
1.18
0.00
2.17
2.17
0.00
1.20
1.20
0.00
1.30
1.30
0.00
1.40
1.40
0.00
0.37
0.37
0.00
0.00
0.00
0.00
0.00
0.00
0.37
0.60
0.50
0.45
0.19
0.79
0.21
0.94
0.85
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.63
0.46
0.24
0.21
1.52
0.35
1.16
1.65
0.36
1.29
1.31
0.34
0.97
10.48
0.62
9.85
4.10
0.32
3.78
8.06
0.77
7.29
4.70
1.23
3.47
0.92
0.39
0.53
1.81
0.46
1.35
3.07
0.48
2.59
4.63
0.89
3.73
2.32
0.50
1.83
4.76
0.53
4.23
3.95
0.58
3.37
0.13
0.16
0.00
0.00
0.00
0.00
0.00
0.00
0.16
3.64
3.28
3.07
2.84
3.96
2.93
3.28
3.72
0.39
0.11
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Facility
PE
RVUs
NA
NA
0.24
NA
NA
0.35
NA
NA
0.36
NA
NA
0.34
NA
NA
0.62
NA
NA
0.32
NA
NA
0.77
NA
NA
1.23
NA
NA
0.39
NA
NA
0.46
NA
NA
0.48
NA
NA
0.89
NA
NA
0.50
NA
NA
0.53
NA
NA
0.58
NA
0.13
0.16
0.00
0.00
0.00
0.00
0.00
0.00
0.16
0.32
0.28
0.19
0.16
0.32
0.15
0.36
0.40
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Malpractice
RVUs
0.04
0.04
0.02
0.02
0.05
0.03
0.02
0.05
0.03
0.02
0.05
0.03
0.02
0.13
0.06
0.07
0.09
0.03
0.06
0.13
0.07
0.06
0.19
0.12
0.07
0.17
0.10
0.07
0.08
0.06
0.02
0.17
0.10
0.07
0.15
0.09
0.06
0.05
0.03
0.02
0.12
0.06
0.06
0.12
0.06
0.06
0.01
0.01
0.00
0.00
0.00
0.00
0.00
0.00
0.01
0.03
0.02
0.02
0.01
0.04
0.01
0.04
0.03
0.02
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00218
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.67
1.09
0.85
0.23
2.42
1.23
1.18
2.56
1.25
1.31
2.22
1.23
0.99
12.12
2.20
9.92
4.95
1.11
3.84
10.04
2.70
7.35
7.91
4.37
3.54
2.04
1.44
0.60
2.99
1.62
1.37
4.42
1.76
2.66
6.95
3.16
3.79
3.58
1.73
1.85
6.18
1.89
4.29
5.47
2.05
3.43
0.51
0.54
0.00
0.00
0.00
0.00
0.00
0.00
0.54
4.27
3.80
3.54
3.04
4.79
3.15
4.26
4.60
0.41
0.13
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Facility
total
NA
NA
0.85
NA
NA
1.23
NA
NA
1.25
NA
NA
1.23
NA
NA
2.20
NA
NA
1.11
NA
NA
2.70
NA
NA
4.37
NA
NA
1.44
NA
NA
1.62
NA
NA
1.76
NA
NA
3.16
NA
NA
1.73
NA
NA
1.89
NA
NA
2.05
NA
0.51
0.54
0.00
0.00
0.00
0.00
0.00
0.00
0.54
0.95
0.80
0.66
0.36
1.15
0.37
1.35
1.29
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45981
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
90376
90379
90384
90385
90386
90389
90393
90396
90399
90465
90466
90467
90468
90471
90472
90473
90474
90476
90477
90581
90585
90586
90632
90633
90634
90636
90645
90646
90647
90648
90665
90669
90675
90676
90680
90690
90691
90692
90693
90698
90700
90701
90702
90703
90704
90705
90706
90707
90708
90710
90712
90713
90715
90716
90717
90718
90719
90720
90721
90723
90725
90727
90733
90734
90735
90748
90749
90780
90781
90782
90783
90784
90788
90799
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
E
I
I
E
I
I
E
E
I
A
A
R
R
A
A
R
R
E
E
E
E
E
E
E
E
E
E
E
E
E
E
N
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
I
E
E
E
E
E
I
E
I
I
I
A
I
A
C
Physician
work
RVUs 3
Description
Rabies ig, heat treated ................................
Rsv ig, iv ......................................................
Rh ig, full-dose, im ......................................
Rh ig, minidose, im .....................................
Rh ig, iv .......................................................
Tetanus ig, im ..............................................
Vaccina ig, im ..............................................
Varicella-zoster ig, im ..................................
Immune globulin ..........................................
Immune admin 1 inj, < 8 yrs .......................
Immune admin addl inj, < 8 y .....................
Immune admin o or n, < 8 yrs ....................
Immune admin o/n, addl < 8 y ....................
Immunization admin ....................................
Immunization admin, each add ...................
Immune admin oral/nasal ............................
Immune admin oral/nasal addl ....................
Adenovirus vaccine, type 4 .........................
Adenovirus vaccine, type 7 .........................
Anthrax vaccine, sc .....................................
Bcg vaccine, percut .....................................
Bcg vaccine, intravesical .............................
Hep a vaccine, adult im ..............................
Hep a vacc, ped/adol, 2 dose .....................
Hep a vacc, ped/adol, 3 dose .....................
Hep a/hep b vacc, adult im .........................
Hib vaccine, hboc, im ..................................
Hib vaccine, prp-d, im .................................
Hib vaccine, prp-omp, im ............................
Hib vaccine, prp-t, im ..................................
Lyme disease vaccine, im ...........................
Pneumococcal vacc, ped <5 .......................
Rabies vaccine, im ......................................
Rabies vaccine, id .......................................
Rotovirus vaccine, oral ................................
Typhoid vaccine, oral ..................................
Typhoid vaccine, im ....................................
Typhoid vaccine, h-p, sc/id .........................
Typhoid vaccine, akd, sc .............................
Dtap-hib-ip vaccine, im ................................
Dtap vaccine, < 7 yrs, im ............................
Dtp vaccine, im ............................................
Dt vaccine < 7, im .......................................
Tetanus vaccine, im ....................................
Mumps vaccine, sc ......................................
Measles vaccine, sc ....................................
Rubella vaccine, sc .....................................
Mmr vaccine, sc ..........................................
Measles-rubella vaccine, sc ........................
Mmrv vaccine, sc ........................................
Oral poliovirus vaccine ................................
Poliovirus, ipv, sc ........................................
Tdap vaccine >7 im .....................................
Chicken pox vaccine, sc .............................
Yellow fever vaccine, sc ..............................
Td vaccine > 7, im .......................................
Diphtheria vaccine, im .................................
Dtp/hib vaccine, im ......................................
Dtap/hib vaccine, im ....................................
Dtap-hep b-ipv vaccine, im .........................
Cholera vaccine, injectable .........................
Plague vaccine, im ......................................
Meningococcal vaccine, sc .........................
Meningococcal vaccine, im .........................
Encephalitis vaccine, sc ..............................
Hep b/hib vaccine, im ..................................
Vaccine toxoid .............................................
IV infusion therapy, 1 hour ..........................
IV infusion, additional hour ..........................
Injection, sc/im .............................................
Injection, ia ..................................................
Injection, iv ..................................................
Injection of antibiotic ....................................
Ther/prophylactic/dx inject ...........................
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.17
0.15
0.17
0.15
0.17
0.15
0.17
0.15
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.17
0.17
0.17
0.17
0.17
0.17
0.00
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.31
0.13
0.31
0.13
0.31
0.13
0.31
0.13
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.31
0.00
0.26
0.00
Facility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.27
0.12
0.00
0.00
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.00
NA
0.00
Malpractice
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.07
0.04
0.01
0.02
0.04
0.01
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00219
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.49
0.29
0.49
0.29
0.49
0.29
0.49
0.29
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.24
0.21
0.18
0.50
0.21
0.44
0.00
Facility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.45
0.28
0.18
0.16
NA
NA
0.18
0.16
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.24
0.21
0.18
NA
0.21
NA
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
ZZZ
XXX
ZZZ
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
45982
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
90801
90802
90804
90805
90806
90807
90808
90809
90810
90811
90812
90813
90814
90815
90816
90817
90818
90819
90821
90822
90823
90824
90826
90827
90828
90829
90845
90846
90847
90849
90853
90857
90862
90865
90870
90871
90875
90876
90880
90882
90885
90887
90889
90899
90901
90911
90918
90919
90920
90921
90922
90923
90924
90925
90935
90937
90945
90947
90997
90999
91000
91000
91000
91010
91010
91010
91011
91011
91011
91012
91012
91012
91020
91020
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
R
R
R
A
A
A
A
A
N
N
N
A
N
B
B
B
C
A
A
I
I
I
I
I
I
I
I
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Psy dx interview ..........................................
Intac psy dx interview ..................................
Psytx, office, 20-30 min ...............................
Psytx, off, 20-30 min w/e&m .......................
Psytx, off, 45-50 min ...................................
Psytx, off, 45-50 min w/e&m .......................
Psytx, office, 75-80 min ...............................
Psytx, off, 75-80, w/e&m .............................
Intac psytx, off, 20-30 min ...........................
Intac psytx, 20-30, w/e&m ...........................
Intac psytx, off, 45-50 min ...........................
Intac psytx, 45-50 min w/e&m .....................
Intac psytx, off, 75-80 min ...........................
Intac psytx, 75-80 w/e&m ............................
Psytx, hosp, 20-30 min ...............................
Psytx, hosp, 20-30 min w/e&m ...................
Psytx, hosp, 45-50 min ...............................
Psytx, hosp, 45-50 min w/e&m ...................
Psytx, hosp, 75-80 min ...............................
Psytx, hosp, 75-80 min w/e&m ...................
Intac psytx, hosp, 20-30 min .......................
Intac psytx, hsp 20-30 w/e&m .....................
Intac psytx, hosp, 45-50 min .......................
Intac psytx, hsp 45-50 w/e&m .....................
Intac psytx, hosp, 75-80 min .......................
Intac psytx, hsp 75-80 w/e&m .....................
Psychoanalysis ............................................
Family psytx w/o patient ..............................
Family psytx w/patient .................................
Multiple family group psytx ..........................
Group psychotherapy ..................................
Intac group psytx .........................................
Medication management .............................
Narcosynthesis ............................................
Electroconvulsive therapy ...........................
Electroconvulsive therapy ...........................
Psychophysiological therapy .......................
Psychophysiological therapy .......................
Hypnotherapy ..............................................
Environmental manipulation ........................
Psy evaluation of records ............................
Consultation with family ..............................
Preparation of report ...................................
Psychiatric service/therapy ..........................
Biofeedback train, any meth .......................
Biofeedback peri/uro/rectal ..........................
ESRD related services, month ....................
ESRD related services, month ....................
ESRD related services, month ....................
ESRD related services, month ....................
ESRD related services, day ........................
Esrd related services, day ...........................
Esrd related services, day ...........................
Esrd related services, day ...........................
Hemodialysis, one evaluation .....................
Hemodialysis, repeated eval .......................
Dialysis, one evaluation ..............................
Dialysis, repeated eval ................................
Hemoperfusion ............................................
Dialysis procedure .......................................
Esophageal intubation .................................
Esophageal intubation .................................
Esophageal intubation .................................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Esophagus motility study ............................
Gastric motility .............................................
Gastric motility .............................................
2.81
3.02
1.21
1.37
1.86
2.02
2.80
2.96
1.32
1.48
1.97
2.13
2.91
3.07
1.25
1.41
1.89
2.05
2.84
3.00
1.36
1.52
2.01
2.16
2.95
3.11
1.79
1.83
2.21
0.59
0.59
0.63
0.95
2.85
1.88
2.73
1.20
1.90
2.19
0.00
0.97
1.48
0.00
0.00
0.41
0.89
11.18
8.55
7.27
4.47
0.37
0.28
0.24
0.15
1.22
2.11
1.28
2.16
1.84
0.00
0.73
0.73
0.00
1.25
1.25
0.00
1.50
1.50
0.00
1.46
1.46
0.00
1.44
1.44
Nonfacility
PE
RVUs
1.19
1.23
0.49
0.51
0.68
0.70
1.00
0.99
0.51
0.58
0.77
0.77
1.07
1.05
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.57
0.64
0.81
0.27
0.25
0.29
0.42
1.35
1.82
NA
0.85
1.11
0.98
0.00
0.37
0.82
0.00
0.00
0.64
1.58
5.96
3.90
3.65
2.37
0.21
0.13
0.12
0.08
NA
NA
NA
NA
NA
0.00
0.84
0.25
0.59
4.76
0.47
4.30
5.79
0.57
5.22
5.76
0.55
5.21
4.49
0.51
Facility
PE
RVUs
0.91
0.96
0.37
0.41
0.58
0.61
0.87
0.90
0.41
0.45
0.62
0.65
0.94
0.92
0.45
0.45
0.67
0.64
0.97
0.93
0.47
0.48
0.70
0.67
1.02
0.96
0.54
0.63
0.74
0.24
0.23
0.25
0.32
0.89
0.58
0.99
0.46
0.72
0.67
0.00
0.37
0.56
0.00
0.00
0.14
0.33
5.96
3.90
3.65
2.37
0.21
0.13
0.12
0.08
0.65
0.95
0.67
0.97
0.65
0.00
NA
0.25
NA
NA
0.47
NA
NA
0.57
NA
NA
0.55
NA
NA
0.51
Malpractice
RVUs
0.06
0.07
0.03
0.03
0.04
0.05
0.06
0.07
0.04
0.04
0.04
0.05
0.06
0.07
0.03
0.03
0.04
0.05
0.06
0.08
0.03
0.04
0.05
0.05
0.06
0.07
0.04
0.04
0.05
0.02
0.01
0.01
0.02
0.12
0.04
0.07
0.04
0.05
0.05
0.00
0.02
0.04
0.00
0.00
0.02
0.06
0.36
0.29
0.23
0.14
0.01
0.01
0.01
0.01
0.04
0.07
0.04
0.07
0.06
0.00
0.04
0.03
0.01
0.12
0.06
0.06
0.13
0.07
0.06
0.13
0.06
0.07
0.13
0.07
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00220
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
4.05
4.32
1.74
1.91
2.59
2.78
3.85
4.02
1.87
2.10
2.79
2.96
4.04
4.19
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.40
2.51
3.08
0.88
0.85
0.93
1.39
4.31
3.74
NA
2.09
3.06
3.22
0.00
1.36
2.34
0.00
0.00
1.07
2.53
17.50
12.74
11.16
6.98
0.59
0.42
0.37
0.24
NA
NA
NA
NA
NA
0.00
1.62
1.01
0.60
6.14
1.78
4.36
7.42
2.15
5.28
7.35
2.07
5.28
6.07
2.02
Facility
total
3.77
4.05
1.61
1.81
2.49
2.69
3.73
3.92
1.77
1.97
2.64
2.84
3.91
4.06
1.73
1.90
2.60
2.75
3.87
4.01
1.86
2.05
2.76
2.89
4.03
4.14
2.37
2.50
3.01
0.85
0.83
0.89
1.29
3.86
2.50
3.78
1.70
2.68
2.92
0.00
1.36
2.08
0.00
0.00
0.57
1.28
17.50
12.74
11.16
6.98
0.59
0.42
0.37
0.24
1.91
3.13
1.99
3.20
2.55
0.00
NA
1.01
NA
NA
1.78
NA
NA
2.15
NA
NA
2.07
NA
NA
2.02
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
000
000
XXX
000
000
000
000
000
000
000
000
000
000
000
000
000
000
45983
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
91020
91030
91030
91030
91034
91034
91034
91035
91035
91035
91037
91037
91037
91038
91038
91038
91040
91040
91040
91052
91052
91052
91055
91055
91055
91060
91060
91060
91065
91065
91065
91100
91105
91110
91110
91110
91120
91120
91120
91122
91122
91122
91123
91132
91132
91132
91133
91133
91133
91299
91299
91299
92002
92004
92012
92014
92015
92018
92019
92020
92060
92060
92060
92065
92065
92065
92070
92081
92081
92081
92082
92082
92082
92083
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
C
A
C
C
A
C
C
C
C
A
A
A
A
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Gastric motility .............................................
Acid perfusion of esophagus .......................
Acid perfusion of esophagus .......................
Acid perfusion of esophagus .......................
Gastroesophageal reflux test ......................
Gastroesophageal reflux test ......................
Gastroesophageal reflux test ......................
G-esoph reflx tst w/electrod ........................
G-esoph reflx tst w/electrod ........................
G-esoph reflx tst w/electrod ........................
Esoph imped function test ...........................
Esoph imped function test ...........................
Esoph imped function test ...........................
Esoph imped funct test > 1h .......................
Esoph imped funct test > 1h .......................
Esoph imped funct test > 1h .......................
Esoph balloon distension tst .......................
Esoph balloon distension tst .......................
Esoph balloon distension tst .......................
Gastric analysis test ....................................
Gastric analysis test ....................................
Gastric analysis test ....................................
Gastric intubation for smear ........................
Gastric intubation for smear ........................
Gastric intubation for smear ........................
Gastric saline load test ................................
Gastric saline load test ................................
Gastric saline load test ................................
Breath hydrogen test ...................................
Breath hydrogen test ...................................
Breath hydrogen test ...................................
Pass intestine bleeding tube .......................
Gastric intubation treatment ........................
Gi tract capsule endoscopy .........................
Gi tract capsule endoscopy .........................
Gi tract capsule endoscopy .........................
Rectal sensation test ...................................
Rectal sensation test ...................................
Rectal sensation test ...................................
Anal pressure record ...................................
Anal pressure record ...................................
Anal pressure record ...................................
Irrigate fecal impaction ................................
Electrogastrography ....................................
Electrogastrography ....................................
Electrogastrography ....................................
Electrogastrography w/test ..........................
Electrogastrography w/test ..........................
Electrogastrography w/test ..........................
Gastroenterology procedure ........................
Gastroenterology procedure ........................
Gastroenterology procedure ........................
Eye exam, new patient ................................
Eye exam, new patient ................................
Eye exam established pat ...........................
Eye exam & treatment ................................
Refraction ....................................................
New eye exam & treatment ........................
Eye exam & treatment ................................
Special eye evaluation ................................
Special eye evaluation ................................
Special eye evaluation ................................
Special eye evaluation ................................
Orthoptic/pleoptic training ............................
Orthoptic/pleoptic training ............................
Orthoptic/pleoptic training ............................
Fitting of contact lens ..................................
Visual field examination(s) ..........................
Visual field examination(s) ..........................
Visual field examination(s) ..........................
Visual field examination(s) ..........................
Visual field examination(s) ..........................
Visual field examination(s) ..........................
Visual field examination(s) ..........................
0.00
0.91
0.91
0.00
0.97
0.97
0.00
1.59
1.59
0.00
0.97
0.97
0.00
1.10
1.10
0.00
0.97
0.97
0.00
0.79
0.79
0.00
0.94
0.94
0.00
0.45
0.45
0.00
0.20
0.20
0.00
1.08
0.37
3.65
3.65
0.00
0.97
0.97
0.00
1.77
1.77
0.00
0.00
0.00
0.52
0.00
0.00
0.66
0.00
0.00
0.00
0.00
0.88
1.67
0.67
1.10
0.38
2.51
1.31
0.37
0.69
0.69
0.00
0.37
0.37
0.00
0.70
0.36
0.36
0.00
0.44
0.44
0.00
0.50
Nonfacility
PE
RVUs
3.99
2.67
0.35
2.32
5.70
0.36
5.33
11.65
0.60
11.05
3.22
0.36
2.86
2.47
0.42
2.05
11.26
0.36
10.89
2.64
0.30
2.34
2.91
0.27
2.64
1.89
0.14
1.75
1.62
0.07
1.55
2.70
1.99
24.17
1.38
22.79
11.11
0.36
10.74
5.15
0.62
4.53
0.00
0.00
0.20
0.00
0.00
0.25
0.00
0.00
0.00
0.00
0.97
1.68
1.01
1.39
1.21
NA
NA
0.33
0.72
0.28
0.44
0.57
0.15
0.43
1.04
0.93
0.15
0.78
1.22
0.19
1.03
1.41
Facility
PE
RVUs
NA
NA
0.35
NA
NA
0.36
NA
NA
0.60
NA
NA
0.36
NA
NA
0.42
NA
NA
0.36
NA
NA
0.30
NA
NA
0.27
NA
NA
0.14
NA
NA
0.07
NA
0.28
0.09
NA
1.38
NA
NA
0.36
NA
NA
0.62
NA
0.00
0.00
0.20
0.00
0.00
0.25
0.00
0.00
0.00
0.00
0.33
0.66
0.28
0.46
0.15
1.05
0.55
0.16
NA
0.28
NA
NA
0.15
NA
0.31
NA
0.15
NA
NA
0.19
NA
NA
Malpractice
RVUs
0.06
0.06
0.04
0.02
0.12
0.06
0.06
0.12
0.06
0.06
0.12
0.06
0.06
0.12
0.06
0.06
0.12
0.06
0.06
0.05
0.03
0.02
0.07
0.05
0.02
0.05
0.03
0.02
0.03
0.01
0.02
0.07
0.03
0.16
0.09
0.07
0.11
0.07
0.04
0.21
0.13
0.08
0.00
0.00
0.02
0.00
0.00
0.03
0.00
0.00
0.00
0.00
0.02
0.04
0.02
0.03
0.01
0.07
0.03
0.01
0.03
0.02
0.01
0.02
0.01
0.01
0.02
0.02
0.01
0.01
0.02
0.01
0.01
0.02
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00221
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
4.05
3.64
1.30
2.34
6.79
1.40
5.39
13.36
2.25
11.11
4.32
1.40
2.92
3.69
1.58
2.11
12.35
1.40
10.95
3.48
1.12
2.36
3.92
1.26
2.66
2.39
0.62
1.77
1.85
0.28
1.57
3.85
2.39
27.98
5.12
22.86
12.19
1.41
10.78
7.13
2.52
4.61
0.00
0.00
0.74
0.00
0.00
0.94
0.00
0.00
0.00
0.00
1.87
3.40
1.70
2.52
1.61
NA
NA
0.71
1.45
0.99
0.45
0.96
0.53
0.44
1.76
1.31
0.52
0.79
1.68
0.64
1.04
1.93
Facility
total
NA
NA
1.30
NA
NA
1.40
NA
NA
2.25
NA
NA
1.40
NA
NA
1.58
NA
NA
1.40
NA
NA
1.12
NA
NA
1.26
NA
NA
0.62
NA
NA
0.28
NA
1.43
0.49
NA
5.12
NA
NA
1.41
NA
NA
2.52
NA
0.00
0.00
0.74
0.00
0.00
0.94
0.00
0.00
0.00
0.00
1.23
2.38
0.97
1.59
0.54
3.62
1.89
0.54
NA
0.99
NA
NA
0.53
NA
1.03
NA
0.52
NA
NA
0.64
NA
NA
Global
000
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
000
000
000
000
000
000
000
000
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45984
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
92083
92083
92100
92120
92130
92135
92135
92135
92136
92136
92136
92140
92225
92226
92230
92235
92235
92235
92240
92240
92240
92250
92250
92250
92260
92265
92265
92265
92270
92270
92270
92275
92275
92275
92283
92283
92283
92284
92284
92284
92285
92285
92285
92286
92286
92286
92287
92310
92311
92312
92313
92314
92315
92316
92317
92325
92326
92330
92335
92340
92341
92342
92352
92353
92354
92355
92358
92370
92371
92390
92391
92392
92393
92395
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
A
A
A
N
A
A
A
A
A
A
A
N
N
N
B
B
B
B
B
N
B
N
N
I
I
I
Physician
work
RVUs 3
Description
Visual field examination(s) ..........................
Visual field examination(s) ..........................
Serial tonometry exam(s) ............................
Tonography & eye evaluation .....................
Water provocation tonography ....................
Opthalmic dx imaging ..................................
Opthalmic dx imaging ..................................
Opthalmic dx imaging ..................................
Ophthalmic biometry ...................................
Ophthalmic biometry ...................................
Ophthalmic biometry ...................................
Glaucoma provocative tests ........................
Special eye exam, initial .............................
Special eye exam, subsequent ...................
Eye exam with photos .................................
Eye exam with photos .................................
Eye exam with photos .................................
Eye exam with photos .................................
Icg angiography ...........................................
Icg angiography ...........................................
Icg angiography ...........................................
Eye exam with photos .................................
Eye exam with photos .................................
Eye exam with photos .................................
Ophthalmoscopy/dynamometry ...................
Eye muscle evaluation ................................
Eye muscle evaluation ................................
Eye muscle evaluation ................................
Electro-oculography .....................................
Electro-oculography .....................................
Electro-oculography .....................................
Electroretinography .....................................
Electroretinography .....................................
Electroretinography .....................................
Color vision examination .............................
Color vision examination .............................
Color vision examination .............................
Dark adaptation eye exam ..........................
Dark adaptation eye exam ..........................
Dark adaptation eye exam ..........................
Eye photography .........................................
Eye photography .........................................
Eye photography .........................................
Internal eye photography ............................
Internal eye photography ............................
Internal eye photography ............................
Internal eye photography ............................
Contact lens fitting .......................................
Contact lens fitting .......................................
Contact lens fitting .......................................
Contact lens fitting .......................................
Prescription of contact lens .........................
Prescription of contact lens .........................
Prescription of contact lens .........................
Prescription of contact lens .........................
Modification of contact lens .........................
Replacement of contact lens .......................
Fitting of artificial eye ..................................
Fitting of artificial eye ..................................
Fitting of spectacles ....................................
Fitting of spectacles ....................................
Fitting of spectacles ....................................
Special spectacles fitting .............................
Special spectacles fitting .............................
Special spectacles fitting .............................
Special spectacles fitting .............................
Eye prosthesis service ................................
Repair & adjust spectacles .........................
Repair & adjust spectacles .........................
Supply of spectacles ...................................
Supply of contact lenses .............................
Supply of low vision aids .............................
Supply of artificial eye .................................
Supply of spectacles ...................................
0.50
0.00
0.92
0.81
0.81
0.35
0.35
0.00
0.54
0.54
0.00
0.50
0.38
0.33
0.60
0.81
0.81
0.00
1.10
1.10
0.00
0.44
0.44
0.00
0.20
0.81
0.81
0.00
0.81
0.81
0.00
1.01
1.01
0.00
0.17
0.17
0.00
0.24
0.24
0.00
0.20
0.20
0.00
0.66
0.66
0.00
0.81
1.17
1.08
1.26
0.92
0.69
0.45
0.68
0.45
0.00
0.00
1.08
0.45
0.37
0.47
0.53
0.37
0.50
0.00
0.00
0.00
0.32
0.00
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.22
1.19
1.34
1.06
1.26
0.77
0.15
0.63
1.58
0.24
1.35
0.98
0.22
0.21
1.39
2.50
0.36
2.14
5.75
0.49
5.27
1.47
0.19
1.29
0.25
1.39
0.28
1.11
1.49
0.32
1.17
1.92
0.42
1.50
0.84
0.07
0.77
1.74
0.08
1.66
0.94
0.09
0.86
2.88
0.29
2.59
2.28
1.13
1.14
1.17
1.13
0.98
0.95
1.05
1.05
0.49
1.41
0.99
0.88
0.66
0.70
0.72
0.67
0.72
7.13
3.53
0.81
0.53
0.53
0.00
0.00
0.00
0.00
0.00
Facility
PE
RVUs
0.22
NA
0.35
0.31
0.36
NA
0.15
NA
NA
0.24
NA
0.21
0.16
0.14
0.20
NA
0.36
NA
NA
0.49
NA
NA
0.19
NA
0.09
NA
0.28
NA
NA
0.32
NA
NA
0.42
NA
NA
0.07
NA
NA
0.08
NA
NA
0.09
NA
NA
0.29
NA
0.30
0.45
0.35
0.49
0.28
0.27
0.16
0.28
0.15
NA
NA
0.32
0.16
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
Malpractice
RVUs
0.01
0.01
0.02
0.02
0.02
0.02
0.01
0.01
0.08
0.01
0.07
0.01
0.01
0.01
0.02
0.08
0.02
0.06
0.09
0.03
0.06
0.02
0.01
0.01
0.01
0.06
0.04
0.02
0.05
0.03
0.02
0.05
0.03
0.02
0.02
0.01
0.01
0.02
0.01
0.01
0.02
0.01
0.01
0.04
0.02
0.02
0.02
0.04
0.03
0.03
0.02
0.01
0.01
0.02
0.01
0.01
0.06
0.03
0.01
0.01
0.01
0.01
0.01
0.02
0.10
0.01
0.05
0.02
0.02
0.00
0.00
0.02
0.57
0.10
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00222
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.73
1.20
2.28
1.89
2.09
1.14
0.51
0.64
2.20
0.79
1.42
1.49
0.61
0.55
2.01
3.39
1.19
2.20
6.94
1.62
5.33
1.93
0.64
1.30
0.46
2.26
1.13
1.13
2.35
1.16
1.19
2.98
1.46
1.52
1.03
0.25
0.78
2.00
0.33
1.67
1.16
0.30
0.87
3.58
0.97
2.61
3.12
2.34
2.25
2.47
2.07
1.68
1.41
1.75
1.52
0.50
1.47
2.10
1.34
1.04
1.18
1.27
1.05
1.24
7.23
3.54
0.86
0.87
0.55
0.00
0.00
0.02
0.57
0.10
Facility
total
0.73
NA
1.30
1.14
1.19
NA
0.51
NA
NA
0.79
NA
0.72
0.55
0.48
0.82
NA
1.19
NA
NA
1.62
NA
NA
0.64
NA
0.30
NA
1.13
NA
NA
1.16
NA
NA
1.46
NA
NA
0.25
NA
NA
0.33
NA
NA
0.30
NA
NA
0.97
NA
1.13
1.66
1.47
1.78
1.22
0.97
0.62
0.98
0.61
NA
NA
1.43
0.62
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
0.02
0.57
0.10
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45985
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
92396
92499
92499
92499
92502
92504
92506
92507
92508
92510
92511
92512
92516
92520
92526
92531
92532
92533
92534
92541
92541
92541
92542
92542
92542
92543
92543
92543
92544
92544
92544
92545
92545
92545
92546
92546
92546
92547
92548
92548
92548
92551
92552
92553
92555
92556
92557
92559
92560
92561
92562
92563
92564
92565
92567
92568
92569
92571
92572
92573
92575
92576
92577
92579
92582
92583
92584
92585
92585
92585
92586
92587
92587
92587
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
............
26 .......
TC ......
Status
I
C
C
C
A
A
A
A
A
I
A
A
A
A
A
B
B
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
A
A
A
A
A
N
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Supply of contact lenses .............................
Eye service or procedure ............................
Eye service or procedure ............................
Eye service or procedure ............................
Ear and throat examination .........................
Ear microscopy examination .......................
Speech/hearing evaluation ..........................
Speech/hearing therapy ..............................
Speech/hearing therapy ..............................
Rehab for ear implant .................................
Nasopharyngoscopy ....................................
Nasal function studies .................................
Facial nerve function test ............................
Laryngeal function studies ..........................
Oral function therapy ...................................
Spontaneous nystagmus study ...................
Positional nystagmus test ...........................
Caloric vestibular test ..................................
Optokinetic nystagmus test .........................
Spontaneous nystagmus test ......................
Spontaneous nystagmus test ......................
Spontaneous nystagmus test ......................
Positional nystagmus test ...........................
Positional nystagmus test ...........................
Positional nystagmus test ...........................
Caloric vestibular test ..................................
Caloric vestibular test ..................................
Caloric vestibular test ..................................
Optokinetic nystagmus test .........................
Optokinetic nystagmus test .........................
Optokinetic nystagmus test .........................
Oscillating tracking test ...............................
Oscillating tracking test ...............................
Oscillating tracking test ...............................
Sinusoidal rotational test .............................
Sinusoidal rotational test .............................
Sinusoidal rotational test .............................
Supplemental electrical test ........................
Posturography .............................................
Posturography .............................................
Posturography .............................................
Pure tone hearing test, air ..........................
Pure tone audiometry, air ............................
Audiometry, air & bone ...............................
Speech threshold audiometry .....................
Speech audiometry, complete .....................
Comprehensive hearing test .......................
Group audiometric testing ...........................
Bekesy audiometry, screen .........................
Bekesy audiometry, diagnosis ....................
Loudness balance test ................................
Tone decay hearing test .............................
Sisi hearing test ...........................................
Stenger test, pure tone ...............................
Tympanometry .............................................
Acoustic reflex testing .................................
Acoustic reflex decay test ...........................
Filtered speech hearing test ........................
Staggered spondaic word test ....................
Lombard test ...............................................
Sensorineural acuity test .............................
Synthetic sentence test ...............................
Stenger test, speech ...................................
Visual audiometry (vra) ...............................
Conditioning play audiometry ......................
Select picture audiometry ............................
Electrocochleography ..................................
Auditor evoke potent, compre .....................
Auditor evoke potent, compre .....................
Auditor evoke potent, compre .....................
Auditor evoke potent, limit ...........................
Evoked auditory test ....................................
Evoked auditory test ....................................
Evoked auditory test ....................................
0.00
0.00
0.00
0.00
1.51
0.18
0.86
0.52
0.26
1.50
0.84
0.55
0.43
0.76
0.55
0.00
0.00
0.00
0.00
0.40
0.40
0.00
0.33
0.33
0.00
0.10
0.10
0.00
0.26
0.26
0.00
0.23
0.23
0.00
0.29
0.29
0.00
0.00
0.50
0.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.50
0.50
0.00
0.00
0.13
0.13
0.00
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
NA
0.50
2.68
1.10
0.51
0.00
3.23
1.13
1.18
0.51
1.75
0.00
0.00
0.00
0.00
1.02
0.18
0.84
1.13
0.15
0.98
0.57
0.05
0.52
0.90
0.12
0.78
0.81
0.11
0.71
1.93
0.13
1.81
0.08
2.14
0.25
1.89
0.00
0.44
0.63
0.35
0.54
1.12
0.00
0.00
0.68
0.42
0.37
0.45
0.36
0.48
0.32
0.34
0.36
0.17
0.33
0.41
0.42
0.60
0.68
0.72
0.79
2.15
1.97
0.21
1.77
1.67
1.15
0.06
1.09
Facility
PE
RVUs
0.00
0.00
0.00
0.00
1.08
0.09
0.38
0.22
0.12
0.00
0.76
0.18
0.21
0.38
0.20
0.00
0.00
0.00
0.00
NA
0.18
NA
NA
0.15
NA
NA
0.05
NA
NA
0.12
NA
NA
0.11
NA
NA
0.13
NA
NA
NA
0.25
NA
0.00
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.21
NA
NA
NA
0.06
NA
Malpractice
RVUs
0.07
0.00
0.00
0.00
0.05
0.01
0.03
0.02
0.01
0.07
0.03
0.02
0.01
0.03
0.02
0.00
0.00
0.00
0.00
0.04
0.02
0.02
0.03
0.01
0.02
0.02
0.01
0.01
0.03
0.01
0.02
0.03
0.01
0.02
0.03
0.01
0.02
0.06
0.15
0.02
0.13
0.00
0.04
0.06
0.04
0.06
0.12
0.00
0.00
0.06
0.04
0.04
0.05
0.04
0.06
0.04
0.04
0.04
0.01
0.04
0.02
0.05
0.07
0.06
0.06
0.08
0.21
0.17
0.03
0.14
0.14
0.12
0.01
0.11
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00223
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.07
0.00
0.00
0.00
NA
0.69
3.57
1.65
0.78
1.57
4.10
1.70
1.62
1.31
2.32
0.00
0.00
0.00
0.00
1.47
0.60
0.86
1.50
0.49
1.00
0.69
0.16
0.53
1.19
0.39
0.80
1.07
0.35
0.73
2.25
0.43
1.83
0.14
2.79
0.77
2.02
0.00
0.48
0.69
0.39
0.60
1.24
0.00
0.00
0.74
0.46
0.41
0.50
0.40
0.54
0.36
0.38
0.40
0.18
0.37
0.43
0.47
0.67
0.74
0.78
0.87
2.36
2.64
0.74
1.91
1.81
1.40
0.20
1.20
Facility
total
0.07
0.00
0.00
0.00
2.65
0.28
1.27
0.76
0.39
1.57
1.64
0.75
0.65
1.17
0.77
0.00
0.00
0.00
0.00
NA
0.60
NA
NA
0.49
NA
NA
0.16
NA
NA
0.39
NA
NA
0.35
NA
NA
0.43
NA
NA
NA
0.77
NA
0.00
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.74
NA
NA
NA
0.20
NA
Global
XXX
XXX
XXX
XXX
000
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45986
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
92588
92588
92588
92590
92591
92592
92593
92594
92595
92596
92597
92601
92602
92603
92604
92605
92606
92607
92608
92609
92610
92611
92612
92613
92614
92615
92616
92617
92620
92621
92625
92700
92950
92953
92960
92961
92970
92971
92973
92974
92975
92977
92978
92978
92978
92979
92979
92979
92980
92981
92982
92984
92986
92987
92990
92992
92993
92995
92996
92997
92998
93000
93005
93010
93012
93014
93015
93016
93017
93018
93024
93024
93024
93025
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
Status
A
A
A
N
N
N
N
N
N
A
A
A
A
A
A
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Evoked auditory test ....................................
Evoked auditory test ....................................
Evoked auditory test ....................................
Hearing aid exam, one ear .........................
Hearing aid exam, both ears .......................
Hearing aid check, one ear .........................
Hearing aid check, both ears ......................
Electro hearng aid test, one ........................
Electro hearng aid tst, both .........................
Ear protector evaluation ..............................
Oral speech device eval ..............................
Cochlear implt f/up exam < 7 ......................
Reprogram cochlear implt < 7 .....................
Cochlear implt f/up exam 7 > ......................
Reprogram cochlear implt 7 > .....................
Eval for nonspeech device rx ......................
Non-speech device service .........................
Ex for speech device rx, 1hr .......................
Ex for speech device rx addl ......................
Use of speech device service .....................
Evaluate swallowing function ......................
Motion fluoroscopy/swallow .........................
Endoscopy swallow tst (fees) ......................
Endoscopy swallow tst (fees) ......................
Laryngoscopic sensory test .........................
Eval laryngoscopy sense tst .......................
Fees w/laryngeal sense test .......................
Interprt fees/laryngeal test ...........................
Auditory function, 60 min ............................
Auditory function, + 15 min .........................
Tinnitus assessment ....................................
Ent procedure/service .................................
Heart/lung resuscitation cpr ........................
Temporary external pacing .........................
Cardioversion electric, ext ...........................
Cardioversion, electric, int ...........................
Cardioassist, internal ...................................
Cardioassist, external ..................................
Percut coronary thrombectomy ...................
Cath place, cardio brachytx ........................
Dissolve clot, heart vessel ..........................
Dissolve clot, heart vessel ..........................
Intravasc us, heart add-on ..........................
Intravasc us, heart add-on ..........................
Intravasc us, heart add-on ..........................
Intravasc us, heart add-on ..........................
Intravasc us, heart add-on ..........................
Intravasc us, heart add-on ..........................
Insert intracoronary stent ............................
Insert intracoronary stent ............................
Coronary artery dilation ...............................
Coronary artery dilation ...............................
Revision of aortic valve ...............................
Revision of mitral valve ...............................
Revision of pulmonary valve .......................
Revision of heart chamber ..........................
Revision of heart chamber ..........................
Coronary atherectomy .................................
Coronary atherectomy add-on ....................
Pul art balloon repr, percut .........................
Pul art balloon repr, percut .........................
Electrocardiogram, complete .......................
Electrocardiogram, tracing ..........................
Electrocardiogram report .............................
Transmission of ecg ....................................
Report on transmitted ecg ...........................
Cardiovascular stress test ...........................
Cardiovascular stress test ...........................
Cardiovascular stress test ...........................
Cardiovascular stress test ...........................
Cardiac drug stress test ..............................
Cardiac drug stress test ..............................
Cardiac drug stress test ..............................
Microvolt t-wave assess ..............................
0.36
0.36
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.86
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.27
0.71
1.27
0.63
1.88
0.79
0.00
0.00
0.00
0.00
3.80
0.23
2.25
4.60
3.52
1.77
3.29
3.01
7.25
0.00
1.80
1.80
0.00
1.44
1.44
0.00
14.85
4.17
10.98
2.98
21.81
22.72
17.34
0.00
0.00
12.09
3.27
12.00
6.00
0.17
0.00
0.17
0.00
0.52
0.75
0.45
0.00
0.30
1.17
1.17
0.00
0.75
Nonfacility
PE
RVUs
1.43
0.15
1.28
0.00
0.00
0.00
0.00
0.00
0.00
0.58
1.68
3.54
2.41
2.19
1.39
0.00
0.00
3.11
0.56
1.61
2.97
3.09
2.74
0.38
2.47
0.34
3.31
0.42
1.18
0.26
1.16
0.00
3.97
NA
6.22
NA
NA
NA
NA
NA
NA
6.62
NA
0.74
NA
NA
0.59
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
0.47
0.41
0.06
4.81
0.19
2.11
0.18
1.82
0.12
1.93
0.47
1.46
7.06
Facility
PE
RVUs
NA
0.15
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.43
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
0.63
0.38
0.63
0.34
0.95
0.42
NA
NA
NA
0.00
0.95
0.07
1.26
2.19
1.06
0.91
1.35
1.24
2.94
NA
NA
0.74
NA
NA
0.59
NA
6.36
1.71
4.77
1.21
12.62
13.01
10.33
0.00
0.00
5.22
1.33
5.04
2.24
NA
NA
0.06
NA
0.19
NA
0.18
NA
0.12
NA
0.47
NA
NA
Malpractice
RVUs
0.14
0.01
0.13
0.00
0.00
0.00
0.00
0.00
0.00
0.06
0.03
0.07
0.07
0.07
0.07
0.00
0.00
0.05
0.05
0.04
0.08
0.08
0.04
0.05
0.04
0.05
0.06
0.05
0.06
0.06
0.06
0.00
0.28
0.02
0.07
0.29
0.16
0.06
0.23
0.21
0.50
0.46
0.30
0.06
0.24
0.19
0.06
0.13
1.03
0.29
0.76
0.21
1.51
1.59
1.20
0.00
0.00
0.84
0.10
0.40
0.28
0.03
0.02
0.01
0.18
0.02
0.14
0.02
0.11
0.01
0.12
0.04
0.08
0.14
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00224
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.93
0.52
1.41
0.00
0.00
0.00
0.00
0.00
0.00
0.64
2.57
3.61
2.48
2.26
1.46
0.00
0.00
3.16
0.61
1.65
3.05
3.17
4.06
1.14
3.78
1.02
5.26
1.26
1.24
0.32
1.22
0.00
8.04
NA
8.55
NA
NA
NA
NA
NA
NA
7.08
NA
2.61
NA
NA
2.09
NA
NA
NA
NA
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
0.67
0.43
0.24
4.99
0.73
3.00
0.65
1.93
0.43
3.22
1.68
1.54
7.95
Facility
total
NA
0.52
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
1.32
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
1.95
1.14
1.95
1.02
2.90
1.26
NA
NA
NA
0.00
5.03
0.32
3.58
7.08
4.74
2.74
4.86
4.45
10.69
NA
NA
2.61
NA
NA
2.09
NA
22.24
6.17
16.52
4.40
35.94
37.32
28.87
0.00
0.00
18.16
4.70
17.44
8.53
NA
NA
0.24
NA
0.73
NA
0.65
NA
0.43
NA
1.68
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
000
000
000
000
000
000
ZZZ
ZZZ
000
XXX
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
000
ZZZ
000
ZZZ
090
090
090
090
090
000
ZZZ
000
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45987
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
93025
93025
93040
93041
93042
93224
93225
93226
93227
93230
93231
93232
93233
93235
93236
93237
93268
93270
93271
93272
93278
93278
93278
93303
93303
93303
93304
93304
93304
93307
93307
93307
93308
93308
93308
93312
93312
93312
93313
93314
93314
93314
93315
93315
93315
93316
93317
93317
93317
93318
93318
93318
93320
93320
93320
93321
93321
93321
93325
93325
93325
93350
93350
93350
93501
93501
93501
93503
93505
93505
93505
93508
93508
93508
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
A
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Microvolt t-wave assess ..............................
Microvolt t-wave assess ..............................
Rhythm ECG with report .............................
Rhythm ECG, tracing ..................................
Rhythm ECG, report ....................................
ECG monitor/report, 24 hrs .........................
ECG monitor/record, 24 hrs ........................
ECG monitor/report, 24 hrs .........................
ECG monitor/review, 24 hrs ........................
ECG monitor/report, 24 hrs .........................
Ecg monitor/record, 24 hrs ..........................
ECG monitor/report, 24 hrs .........................
ECG monitor/review, 24 hrs ........................
ECG monitor/report, 24 hrs .........................
ECG monitor/report, 24 hrs .........................
ECG monitor/review, 24 hrs ........................
ECG record/review ......................................
ECG recording .............................................
Ecg/monitoring and analysis .......................
Ecg/review, interpret only ............................
ECG/signal-averaged ..................................
ECG/signal-averaged ..................................
ECG/signal-averaged ..................................
Echo transthoracic .......................................
Echo transthoracic .......................................
Echo transthoracic .......................................
Echo transthoracic .......................................
Echo transthoracic .......................................
Echo transthoracic .......................................
Echo exam of heart .....................................
Echo exam of heart .....................................
Echo exam of heart .....................................
Echo exam of heart .....................................
Echo exam of heart .....................................
Echo exam of heart .....................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal .................................
Echo transesophageal intraop ....................
Echo transesophageal intraop ....................
Echo transesophageal intraop ....................
Doppler echo exam, heart ...........................
Doppler echo exam, heart ...........................
Doppler echo exam, heart ...........................
Doppler echo exam, heart ...........................
Doppler echo exam, heart ...........................
Doppler echo exam, heart ...........................
Doppler color flow add-on ...........................
Doppler color flow add-on ...........................
Doppler color flow add-on ...........................
Echo transthoracic .......................................
Echo transthoracic .......................................
Echo transthoracic .......................................
Right heart catheterization ..........................
Right heart catheterization ..........................
Right heart catheterization ..........................
Insert/place heart catheter ..........................
Biopsy of heart lining ...................................
Biopsy of heart lining ...................................
Biopsy of heart lining ...................................
Cath placement, angiography .....................
Cath placement, angiography .....................
Cath placement, angiography .....................
0.75
0.00
0.16
0.00
0.16
0.52
0.00
0.00
0.52
0.52
0.00
0.00
0.52
0.45
0.00
0.45
0.52
0.00
0.00
0.52
0.25
0.25
0.00
1.30
1.30
0.00
0.75
0.75
0.00
0.92
0.92
0.00
0.53
0.53
0.00
2.20
2.20
0.00
0.95
1.25
1.25
0.00
0.00
2.79
0.00
0.95
0.00
1.83
0.00
0.00
2.20
0.00
0.38
0.38
0.00
0.15
0.15
0.00
0.07
0.07
0.00
1.48
1.48
0.00
3.03
3.03
0.00
2.92
4.38
4.38
0.00
4.10
4.10
0.00
Nonfacility
PE
RVUs
0.30
6.76
0.21
0.16
0.05
3.30
1.20
1.90
0.20
3.42
1.38
1.85
0.20
2.79
2.63
0.17
5.84
1.04
4.60
0.19
1.10
0.10
1.00
4.74
0.50
4.25
2.71
0.29
2.42
4.30
0.36
3.94
2.39
0.21
2.19
5.88
0.82
5.06
0.00
5.32
0.49
4.84
0.00
1.04
0.00
NA
0.00
0.69
0.00
0.00
0.47
0.00
1.92
0.16
1.76
1.07
0.06
1.01
2.41
0.03
2.38
3.36
0.59
2.77
21.04
1.19
19.84
NA
10.54
1.75
8.79
15.76
2.23
13.52
Facility
PE
RVUs
0.30
NA
NA
NA
0.05
NA
NA
NA
0.20
NA
NA
NA
0.20
NA
NA
0.17
NA
NA
NA
0.19
NA
0.10
NA
NA
0.50
NA
NA
0.29
NA
NA
0.36
NA
NA
0.21
NA
NA
0.82
NA
0.21
NA
0.49
NA
0.00
1.04
0.00
0.24
0.00
0.69
0.00
0.00
0.47
0.00
NA
0.16
NA
NA
0.06
NA
NA
0.03
NA
NA
0.59
NA
NA
1.19
NA
0.67
NA
1.75
NA
NA
2.23
NA
Malpractice
RVUs
0.03
0.11
0.02
0.01
0.01
0.24
0.08
0.14
0.02
0.26
0.11
0.13
0.02
0.16
0.14
0.02
0.28
0.08
0.18
0.02
0.12
0.01
0.11
0.27
0.04
0.23
0.15
0.02
0.13
0.26
0.03
0.23
0.15
0.02
0.13
0.37
0.08
0.29
0.06
0.33
0.04
0.29
0.00
0.09
0.00
0.05
0.00
0.08
0.00
0.00
0.14
0.00
0.13
0.01
0.12
0.09
0.01
0.08
0.22
0.01
0.21
0.18
0.05
0.13
1.26
0.21
1.05
0.20
0.46
0.30
0.16
0.93
0.28
0.65
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00225
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.08
6.87
0.39
0.17
0.22
4.07
1.28
2.04
0.74
4.20
1.49
1.98
0.74
3.40
2.77
0.64
6.65
1.12
4.78
0.73
1.47
0.36
1.11
6.32
1.84
4.48
3.61
1.06
2.55
5.48
1.32
4.17
3.08
0.76
2.32
8.45
3.10
5.35
1.01
6.91
1.78
5.13
0.00
3.92
0.00
NA
0.00
2.60
0.00
0.00
2.82
0.00
2.43
0.55
1.88
1.31
0.22
1.09
2.70
0.11
2.59
5.02
2.12
2.90
25.33
4.43
20.89
NA
15.38
6.42
8.95
20.78
6.61
14.17
Facility
total
1.08
NA
NA
NA
0.22
NA
NA
NA
0.74
NA
NA
NA
0.74
NA
NA
0.64
NA
NA
NA
0.73
NA
0.36
NA
NA
1.84
NA
NA
1.06
NA
NA
1.32
NA
NA
0.76
NA
NA
3.10
NA
1.22
NA
1.78
NA
0.00
3.92
0.00
1.24
0.00
2.60
0.00
0.00
2.82
0.00
NA
0.55
NA
NA
0.22
NA
NA
0.11
NA
NA
2.12
NA
NA
4.43
NA
3.79
NA
6.42
NA
NA
6.61
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
000
000
000
000
000
000
000
000
000
000
45988
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
93510
93510
93510
93511
93511
93511
93514
93514
93514
93524
93524
93524
93526
93526
93526
93527
93527
93527
93528
93528
93528
93529
93529
93529
93530
93530
93530
93531
93531
93531
93532
93532
93532
93533
93533
93533
93539
93540
93541
93542
93543
93544
93545
93555
93555
93555
93556
93556
93556
93561
93561
93561
93562
93562
93562
93571
93571
93571
93572
93572
93572
93580
93581
93600
93600
93600
93602
93602
93602
93603
93603
93603
93609
93609
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Left heart catheterization .............................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt & Lt heart catheters ................................
Rt, lt heart catheterization ...........................
Rt, lt heart catheterization ...........................
Rt, lt heart catheterization ...........................
Rt heart cath, congenital .............................
Rt heart cath, congenital .............................
Rt heart cath, congenital .............................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
R & l heart cath, congenital ........................
Injection, cardiac cath .................................
Injection, cardiac cath .................................
Injection for lung angiogram ........................
Injection for heart x-rays .............................
Injection for heart x-rays .............................
Injection for aortography .............................
Inject for coronary x-rays ............................
Imaging, cardiac cath ..................................
Imaging, cardiac cath ..................................
Imaging, cardiac cath ..................................
Imaging, cardiac cath ..................................
Imaging, cardiac cath ..................................
Imaging, cardiac cath ..................................
Cardiac output measurement ......................
Cardiac output measurement ......................
Cardiac output measurement ......................
Cardiac output measurement ......................
Cardiac output measurement ......................
Cardiac output measurement ......................
Heart flow reserve measure ........................
Heart flow reserve measure ........................
Heart flow reserve measure ........................
Heart flow reserve measure ........................
Heart flow reserve measure ........................
Heart flow reserve measure ........................
Transcath closure of asd .............................
Transcath closure of vsd .............................
Bundle of His recording ...............................
Bundle of His recording ...............................
Bundle of His recording ...............................
Intra-atrial recording ....................................
Intra-atrial recording ....................................
Intra-atrial recording ....................................
Right ventricular recording ..........................
Right ventricular recording ..........................
Right ventricular recording ..........................
Map tachycardia, add-on .............................
Map tachycardia, add-on .............................
4.33
4.33
0.00
5.03
5.03
0.00
7.05
7.05
0.00
6.95
6.95
0.00
5.99
5.99
0.00
7.28
7.28
0.00
9.01
9.01
0.00
4.80
4.80
0.00
4.23
4.23
0.00
8.36
8.36
0.00
10.01
10.01
0.00
6.70
6.70
0.00
0.40
0.43
0.29
0.29
0.29
0.25
0.40
0.81
0.81
0.00
0.83
0.83
0.00
0.50
0.50
0.00
0.16
0.16
0.00
1.80
1.80
0.00
1.44
1.44
0.00
18.01
24.44
2.12
2.12
0.00
2.12
2.12
0.00
2.12
2.12
0.00
5.00
5.00
Nonfacility
PE
RVUs
35.48
2.34
33.14
NA
2.62
NA
NA
3.31
NA
NA
3.38
NA
49.26
3.00
46.25
NA
3.52
NA
NA
4.30
NA
NA
2.42
NA
NA
2.02
NA
NA
3.74
NA
NA
4.44
NA
NA
2.87
NA
NA
NA
NA
NA
NA
NA
NA
5.12
0.33
4.79
7.95
0.34
7.61
NA
0.16
NA
NA
0.05
NA
NA
0.70
NA
NA
0.50
NA
NA
NA
NA
0.87
NA
NA
0.86
NA
NA
0.84
NA
NA
2.03
Facility
PE
RVUs
NA
2.34
NA
NA
2.62
NA
NA
3.31
NA
NA
3.38
NA
NA
3.00
NA
NA
3.52
NA
NA
4.30
NA
NA
2.42
NA
NA
2.02
NA
NA
3.74
NA
NA
4.44
NA
NA
2.87
NA
0.17
0.18
0.12
0.12
0.12
0.10
0.17
NA
0.33
NA
NA
0.34
NA
NA
0.16
NA
NA
0.05
NA
NA
0.70
NA
NA
0.50
NA
7.75
9.69
NA
0.87
NA
NA
0.86
NA
NA
0.84
NA
NA
2.03
Malpractice
RVUs
2.61
0.30
2.31
2.59
0.35
2.24
2.74
0.49
2.24
3.43
0.48
2.95
3.46
0.42
3.04
3.46
0.51
2.95
3.57
0.62
2.95
3.28
0.33
2.95
1.34
0.29
1.05
3.62
0.58
3.04
3.64
0.69
2.95
3.42
0.47
2.95
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.37
0.03
0.34
0.54
0.03
0.51
0.08
0.02
0.06
0.05
0.01
0.04
0.30
0.06
0.24
0.17
0.04
0.13
1.25
1.71
0.29
0.16
0.13
0.24
0.17
0.07
0.29
0.18
0.11
0.52
0.35
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00226
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
42.42
6.97
35.45
NA
8.00
NA
NA
10.85
NA
NA
10.81
NA
58.71
9.42
49.29
NA
11.32
NA
NA
13.93
NA
NA
7.55
NA
NA
6.54
NA
NA
12.68
NA
NA
15.14
NA
NA
10.04
NA
NA
NA
NA
NA
NA
NA
NA
6.30
1.17
5.13
9.32
1.20
8.12
NA
0.68
NA
NA
0.22
NA
NA
2.57
NA
NA
1.98
NA
NA
NA
NA
3.15
NA
NA
3.15
NA
NA
3.15
NA
NA
7.38
Facility
total
NA
6.97
NA
NA
8.00
NA
NA
10.85
NA
NA
10.81
NA
NA
9.42
NA
NA
11.32
NA
NA
13.93
NA
NA
7.55
NA
NA
6.54
NA
NA
12.68
NA
NA
15.14
NA
NA
10.04
NA
0.58
0.62
0.42
0.42
0.42
0.36
0.58
NA
1.17
NA
NA
1.20
NA
NA
0.68
NA
NA
0.22
NA
NA
2.57
NA
NA
1.98
NA
27.00
35.84
NA
3.15
NA
NA
3.15
NA
NA
3.15
NA
NA
7.38
Global
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
000
000
000
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
000
000
000
000
000
000
000
000
000
000
000
ZZZ
ZZZ
45989
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
93609
93610
93610
93610
93612
93612
93612
93613
93615
93615
93615
93616
93616
93616
93618
93618
93618
93619
93619
93619
93620
93620
93620
93621
93621
93621
93622
93622
93622
93623
93623
93623
93624
93624
93624
93631
93631
93631
93640
93640
93640
93641
93641
93641
93642
93642
93642
93650
93651
93652
93660
93660
93660
93662
93662
93662
93668
93701
93701
93701
93720
93721
93722
93724
93724
93724
93727
93731
93731
93731
93732
93732
93732
93733
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
............
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Map tachycardia, add-on .............................
Intra-atrial pacing .........................................
Intra-atrial pacing .........................................
Intra-atrial pacing .........................................
Intraventricular pacing .................................
Intraventricular pacing .................................
Intraventricular pacing .................................
Electrophys map 3d, add-on .......................
Esophageal recording .................................
Esophageal recording .................................
Esophageal recording .................................
Esophageal recording .................................
Esophageal recording .................................
Esophageal recording .................................
Heart rhythm pacing ....................................
Heart rhythm pacing ....................................
Heart rhythm pacing ....................................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Stimulation, pacing heart .............................
Stimulation, pacing heart .............................
Stimulation, pacing heart .............................
Electrophysiologic study ..............................
Electrophysiologic study ..............................
Electrophysiologic study ..............................
Heart pacing, mapping ................................
Heart pacing, mapping ................................
Heart pacing, mapping ................................
Evaluation heart device ...............................
Evaluation heart device ...............................
Evaluation heart device ...............................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Electrophysiology evaluation .......................
Ablate heart dysrhythm focus .....................
Ablate heart dysrhythm focus .....................
Ablate heart dysrhythm focus .....................
Tilt table evaluation .....................................
Tilt table evaluation .....................................
Tilt table evaluation .....................................
Intracardiac ecg (ice) ...................................
Intracardiac ecg (ice) ...................................
Intracardiac ecg (ice) ...................................
Peripheral vascular rehab ...........................
Bioimpedance, thoracic ...............................
Bioimpedance, thoracic ...............................
Bioimpedance, thoracic ...............................
Total body plethysmography .......................
Plethysmography tracing .............................
Plethysmography report ..............................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze ilr system .......................................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Telephone analy, pacemaker ......................
0.00
3.03
3.03
0.00
3.03
3.03
0.00
7.00
0.99
0.99
0.00
1.49
1.49
0.00
4.26
4.26
0.00
7.32
7.32
0.00
0.00
11.59
0.00
0.00
2.10
0.00
0.00
3.11
0.00
0.00
2.86
0.00
4.81
4.81
0.00
7.61
7.61
0.00
3.52
3.52
0.00
5.93
5.93
0.00
4.89
4.89
0.00
10.51
16.26
17.69
1.89
1.89
0.00
0.00
2.81
0.00
0.00
0.17
0.17
0.00
0.17
0.00
0.17
4.89
4.89
0.00
0.52
0.45
0.45
0.00
0.92
0.92
0.00
0.17
Nonfacility
PE
RVUs
NA
NA
1.21
NA
NA
1.20
NA
NA
NA
0.27
NA
NA
0.44
NA
NA
1.75
NA
NA
3.37
NA
0.00
5.11
0.00
0.00
0.86
0.00
0.00
1.26
0.00
0.00
1.16
0.00
NA
2.33
NA
NA
2.83
NA
NA
1.42
NA
NA
2.41
NA
8.17
2.35
5.81
NA
NA
NA
2.58
0.77
1.81
0.00
1.16
0.00
0.00
0.94
0.07
0.87
0.92
0.87
0.05
5.22
2.00
3.22
0.37
0.74
0.18
0.56
0.98
0.37
0.62
0.69
Facility
PE
RVUs
NA
NA
1.21
NA
NA
1.20
NA
2.90
NA
0.27
NA
NA
0.44
NA
NA
1.75
NA
NA
3.37
NA
0.00
5.11
0.00
0.00
0.86
0.00
0.00
1.26
0.00
0.00
1.16
0.00
NA
2.33
NA
NA
2.83
NA
NA
1.42
NA
NA
2.41
NA
NA
2.35
NA
4.68
6.61
7.17
NA
0.77
NA
0.00
1.16
0.00
0.00
NA
0.07
NA
NA
NA
0.05
NA
2.00
NA
0.20
NA
0.18
NA
NA
0.37
NA
NA
Malpractice
RVUs
0.17
0.34
0.24
0.10
0.36
0.25
0.11
0.49
0.05
0.03
0.02
0.11
0.09
0.02
0.54
0.30
0.24
0.98
0.51
0.47
0.00
0.80
0.00
0.00
0.15
0.00
0.00
0.22
0.00
0.00
0.20
0.00
0.46
0.33
0.13
1.60
0.97
0.62
0.66
0.24
0.42
0.83
0.41
0.42
0.57
0.15
0.42
0.73
1.13
1.23
0.08
0.06
0.02
0.00
0.09
0.00
0.00
0.02
0.01
0.01
0.07
0.06
0.01
0.39
0.15
0.24
0.02
0.05
0.01
0.04
0.07
0.03
0.04
0.07
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00227
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
4.47
NA
NA
4.48
NA
NA
NA
1.30
NA
NA
2.02
NA
NA
6.30
NA
NA
11.21
NA
0.00
17.50
0.00
0.00
3.11
0.00
0.00
4.59
0.00
0.00
4.21
0.00
NA
7.47
NA
NA
11.41
NA
NA
5.18
NA
NA
8.75
NA
13.63
7.39
6.23
NA
NA
NA
4.55
2.73
1.83
0.00
4.06
0.00
0.00
1.13
0.25
0.88
1.16
0.93
0.23
10.50
7.04
3.46
0.91
1.24
0.64
0.60
1.97
1.32
0.66
0.93
Facility
total
NA
NA
4.47
NA
NA
4.48
NA
10.39
NA
1.30
NA
NA
2.02
NA
NA
6.30
NA
NA
11.21
NA
0.00
17.50
0.00
0.00
3.11
0.00
0.00
4.59
0.00
0.00
4.21
0.00
NA
7.47
NA
NA
11.41
NA
NA
5.18
NA
NA
8.75
NA
NA
7.39
NA
15.92
24.00
26.08
NA
2.73
NA
0.00
4.06
0.00
0.00
NA
0.25
NA
NA
NA
0.23
NA
7.04
NA
0.74
NA
0.64
NA
NA
1.32
NA
NA
Global
ZZZ
000
000
000
000
000
000
ZZZ
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45990
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
93733
93733
93734
93734
93734
93735
93735
93735
93736
93736
93736
93740
93740
93740
93741
93741
93741
93742
93742
93742
93743
93743
93743
93744
93744
93744
93745
93745
93745
93760
93762
93770
93770
93770
93784
93786
93788
93790
93797
93798
93799
93799
93799
93875
93875
93875
93880
93880
93880
93882
93882
93882
93886
93886
93886
93888
93888
93888
93890
93890
93890
93892
93892
93892
93893
93893
93893
93922
93922
93922
93923
93923
93923
93924
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
26 .......
TC ......
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
A
A
A
A
A
A
A
A
A
A
A
B
B
B
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
N
N
B
B
B
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Telephone analy, pacemaker ......................
Telephone analy, pacemaker ......................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Analyze pacemaker system ........................
Telephonic analy, pacemaker .....................
Telephonic analy, pacemaker .....................
Telephonic analy, pacemaker .....................
Temperature gradient studies .....................
Temperature gradient studies .....................
Temperature gradient studies .....................
Analyze ht pace device sngl .......................
Analyze ht pace device sngl .......................
Analyze ht pace device sngl .......................
Analyze ht pace device sngl .......................
Analyze ht pace device sngl .......................
Analyze ht pace device sngl .......................
Analyze ht pace device dual .......................
Analyze ht pace device dual .......................
Analyze ht pace device dual .......................
Analyze ht pace device dual .......................
Analyze ht pace device dual .......................
Analyze ht pace device dual .......................
Set-up cardiovert-defibrill ............................
Set-up cardiovert-defibrill ............................
Set-up cardiovert-defibrill ............................
Cephalic thermogram ..................................
Peripheral thermogram ................................
Measure venous pressure ...........................
Measure venous pressure ...........................
Measure venous pressure ...........................
Ambulatory BP monitoring ..........................
Ambulatory BP recording ............................
Ambulatory BP analysis ..............................
Review/report BP recording ........................
Cardiac rehab ..............................................
Cardiac rehab/monitor .................................
Cardiovascular procedure ...........................
Cardiovascular procedure ...........................
Cardiovascular procedure ...........................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Extracranial study ........................................
Intracranial study .........................................
Intracranial study .........................................
Intracranial study .........................................
Intracranial study .........................................
Intracranial study .........................................
Intracranial study .........................................
Tcd, vasoreactivity study .............................
Tcd, vasoreactivity study .............................
Tcd, vasoreactivity study .............................
Tcd, emboli detect w/o inj ...........................
Tcd, emboli detect w/o inj ...........................
Tcd, emboli detect w/o inj ...........................
Tcd, emboli detect w/inj ..............................
Tcd, emboli detect w/inj ..............................
Tcd, emboli detect w/inj ..............................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
0.17
0.00
0.38
0.38
0.00
0.74
0.74
0.00
0.15
0.15
0.00
0.16
0.16
0.00
0.80
0.80
0.00
0.91
0.91
0.00
1.03
1.03
0.00
1.18
1.18
0.00
0.00
0.00
0.00
0.00
0.00
0.16
0.16
0.00
0.38
0.00
0.00
0.38
0.18
0.28
0.00
0.00
0.00
0.22
0.22
0.00
0.60
0.60
0.00
0.40
0.40
0.00
0.94
0.94
0.00
0.62
0.62
0.00
1.00
1.00
0.00
1.15
1.15
0.00
1.15
1.15
0.00
0.25
0.25
0.00
0.45
0.45
0.00
0.50
Nonfacility
PE
RVUs
0.07
0.62
0.59
0.16
0.43
0.82
0.29
0.53
0.60
0.06
0.54
0.16
0.04
0.12
1.04
0.32
0.72
1.11
0.38
0.73
1.20
0.42
0.78
1.23
0.48
0.75
0.00
0.00
0.00
0.00
0.00
0.07
0.05
0.02
1.66
0.99
0.55
0.13
0.34
0.50
0.00
0.00
0.00
2.40
0.08
2.32
5.78
0.21
5.58
3.57
0.14
3.43
6.78
0.36
6.42
4.33
0.23
4.11
5.09
0.39
4.70
5.40
0.45
4.95
5.23
0.45
4.78
2.74
0.08
2.65
4.15
0.15
4.00
5.02
Facility
PE
RVUs
0.07
NA
NA
0.16
NA
NA
0.29
NA
NA
0.06
NA
NA
0.04
NA
NA
0.32
NA
NA
0.38
NA
NA
0.42
NA
NA
0.48
NA
0.00
0.00
0.00
0.00
0.00
NA
0.05
NA
NA
NA
NA
0.13
0.07
0.11
0.00
0.00
0.00
NA
0.08
NA
NA
0.21
NA
NA
0.14
NA
NA
0.36
NA
NA
0.23
NA
NA
0.39
NA
NA
0.45
NA
NA
0.45
NA
NA
0.08
NA
NA
0.15
NA
NA
Malpractice
RVUs
0.01
0.06
0.03
0.01
0.02
0.06
0.02
0.04
0.07
0.01
0.06
0.02
0.01
0.01
0.07
0.03
0.04
0.07
0.03
0.04
0.07
0.03
0.04
0.08
0.04
0.04
0.00
0.00
0.00
0.00
0.00
0.02
0.01
0.01
0.03
0.01
0.01
0.01
0.01
0.01
0.00
0.00
0.00
0.12
0.01
0.11
0.39
0.04
0.35
0.26
0.04
0.22
0.45
0.06
0.39
0.32
0.05
0.27
0.45
0.06
0.39
0.45
0.06
0.39
0.45
0.06
0.39
0.15
0.02
0.13
0.26
0.04
0.22
0.30
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00228
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.25
0.68
1.00
0.55
0.45
1.62
1.05
0.57
0.82
0.22
0.60
0.34
0.21
0.13
1.91
1.15
0.76
2.09
1.32
0.77
2.30
1.48
0.82
2.50
1.70
0.79
0.00
0.00
0.00
0.00
0.00
0.25
0.22
0.03
2.07
1.00
0.56
0.52
0.53
0.79
0.00
0.00
0.00
2.75
0.31
2.43
6.78
0.85
5.93
4.23
0.58
3.65
8.17
1.37
6.81
5.27
0.90
4.38
6.54
1.45
5.09
7.00
1.66
5.34
6.83
1.66
5.17
3.14
0.35
2.78
4.86
0.64
4.22
5.82
Facility
total
0.25
NA
NA
0.55
NA
NA
1.05
NA
NA
0.22
NA
NA
0.21
NA
NA
1.15
NA
NA
1.32
NA
NA
1.48
NA
NA
1.70
NA
0.00
0.00
0.00
0.00
0.00
NA
0.22
NA
NA
NA
NA
0.52
0.26
0.40
0.00
0.00
0.00
NA
0.31
NA
NA
0.85
NA
NA
0.58
NA
NA
1.37
NA
NA
0.90
NA
NA
1.45
NA
NA
1.66
NA
NA
1.66
NA
NA
0.35
NA
NA
0.64
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45991
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
93924
93924
93925
93925
93925
93926
93926
93926
93930
93930
93930
93931
93931
93931
93965
93965
93965
93970
93970
93970
93971
93971
93971
93975
93975
93975
93976
93976
93976
93978
93978
93978
93979
93979
93979
93980
93980
93980
93981
93981
93981
93990
93990
93990
94010
94010
94010
94014
94015
94016
94060
94060
94060
94070
94070
94070
94150
94150
94150
94200
94200
94200
94240
94240
94240
94250
94250
94250
94260
94260
94260
94350
94350
94350
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Extremity study ............................................
Extremity study ............................................
Lower extremity study .................................
Lower extremity study .................................
Lower extremity study .................................
Lower extremity study .................................
Lower extremity study .................................
Lower extremity study .................................
Upper extremity study .................................
Upper extremity study .................................
Upper extremity study .................................
Upper extremity study .................................
Upper extremity study .................................
Upper extremity study .................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Extremity study ............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Vascular study .............................................
Penile vascular study ..................................
Penile vascular study ..................................
Penile vascular study ..................................
Penile vascular study ..................................
Penile vascular study ..................................
Penile vascular study ..................................
Doppler flow testing .....................................
Doppler flow testing .....................................
Doppler flow testing .....................................
Breathing capacity test ................................
Breathing capacity test ................................
Breathing capacity test ................................
Patient recorded spirometry ........................
Patient recorded spirometry ........................
Review patient spirometry ...........................
Evaluation of wheezing ...............................
Evaluation of wheezing ...............................
Evaluation of wheezing ...............................
Evaluation of wheezing ...............................
Evaluation of wheezing ...............................
Evaluation of wheezing ...............................
Vital capacity test ........................................
Vital capacity test ........................................
Vital capacity test ........................................
Lung function test (MBC/MVV) ...................
Lung function test (MBC/MVV) ...................
Lung function test (MBC/MVV) ...................
Residual lung capacity ................................
Residual lung capacity ................................
Residual lung capacity ................................
Expired gas collection .................................
Expired gas collection .................................
Expired gas collection .................................
Thoracic gas volume ...................................
Thoracic gas volume ...................................
Thoracic gas volume ...................................
Lung nitrogen washout curve ......................
Lung nitrogen washout curve ......................
Lung nitrogen washout curve ......................
0.50
0.00
0.58
0.58
0.00
0.39
0.39
0.00
0.46
0.46
0.00
0.31
0.31
0.00
0.35
0.35
0.00
0.68
0.68
0.00
0.45
0.45
0.00
1.80
1.80
0.00
1.21
1.21
0.00
0.65
0.65
0.00
0.44
0.44
0.00
1.25
1.25
0.00
0.44
0.44
0.00
0.25
0.25
0.00
0.17
0.17
0.00
0.52
0.00
0.52
0.31
0.31
0.00
0.60
0.60
0.00
0.07
0.07
0.00
0.11
0.11
0.00
0.26
0.26
0.00
0.11
0.11
0.00
0.13
0.13
0.00
0.26
0.26
0.00
Nonfacility
PE
RVUs
0.17
4.85
7.09
0.20
6.89
4.21
0.13
4.08
5.52
0.16
5.35
3.65
0.10
3.55
2.85
0.12
2.73
5.46
0.23
5.22
3.69
0.16
3.53
8.00
0.62
7.38
4.46
0.42
4.04
4.79
0.22
4.57
3.39
0.15
3.24
3.13
0.44
2.69
2.85
0.15
2.71
4.13
0.09
4.03
0.67
0.05
0.62
0.77
0.60
0.17
1.08
0.09
0.99
0.83
0.18
0.66
0.47
0.03
0.44
0.44
0.03
0.41
0.66
0.08
0.58
0.61
0.03
0.58
0.58
0.04
0.54
0.72
0.08
0.64
Facility
PE
RVUs
0.17
NA
NA
0.20
NA
NA
0.13
NA
NA
0.16
NA
NA
0.10
NA
NA
0.12
NA
NA
0.23
NA
NA
0.16
NA
NA
0.62
NA
NA
0.42
NA
NA
0.22
NA
NA
0.15
NA
NA
0.44
NA
NA
0.15
NA
NA
0.09
NA
NA
0.05
NA
NA
NA
0.17
NA
0.09
NA
NA
0.18
NA
NA
0.03
NA
NA
0.03
NA
NA
0.08
NA
NA
0.03
NA
NA
0.04
NA
NA
0.08
NA
Malpractice
RVUs
0.05
0.25
0.39
0.04
0.35
0.27
0.04
0.23
0.41
0.04
0.37
0.27
0.03
0.24
0.14
0.02
0.12
0.46
0.06
0.40
0.30
0.03
0.27
0.56
0.13
0.43
0.35
0.05
0.30
0.43
0.06
0.37
0.27
0.03
0.24
0.42
0.08
0.34
0.33
0.02
0.31
0.26
0.03
0.23
0.03
0.01
0.02
0.03
0.01
0.02
0.07
0.01
0.06
0.13
0.03
0.10
0.02
0.01
0.01
0.03
0.01
0.02
0.06
0.01
0.05
0.02
0.01
0.01
0.05
0.01
0.04
0.05
0.01
0.04
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00229
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.72
5.10
8.06
0.82
7.24
4.87
0.56
4.31
6.39
0.66
5.72
4.24
0.44
3.79
3.34
0.49
2.85
6.60
0.97
5.62
4.44
0.64
3.80
10.36
2.55
7.81
6.02
1.68
4.34
5.88
0.93
4.94
4.10
0.62
3.48
4.80
1.78
3.03
3.62
0.61
3.02
4.64
0.37
4.26
0.87
0.23
0.64
1.32
0.61
0.71
1.46
0.41
1.05
1.57
0.81
0.76
0.56
0.11
0.45
0.58
0.15
0.43
0.98
0.35
0.63
0.74
0.15
0.59
0.76
0.18
0.58
1.03
0.35
0.68
Facility
total
0.72
NA
NA
0.82
NA
NA
0.56
NA
NA
0.66
NA
NA
0.44
NA
NA
0.49
NA
NA
0.97
NA
NA
0.64
NA
NA
2.55
NA
NA
1.68
NA
NA
0.93
NA
NA
0.62
NA
NA
1.78
NA
NA
0.61
NA
NA
0.37
NA
NA
0.23
NA
NA
NA
0.71
NA
0.41
NA
NA
0.81
NA
NA
0.11
NA
NA
0.15
NA
NA
0.35
NA
NA
0.15
NA
NA
0.18
NA
NA
0.35
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45992
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
94360
94360
94360
94370
94370
94370
94375
94375
94375
94400
94400
94400
94450
94450
94450
94452
94452
94452
94453
94453
94453
94620
94620
94620
94621
94621
94621
94640
94642
94656
94657
94660
94662
94664
94667
94668
94680
94680
94680
94681
94681
94681
94690
94690
94690
94720
94720
94720
94725
94725
94725
94750
94750
94750
94760
94761
94762
94770
94770
94770
94772
94772
94772
94799
94799
94799
95004
95010
95015
95024
95027
95028
95044
95052
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
T
T
A
A
A
A
C
C
C
C
C
C
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Measure airflow resistance .........................
Measure airflow resistance .........................
Measure airflow resistance .........................
Breath airway closing volume .....................
Breath airway closing volume .....................
Breath airway closing volume .....................
Respiratory flow volume loop ......................
Respiratory flow volume loop ......................
Respiratory flow volume loop ......................
CO2 breathing response curve ...................
CO2 breathing response curve ...................
CO2 breathing response curve ...................
Hypoxia response curve ..............................
Hypoxia response curve ..............................
Hypoxia response curve ..............................
Hast w/report ...............................................
Hast w/report ...............................................
Hast w/report ...............................................
Hast w/oxygen titrate ...................................
Hast w/oxygen titrate ...................................
Hast w/oxygen titrate ...................................
Pulmonary stress test/simple ......................
Pulmonary stress test/simple ......................
Pulmonary stress test/simple ......................
Pulm stress test/complex ............................
Pulm stress test/complex ............................
Pulm stress test/complex ............................
Airway inhalation treatment .........................
Aerosol inhalation treatment .......................
Initial ventilator mgmt ..................................
Continued ventilator mgmt ..........................
Pos airway pressure, CPAP ........................
Neg press ventilation, cnp ...........................
Evaluate pt use of inhaler ...........................
Chest wall manipulation ..............................
Chest wall manipulation ..............................
Exhaled air analysis, o2 ..............................
Exhaled air analysis, o2 ..............................
Exhaled air analysis, o2 ..............................
Exhaled air analysis, o2/co2 .......................
Exhaled air analysis, o2/co2 .......................
Exhaled air analysis, o2/co2 .......................
Exhaled air analysis ....................................
Exhaled air analysis ....................................
Exhaled air analysis ....................................
Monoxide diffusing capacity ........................
Monoxide diffusing capacity ........................
Monoxide diffusing capacity ........................
Membrane diffusion capacity ......................
Membrane diffusion capacity ......................
Membrane diffusion capacity ......................
Pulmonary compliance study ......................
Pulmonary compliance study ......................
Pulmonary compliance study ......................
Measure blood oxygen level .......................
Measure blood oxygen level .......................
Measure blood oxygen level .......................
Exhaled carbon dioxide test ........................
Exhaled carbon dioxide test ........................
Exhaled carbon dioxide test ........................
Breath recording, infant ...............................
Breath recording, infant ...............................
Breath recording, infant ...............................
Pulmonary service/procedure ......................
Pulmonary service/procedure ......................
Pulmonary service/procedure ......................
Percut allergy skin tests ..............................
Percut allergy titrate test .............................
Id allergy titrate-drug/bug ............................
Id allergy test, drug/bug ..............................
Id allergy titrate-airborne .............................
Id allergy test-delayed type .........................
Allergy patch tests .......................................
Photo patch test ..........................................
0.26
0.26
0.00
0.26
0.26
0.00
0.31
0.31
0.00
0.40
0.40
0.00
0.40
0.40
0.00
0.31
0.31
0.00
0.40
0.40
0.00
0.64
0.64
0.00
1.42
1.42
0.00
0.00
0.00
1.22
0.83
0.76
0.76
0.00
0.00
0.00
0.26
0.26
0.00
0.20
0.20
0.00
0.07
0.07
0.00
0.26
0.26
0.00
0.26
0.26
0.00
0.23
0.23
0.00
0.00
0.00
0.00
0.15
0.15
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.15
0.15
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.71
0.08
0.63
0.69
0.08
0.61
0.60
0.09
0.51
0.86
0.12
0.74
0.86
0.12
0.74
1.00
0.09
0.92
1.47
0.12
1.36
2.17
0.20
1.98
2.21
0.43
1.78
0.30
0.00
1.16
0.98
0.62
NA
0.31
0.51
0.44
1.70
0.08
1.62
2.27
0.06
2.21
1.76
0.02
1.74
0.98
0.08
0.90
2.55
0.08
2.47
1.37
0.07
1.30
0.04
0.07
0.52
0.76
0.04
0.72
0.00
0.00
0.00
0.00
0.00
0.00
0.11
0.33
0.16
0.16
0.16
0.23
0.19
0.23
Facility
PE
RVUs
NA
0.08
NA
NA
0.08
NA
NA
0.09
NA
NA
0.12
NA
NA
0.12
NA
NA
0.09
NA
NA
0.12
NA
NA
0.20
NA
NA
0.43
NA
NA
0.00
0.31
0.24
0.23
0.23
NA
NA
NA
NA
0.08
NA
NA
0.06
NA
NA
0.02
NA
NA
0.08
NA
NA
0.08
NA
NA
0.07
NA
NA
NA
NA
NA
0.04
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.07
0.06
NA
NA
NA
NA
NA
Malpractice
RVUs
0.07
0.01
0.06
0.03
0.01
0.02
0.03
0.01
0.02
0.09
0.03
0.06
0.04
0.02
0.02
0.04
0.02
0.02
0.04
0.02
0.02
0.13
0.03
0.10
0.16
0.06
0.10
0.02
0.00
0.06
0.04
0.04
0.03
0.04
0.05
0.02
0.07
0.01
0.06
0.13
0.01
0.12
0.05
0.01
0.04
0.07
0.01
0.06
0.13
0.01
0.12
0.05
0.01
0.04
0.02
0.06
0.10
0.08
0.01
0.07
0.00
0.00
0.00
0.00
0.00
0.00
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00230
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.04
0.35
0.69
0.98
0.35
0.63
0.94
0.41
0.53
1.35
0.55
0.80
1.30
0.54
0.76
1.35
0.42
0.94
1.91
0.54
1.38
2.94
0.87
2.08
3.79
1.91
1.88
0.32
0.00
2.44
1.85
1.42
NA
0.35
0.56
0.46
2.03
0.35
1.68
2.60
0.27
2.33
1.88
0.10
1.78
1.31
0.35
0.96
2.94
0.35
2.59
1.65
0.31
1.34
0.06
0.13
0.62
0.99
0.20
0.79
0.00
0.00
0.00
0.00
0.00
0.00
0.12
0.49
0.32
0.17
0.17
0.24
0.20
0.24
Facility
total
NA
0.35
NA
NA
0.35
NA
NA
0.41
NA
NA
0.55
NA
NA
0.54
NA
NA
0.42
NA
NA
0.54
NA
NA
0.87
NA
NA
1.91
NA
NA
0.00
1.59
1.11
1.03
1.02
NA
NA
NA
NA
0.35
NA
NA
0.27
NA
NA
0.10
NA
NA
0.35
NA
NA
0.35
NA
NA
0.31
NA
NA
NA
NA
NA
0.20
NA
0.00
0.00
0.00
0.00
0.00
0.00
NA
0.23
0.22
NA
NA
NA
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45993
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
95056
95060
95065
95070
95071
95075
95078
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
95180
95199
95250
95805
95805
95805
95806
95806
95806
95807
95807
95807
95808
95808
95808
95810
95810
95810
95811
95811
95811
95812
95812
95812
95813
95813
95813
95816
95816
95816
95819
95819
95819
95822
95822
95822
95824
95824
95824
95827
95827
95827
95829
95829
95829
95830
95831
95832
95833
95834
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
I
I
I
I
I
I
I
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Photosensitivity tests ...................................
Eye allergy tests ..........................................
Nose allergy test .........................................
Bronchial allergy tests .................................
Bronchial allergy tests .................................
Ingestion challenge test ..............................
Provocative testing ......................................
Immunotherapy, one injection .....................
Immunotherapy injections ...........................
Immunotherapy, one injection .....................
Immunotherapy, many antigens ..................
Immunotherapy, insect venom ....................
Immunotherapy, insect venoms ..................
Immunotherapy, insect venoms ..................
Immunotherapy, insect venoms ..................
Immunotherapy, insect venoms ..................
Antigen therapy services .............................
Antigen therapy services .............................
Antigen therapy services .............................
Antigen therapy services .............................
Antigen therapy services .............................
Antigen therapy services .............................
Antigen therapy services .............................
Antigen therapy services .............................
Rapid desensitization ..................................
Allergy immunology services .......................
Glucose monitoring, cont ............................
Multiple sleep latency test ...........................
Multiple sleep latency test ...........................
Multiple sleep latency test ...........................
Sleep study, unattended .............................
Sleep study, unattended .............................
Sleep study, unattended .............................
Sleep study, attended .................................
Sleep study, attended .................................
Sleep study, attended .................................
Polysomnography, 1-3 ................................
Polysomnography, 1-3 ................................
Polysomnography, 1-3 ................................
Polysomnography, 4 or more ......................
Polysomnography, 4 or more ......................
Polysomnography, 4 or more ......................
Polysomnography w/cpap ...........................
Polysomnography w/cpap ...........................
Polysomnography w/cpap ...........................
Eeg, 41-60 minutes .....................................
Eeg, 41-60 minutes .....................................
Eeg, 41-60 minutes .....................................
Eeg, over 1 hour .........................................
Eeg, over 1 hour .........................................
Eeg, over 1 hour .........................................
Eeg, awake and drowsy ..............................
Eeg, awake and drowsy ..............................
Eeg, awake and drowsy ..............................
Eeg, awake and asleep ...............................
Eeg, awake and asleep ...............................
Eeg, awake and asleep ...............................
Eeg, coma or sleep only .............................
Eeg, coma or sleep only .............................
Eeg, coma or sleep only .............................
Eeg, cerebral death only .............................
Eeg, cerebral death only .............................
Eeg, cerebral death only .............................
Eeg, all night recording ...............................
Eeg, all night recording ...............................
Eeg, all night recording ...............................
Surgery electrocorticogram .........................
Surgery electrocorticogram .........................
Surgery electrocorticogram .........................
Insert electrodes for EEG ............................
Limb muscle testing, manual ......................
Hand muscle testing, manual ......................
Body muscle testing, manual ......................
Body muscle testing, manual ......................
0.00
0.00
0.00
0.00
0.00
0.95
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.06
0.06
0.06
0.06
0.06
0.06
0.06
0.06
2.01
0.00
0.00
1.88
1.88
0.00
1.66
1.66
0.00
1.66
1.66
0.00
2.66
2.66
0.00
3.53
3.53
0.00
3.80
3.80
0.00
1.08
1.08
0.00
1.73
1.73
0.00
1.08
1.08
0.00
1.08
1.08
0.00
1.08
1.08
0.00
0.00
0.74
0.00
1.08
1.08
0.00
6.21
6.21
0.00
1.70
0.28
0.29
0.47
0.60
Nonfacility
PE
RVUs
0.34
0.42
0.31
1.91
2.50
0.83
0.27
0.35
0.45
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.21
0.33
0.48
0.46
0.65
0.89
0.20
0.15
2.07
0.00
3.91
15.27
0.64
14.62
3.31
0.53
2.78
11.70
0.52
11.18
12.98
0.90
12.08
17.14
1.15
15.99
18.83
1.24
17.59
3.85
0.44
3.40
4.77
0.68
4.09
3.52
0.45
3.08
3.00
0.45
2.55
4.29
0.45
3.84
0.00
0.30
0.00
5.15
0.40
4.75
28.77
2.25
26.53
3.14
0.44
0.33
0.56
0.62
Facility
PE
RVUs
NA
NA
NA
NA
NA
0.40
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.02
0.02
0.03
0.02
0.03
0.03
0.02
0.03
0.97
0.00
NA
NA
0.64
NA
NA
0.53
NA
NA
0.52
NA
NA
0.90
NA
NA
1.15
NA
NA
1.24
NA
NA
0.44
NA
NA
0.68
NA
NA
0.45
NA
NA
0.45
NA
NA
0.45
NA
0.00
0.30
0.00
NA
0.40
NA
NA
2.25
NA
0.71
NA
NA
NA
NA
Malpractice
RVUs
0.01
0.02
0.01
0.02
0.02
0.03
0.02
0.02
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.04
0.00
0.01
0.43
0.09
0.34
0.39
0.08
0.31
0.50
0.08
0.42
0.55
0.13
0.42
0.59
0.17
0.42
0.61
0.18
0.43
0.17
0.06
0.11
0.20
0.09
0.11
0.16
0.06
0.10
0.16
0.06
0.10
0.19
0.06
0.13
0.00
0.04
0.00
0.19
0.05
0.14
0.50
0.48
0.02
0.11
0.01
0.02
0.02
0.03
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00231
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.35
0.44
0.32
1.93
2.52
1.81
0.29
0.37
0.47
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.28
0.40
0.55
0.53
0.72
0.96
0.27
0.22
4.13
0.00
3.92
17.58
2.62
14.96
5.36
2.27
3.09
13.86
2.26
11.60
16.18
3.68
12.50
21.26
4.85
16.41
23.24
5.22
18.02
5.10
1.58
3.51
6.71
2.50
4.20
4.77
1.59
3.18
4.24
1.59
2.65
5.56
1.59
3.97
0.00
1.08
0.00
6.42
1.53
4.89
35.49
8.94
26.55
4.95
0.73
0.64
1.05
1.25
Facility
total
NA
NA
NA
NA
NA
1.38
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.09
0.09
0.10
0.09
0.10
0.10
0.09
0.10
3.03
0.00
NA
NA
2.62
NA
NA
2.27
NA
NA
2.26
NA
NA
3.68
NA
NA
4.85
NA
NA
5.22
NA
NA
1.58
NA
NA
2.50
NA
NA
1.59
NA
NA
1.59
NA
NA
1.59
NA
0.00
1.08
0.00
NA
1.53
NA
NA
8.94
NA
2.52
NA
NA
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
000
000
000
000
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45994
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
95851
95852
95857
95858
95858
95858
95860
95860
95860
95861
95861
95861
95863
95863
95863
95864
95864
95864
95867
95867
95867
95868
95868
95868
95869
95869
95869
95870
95870
95870
95872
95872
95872
95875
95875
95875
95900
95900
95900
95903
95903
95903
95904
95904
95904
95920
95920
95920
95921
95921
95921
95922
95922
95922
95923
95923
95923
95925
95925
95925
95926
95926
95926
95927
95927
95927
95928
95928
95928
95929
95929
95929
95930
95930
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Range of motion measurements .................
Range of motion measurements .................
Tensilon test ................................................
Tensilon test & myogram ............................
Tensilon test & myogram ............................
Tensilon test & myogram ............................
Muscle test, one limb ..................................
Muscle test, one limb ..................................
Muscle test, one limb ..................................
Muscle test, 2 limbs ....................................
Muscle test, 2 limbs ....................................
Muscle test, 2 limbs ....................................
Muscle test, 3 limbs ....................................
Muscle test, 3 limbs ....................................
Muscle test, 3 limbs ....................................
Muscle test, 4 limbs ....................................
Muscle test, 4 limbs ....................................
Muscle test, 4 limbs ....................................
Muscle test cran nerv unilat ........................
Muscle test cran nerv unilat ........................
Muscle test cran nerv unilat ........................
Muscle test cran nerve bilat ........................
Muscle test cran nerve bilat ........................
Muscle test cran nerve bilat ........................
Muscle test, thor paraspinal ........................
Muscle test, thor paraspinal ........................
Muscle test, thor paraspinal ........................
Muscle test, nonparaspinal .........................
Muscle test, nonparaspinal .........................
Muscle test, nonparaspinal .........................
Muscle test, one fiber ..................................
Muscle test, one fiber ..................................
Muscle test, one fiber ..................................
Limb exercise test .......................................
Limb exercise test .......................................
Limb exercise test .......................................
Motor nerve conduction test ........................
Motor nerve conduction test ........................
Motor nerve conduction test ........................
Motor nerve conduction test ........................
Motor nerve conduction test ........................
Motor nerve conduction test ........................
Sense nerve conduction test .......................
Sense nerve conduction test .......................
Sense nerve conduction test .......................
Intraop nerve test add-on ............................
Intraop nerve test add-on ............................
Intraop nerve test add-on ............................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
Autonomic nerv function test .......................
*Somatosensory testing ..............................
Somatosensory testing ................................
Somatosensory testing ................................
*Somatosensory testing ..............................
Somatosensory testing ................................
Somatosensory testing ................................
Somatosensory testing ................................
Somatosensory testing ................................
Somatosensory testing ................................
C motor evoked, uppr limbs ........................
C motor evoked, uppr limbs ........................
C motor evoked, uppr limbs ........................
Cmotor evoked, lwr limbs ............................
C motor evoked, lwr limbs ..........................
C motor evoked, lwr limbs ..........................
Visual evoked potential test ........................
Visual evoked potential test ........................
0.16
0.11
0.53
1.56
1.56
0.00
0.96
0.96
0.00
1.54
1.54
0.00
1.87
1.87
0.00
1.99
1.99
0.00
0.79
0.79
0.00
1.18
1.18
0.00
0.37
0.37
0.00
0.37
0.37
0.00
1.50
1.50
0.00
1.10
1.10
0.00
0.42
0.42
0.00
0.60
0.60
0.00
0.34
0.34
0.00
2.11
2.11
0.00
0.90
0.90
0.00
0.96
0.96
0.00
0.90
0.90
0.00
0.54
0.54
0.00
0.54
0.54
0.00
0.54
0.54
0.00
1.50
1.50
0.00
1.50
1.50
0.00
0.35
0.35
Nonfacility
PE
RVUs
0.35
0.25
0.59
NA
0.65
NA
1.35
0.41
0.94
1.47
0.66
0.81
1.78
0.78
0.99
2.53
0.85
1.68
0.96
0.34
0.62
1.26
0.49
0.77
0.52
0.16
0.37
0.51
0.16
0.35
1.28
0.61
0.66
1.40
0.46
0.94
1.18
0.18
1.00
1.14
0.25
0.89
1.03
0.15
0.88
2.06
0.90
1.15
0.79
0.32
0.47
0.89
0.40
0.50
1.87
0.37
1.50
1.57
0.22
1.35
1.52
0.23
1.30
1.63
0.24
1.39
3.03
0.63
2.40
3.23
0.63
2.60
2.20
0.15
Facility
PE
RVUs
NA
NA
0.22
NA
0.65
NA
NA
0.41
NA
NA
0.66
NA
NA
0.78
NA
NA
0.85
NA
NA
0.34
NA
NA
0.49
NA
NA
0.16
NA
NA
0.16
NA
NA
0.61
NA
NA
0.46
NA
NA
0.18
NA
NA
0.25
NA
NA
0.15
NA
NA
0.90
NA
NA
0.32
NA
NA
0.40
NA
NA
0.37
NA
NA
0.22
NA
NA
0.23
NA
NA
0.24
NA
NA
0.63
NA
NA
0.63
NA
NA
0.15
Malpractice
RVUs
0.01
0.01
0.02
0.12
0.08
0.04
0.07
0.05
0.02
0.13
0.07
0.06
0.15
0.09
0.06
0.21
0.09
0.12
0.07
0.03
0.04
0.10
0.05
0.05
0.04
0.02
0.02
0.04
0.02
0.02
0.13
0.08
0.05
0.11
0.05
0.06
0.04
0.02
0.02
0.05
0.03
0.02
0.04
0.02
0.02
0.23
0.16
0.07
0.06
0.04
0.02
0.07
0.05
0.02
0.07
0.05
0.02
0.10
0.04
0.06
0.09
0.03
0.06
0.10
0.04
0.06
0.09
0.06
0.03
0.09
0.06
0.03
0.03
0.02
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00232
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.52
0.37
1.14
NA
2.30
NA
2.38
1.42
0.96
3.15
2.27
0.87
3.80
2.74
1.05
4.73
2.93
1.80
1.82
1.16
0.66
2.54
1.73
0.82
0.93
0.55
0.39
0.92
0.55
0.37
2.91
2.20
0.71
2.61
1.61
1.00
1.64
0.62
1.02
1.79
0.88
0.91
1.41
0.51
0.90
4.40
3.18
1.22
1.75
1.26
0.49
1.92
1.41
0.52
2.84
1.32
1.52
2.21
0.80
1.41
2.15
0.80
1.36
2.27
0.82
1.45
4.63
2.19
2.43
4.82
2.19
2.63
2.59
0.52
Facility
total
NA
NA
0.77
NA
2.30
NA
NA
1.42
NA
NA
2.27
NA
NA
2.74
NA
NA
2.93
NA
NA
1.16
NA
NA
1.73
NA
NA
0.55
NA
NA
0.55
NA
NA
2.20
NA
NA
1.61
NA
NA
0.62
NA
NA
0.88
NA
NA
0.51
NA
NA
3.18
NA
NA
1.26
NA
NA
1.41
NA
NA
1.32
NA
NA
0.80
NA
NA
0.80
NA
NA
0.82
NA
NA
2.19
NA
NA
2.19
NA
NA
0.52
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45995
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
95930
95933
95933
95933
95934
95934
95934
95936
95936
95936
95937
95937
95937
95950
95950
95950
95951
95951
95951
95953
95953
95953
95954
95954
95954
95955
95955
95955
95956
95956
95956
95957
95957
95957
95958
95958
95958
95961
95961
95961
95962
95962
95962
95965
95965
95965
95966
95966
95966
95967
95967
95967
95970
95971
95972
95973
95974
95975
95978
95979
95990
95991
95999
96000
96001
96002
96003
96004
96100
96105
96110
96111
96115
96117
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
TC ......
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
TC ......
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
A
C
C
A
C
C
A
C
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Visual evoked potential test ........................
Blink reflex test ............................................
Blink reflex test ............................................
Blink reflex test ............................................
H-reflex test .................................................
H-reflex test .................................................
H-reflex test .................................................
H-reflex test .................................................
H-reflex test .................................................
H-reflex test .................................................
Neuromuscular junction test ........................
Neuromuscular junction test ........................
Neuromuscular junction test ........................
Ambulatory eeg monitoring .........................
Ambulatory eeg monitoring .........................
Ambulatory eeg monitoring .........................
EEG monitoring/videorecord .......................
EEG monitoring/videorecord .......................
EEG monitoring/videorecord .......................
EEG monitoring/computer ...........................
EEG monitoring/computer ...........................
EEG monitoring/computer ...........................
EEG monitoring/giving drugs ......................
EEG monitoring/giving drugs ......................
EEG monitoring/giving drugs ......................
EEG during surgery .....................................
EEG during surgery .....................................
EEG during surgery .....................................
Eeg monitoring, cable/radio ........................
Eeg monitoring, cable/radio ........................
Eeg monitoring, cable/radio ........................
EEG digital analysis ....................................
EEG digital analysis ....................................
EEG digital analysis ....................................
EEG monitoring/function test ......................
EEG monitoring/function test ......................
EEG monitoring/function test ......................
Electrode stimulation, brain .........................
Electrode stimulation, brain .........................
Electrode stimulation, brain .........................
Electrode stim, brain add-on .......................
Electrode stim, brain add-on .......................
Electrode stim, brain add-on .......................
Meg, spontaneous .......................................
Meg, spontaneous .......................................
Meg, spontaneous .......................................
Meg, evoked, single ....................................
Meg, evoked, single ....................................
Meg, evoked, single ....................................
Meg, evoked, each add’l .............................
Meg, evoked, each add’l .............................
Meg, evoked, each add’l .............................
Analyze neurostim, no prog ........................
Analyze neurostim, simple ..........................
Analyze neurostim, complex .......................
Analyze neurostim, complex .......................
Cranial neurostim, complex .........................
Cranial neurostim, complex .........................
Analyze neurostim brain/1h .........................
Analyz neurostim brain add-on ...................
Spin/brain pump refil & main .......................
Spin/brain pump refil & main .......................
Neurological procedure ...............................
Motion analysis, video/3d ............................
Motion test w/ft press meas ........................
Dynamic surface emg .................................
Dynamic fine wire emg ................................
Phys review of motion tests ........................
Psychological testing ...................................
Assessment of aphasia ...............................
Developmental test, lim ...............................
Developmental test, extend .........................
Neurobehavior status exam ........................
Neuropsych test battery ..............................
0.00
0.59
0.59
0.00
0.51
0.51
0.00
0.55
0.55
0.00
0.65
0.65
0.00
1.51
1.51
0.00
0.00
6.00
0.00
3.09
3.09
0.00
2.45
2.45
0.00
1.01
1.01
0.00
3.09
3.09
0.00
1.98
1.98
0.00
4.25
4.25
0.00
2.98
2.98
0.00
3.22
3.22
0.00
0.00
8.01
0.00
0.00
4.00
0.00
0.00
3.50
0.00
0.45
0.78
1.50
0.92
3.01
1.70
3.51
1.64
0.00
0.77
0.00
1.80
2.15
0.41
0.37
2.14
0.00
0.00
0.00
2.61
0.00
0.00
Nonfacility
PE
RVUs
2.06
1.02
0.23
0.78
0.55
0.22
0.34
0.48
0.23
0.25
0.65
0.26
0.39
3.77
0.62
3.15
0.00
2.48
0.00
7.05
1.25
5.79
4.19
1.01
3.17
2.70
0.35
2.34
14.65
1.27
13.38
3.19
0.83
2.36
3.95
1.71
2.24
2.76
1.29
1.47
2.58
1.36
1.22
0.00
3.36
0.00
0.00
1.67
0.00
0.00
1.23
0.00
0.84
0.67
1.21
0.62
1.68
0.88
1.96
0.86
1.53
1.38
0.00
NA
NA
NA
NA
0.96
1.74
1.64
0.17
1.01
1.82
1.78
Facility
PE
RVUs
NA
NA
0.23
NA
NA
0.22
NA
NA
0.23
NA
NA
0.26
NA
NA
0.62
NA
0.00
2.48
0.00
NA
1.25
NA
NA
1.01
NA
NA
0.35
NA
NA
1.27
NA
NA
0.83
NA
NA
1.71
NA
NA
1.29
NA
NA
1.36
NA
0.00
3.36
0.00
0.00
1.67
0.00
0.00
1.23
0.00
0.14
0.22
0.48
0.33
1.27
0.71
1.32
0.67
NA
NA
0.00
0.52
0.64
0.15
0.13
0.89
NA
NA
NA
0.99
NA
NA
Malpractice
RVUs
0.01
0.10
0.04
0.06
0.04
0.02
0.02
0.05
0.03
0.02
0.10
0.08
0.02
0.51
0.08
0.43
0.00
0.32
0.00
0.60
0.17
0.43
0.19
0.13
0.06
0.22
0.05
0.17
0.59
0.16
0.43
0.23
0.11
0.12
0.34
0.21
0.13
0.55
0.48
0.07
0.39
0.32
0.07
0.00
0.46
0.00
0.00
0.19
0.00
0.00
0.16
0.00
0.03
0.07
0.14
0.07
0.16
0.12
0.18
0.08
0.06
0.06
0.00
0.11
0.10
0.02
0.02
0.11
0.18
0.18
0.18
0.18
0.18
0.18
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00233
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
2.07
1.71
0.86
0.84
1.10
0.75
0.36
1.08
0.81
0.27
1.41
0.99
0.41
5.79
2.22
3.58
0.00
8.81
0.00
10.73
4.51
6.22
6.83
3.60
3.23
3.93
1.41
2.51
18.33
4.51
13.81
5.41
2.92
2.48
8.54
6.17
2.37
6.28
4.74
1.54
6.18
4.89
1.29
0.00
11.83
0.00
0.00
5.85
0.00
0.00
4.89
0.00
1.32
1.53
2.85
1.61
4.85
2.70
5.65
2.58
1.59
2.21
0.00
NA
NA
NA
NA
3.21
1.92
1.82
0.35
3.79
2.00
1.96
Facility
total
NA
NA
0.86
NA
NA
0.75
NA
NA
0.81
NA
NA
0.99
NA
NA
2.22
NA
0.00
8.81
0.00
NA
4.51
NA
NA
3.60
NA
NA
1.41
NA
NA
4.51
NA
NA
2.92
NA
NA
6.17
NA
NA
4.74
NA
NA
4.89
NA
0.00
11.83
0.00
0.00
5.85
0.00
0.00
4.89
0.00
0.62
1.07
2.13
1.32
4.43
2.53
5.00
2.39
NA
NA
0.00
2.43
2.90
0.58
0.52
3.15
NA
NA
NA
3.78
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
XXX
ZZZ
XXX
ZZZ
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45996
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
96150
96151
96152
96153
96154
96155
96400
96405
96406
96408
96410
96412
96414
96420
96422
96423
96425
96440
96445
96450
96520
96530
96542
96545
96549
96567
96570
96571
96900
96902
96910
96912
96913
96920
96921
96922
96999
97001
97002
97003
97004
97005
97006
97010
97012
97014
97016
97018
97020
97022
97024
97026
97028
97032
97033
97034
97035
97036
97039
97110
97112
97113
97116
97124
97139
97140
97150
97504
97520
97530
97532
97533
97535
97537
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
N
I
A
A
I
I
I
I
A
A
A
A
A
A
A
A
A
A
B
C
A
A
A
A
B
A
A
A
A
A
A
C
A
A
A
A
I
I
B
A
I
A
A
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Assess hlth/behave, init ..............................
Assess hlth/behave, subseq .......................
Intervene hlth/behave, indiv ........................
Intervene hlth/behave, group ......................
Interv hlth/behav, fam w/pt ..........................
Interv hlth/behav fam no pt .........................
Chemotherapy, sc/im ..................................
Intralesional chemo admin ..........................
Intralesional chemo admin ..........................
Chemotherapy, push technique ..................
Chemotherapy,infusion method ..................
Chemo, infuse method add-on ....................
Chemo, infuse method add-on ....................
Chemotherapy, push technique ..................
Chemotherapy,infusion method ..................
Chemo, infuse method add-on ....................
Chemotherapy,infusion method ..................
Chemotherapy, intracavitary .......................
Chemotherapy, intracavitary .......................
Chemotherapy, into CNS ............................
Port pump refill & main ...............................
Syst pump refill & main ...............................
Chemotherapy injection ...............................
Provide chemotherapy agent ......................
Chemotherapy, unspecified .........................
Photodynamic tx, skin .................................
Photodynamic tx, 30 min .............................
Photodynamic tx, addl 15 min .....................
Ultraviolet light therapy ................................
Trichogram ..................................................
Photochemotherapy with UV-B ...................
Photochemotherapy with UV-A ...................
Photochemotherapy, UV-A or B ..................
Laser tx, skin < 250 sq cm ..........................
Laser tx, skin 250-500 sq cm ......................
Laser tx, skin > 500 sq cm ..........................
Dermatological procedure ...........................
Pt evaluation ................................................
Pt re-evaluation ...........................................
Ot evaluation ...............................................
Ot re-evaluation ...........................................
Athletic train eval .........................................
Athletic train reeval ......................................
Hot or cold packs therapy ...........................
Mechanical traction therapy ........................
Electric stimulation therapy .........................
Vasopneumatic device therapy ...................
Paraffin bath therapy ...................................
Microwave therapy ......................................
Whirlpool therapy ........................................
Diathermy treatment ....................................
Infrared therapy ...........................................
Ultraviolet therapy .......................................
Electrical stimulation ....................................
Electric current therapy ...............................
Contrast bath therapy ..................................
Ultrasound therapy ......................................
Hydrotherapy ...............................................
Physical therapy treatment ..........................
Therapeutic exercises .................................
Neuromuscular reeducation ........................
Aquatic therapy/exercises ...........................
Gait training therapy ....................................
Massage therapy .........................................
Physical medicine procedure ......................
Manual therapy ............................................
Group therapeutic procedures ....................
Orthotic training ...........................................
Prosthetic training ........................................
Therapeutic activities ...................................
Cognitive skills development .......................
Sensory integration .....................................
Self care mngment training .........................
Community/work reintegration .....................
0.50
0.48
0.46
0.10
0.45
0.44
0.17
0.52
0.80
0.17
0.17
0.17
0.17
0.17
0.17
0.17
0.17
2.37
2.20
1.89
0.21
0.21
1.42
0.00
0.00
0.00
1.10
0.55
0.00
0.41
0.00
0.00
0.00
1.15
1.17
2.10
0.00
1.20
0.60
1.20
0.60
0.00
0.00
0.06
0.25
0.18
0.18
0.06
0.06
0.17
0.06
0.06
0.08
0.25
0.26
0.21
0.21
0.28
0.20
0.45
0.45
0.44
0.40
0.35
0.21
0.43
0.27
0.45
0.45
0.44
0.44
0.44
0.45
0.45
Nonfacility
PE
RVUs
0.17
0.17
0.16
0.04
0.16
0.17
0.00
2.58
3.20
0.00
0.00
0.00
0.00
2.67
4.87
1.89
4.50
7.56
7.64
6.62
3.79
2.66
4.09
0.00
0.00
1.45
0.00
0.00
0.45
0.18
1.13
1.45
1.97
2.91
3.00
3.96
0.00
0.75
0.44
0.86
0.64
0.00
0.00
0.06
0.14
0.19
0.19
0.11
0.06
0.23
0.07
0.06
0.07
0.17
0.30
0.16
0.10
0.34
0.10
0.28
0.32
0.42
0.25
0.24
0.21
0.26
0.19
0.35
0.28
0.33
0.21
0.25
0.34
0.27
Facility
PE
RVUs
0.17
0.16
0.15
0.03
0.15
0.16
0.00
0.24
0.29
0.00
0.00
0.00
0.00
NA
NA
NA
NA
1.20
1.15
1.07
NA
NA
0.64
0.00
0.00
NA
0.37
0.20
NA
0.16
NA
NA
NA
0.61
0.63
0.60
0.00
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Malpractice
RVUs
0.01
0.01
0.01
0.01
0.01
0.02
0.01
0.03
0.03
0.06
0.08
0.07
0.08
0.08
0.08
0.02
0.08
0.17
0.14
0.08
0.06
0.06
0.06
0.00
0.00
0.04
0.11
0.03
0.02
0.01
0.04
0.05
0.10
0.02
0.03
0.04
0.00
0.05
0.02
0.06
0.02
0.00
0.00
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.02
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.03
0.01
0.01
0.01
0.01
0.01
0.01
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00234
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.68
0.66
0.63
0.15
0.62
0.63
0.18
3.13
4.03
0.23
0.25
0.24
0.25
2.92
5.12
2.08
4.75
10.10
9.99
8.59
4.06
2.93
5.57
0.00
0.00
1.49
1.21
0.58
0.47
0.60
1.17
1.50
2.07
4.08
4.21
6.10
0.00
2.00
1.06
2.12
1.26
0.00
0.00
0.13
0.40
0.38
0.38
0.18
0.13
0.41
0.14
0.13
0.16
0.43
0.57
0.38
0.32
0.63
0.31
0.75
0.78
0.87
0.66
0.60
0.43
0.70
0.47
0.83
0.74
0.78
0.66
0.70
0.80
0.73
Facility
total
0.68
0.65
0.62
0.14
0.61
0.62
0.18
0.79
1.12
0.23
0.25
0.24
0.25
NA
NA
NA
NA
3.74
3.50
3.04
NA
NA
2.12
0.00
0.00
NA
1.58
0.78
NA
0.58
NA
NA
NA
1.78
1.83
2.75
0.00
NA
NA
NA
NA
0.00
0.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
XXX
XXX
ZZZ
XXX
XXX
XXX
ZZZ
XXX
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45997
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
97542
97545
97546
97597
97598
97602
97605
97606
97703
97750
97755
97799
97802
97803
97804
97810
97811
97813
97814
98925
98926
98927
98928
98929
98940
98941
98942
98943
99000
99001
99002
99024
99026
99027
99050
99052
99054
99056
99058
99070
99071
99075
99078
99080
99082
99090
99091
99100
99116
99135
99140
99141
99142
99170
99172
99173
99175
99183
99185
99186
99195
99199
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99217
99218
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
R
R
A
A
B
B
B
A
A
A
C
A
A
A
N
N
N
N
A
A
A
A
A
A
A
A
N
B
B
B
B
N
N
B
B
B
B
B
B
B
N
B
B
C
B
B
B
B
B
B
B
B
A
N
N
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Wheelchair mngment training .....................
Work hardening ...........................................
Work hardening add-on ...............................
Active wound care/20 cm or < ....................
Active wound care > 20 cm ........................
Wound(s) care non-selective ......................
Neg press wound tx, < 50 cm .....................
Neg press wound tx, > 50 cm .....................
Prosthetic checkout .....................................
Physical performance test ...........................
Assistive technology assess .......................
Physical medicine procedure ......................
Medical nutrition, indiv, in ............................
Med nutrition, indiv, subseq ........................
Medical nutrition, group ...............................
Acupunct w/o stimul 15 min ........................
Acupunct w/o stimul addl 15m ....................
Acupunct w/stimul 15 min ...........................
Acupunct w/stimul addl 15m .......................
Osteopathic manipulation ............................
Osteopathic manipulation ............................
Osteopathic manipulation ............................
Osteopathic manipulation ............................
Osteopathic manipulation ............................
Chiropractic manipulation ............................
Chiropractic manipulation ............................
Chiropractic manipulation ............................
Chiropractic manipulation ............................
Specimen handling ......................................
Specimen handling ......................................
Device handling ...........................................
Postop follow-up visit ..................................
In-hospital on call service ............................
Out-of-hosp on call service .........................
Medical services after hrs ...........................
Medical services at night .............................
Medical servcs, unusual hrs ........................
Non-office medical services ........................
Office emergency care ................................
Special supplies ..........................................
Patient education materials .........................
Medical testimony ........................................
Group health education ...............................
Special reports or forms ..............................
Unusual physician travel .............................
Computer data analysis ..............................
Collect/review data from pt .........................
Special anesthesia service ..........................
Anesthesia with hypothermia ......................
Special anesthesia procedure .....................
Emergency anesthesia ................................
Sedation, iv/im or inhalant ...........................
Sedation, oral/rectal/nasal ...........................
Anogenitalexam, child .................................
Ocular function screen ................................
Visual acuity screen ....................................
Induction of vomiting ...................................
Hyperbaric oxygen therapy .........................
Regional hypothermia .................................
Total body hypothermia ...............................
Phlebotomy ..................................................
Special service/proc/report ..........................
Office/outpatient visit, new ..........................
Office/outpatient visit, new ..........................
Office/outpatient visit, new ..........................
Office/outpatient visit, new ..........................
Office/outpatient visit, new ..........................
Office/outpatient visit, est ............................
Office/outpatient visit, est ............................
Office/outpatient visit, est ............................
Office/outpatient visit, est ............................
Office/outpatient visit, est ............................
Observation care discharge ........................
Observation care .........................................
0.45
0.00
0.00
0.58
0.80
0.00
0.00
0.00
0.25
0.45
0.62
0.00
0.00
0.00
0.00
0.60
0.50
0.65
0.55
0.45
0.65
0.87
1.03
1.19
0.45
0.65
0.87
0.40
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.80
0.60
1.75
0.00
0.00
0.00
2.34
0.00
0.00
0.00
0.00
0.45
0.88
1.34
2.00
2.68
0.17
0.45
0.67
1.10
1.77
1.28
1.28
Nonfacility
PE
RVUs
0.29
0.00
0.00
0.74
0.88
0.00
0.00
0.00
0.47
0.33
0.29
0.00
0.43
0.42
0.16
0.09
0.06
0.09
0.07
0.31
0.40
0.49
0.58
0.66
0.22
0.29
0.35
0.24
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.84
0.94
1.71
0.00
0.00
1.16
3.09
0.82
1.62
0.88
0.00
0.51
0.81
1.14
1.51
1.78
0.38
0.55
0.70
1.04
1.33
NA
NA
Facility
PE
RVUs
NA
0.00
0.00
NA
NA
0.00
0.00
0.00
NA
NA
NA
0.00
NA
NA
NA
0.06
0.05
0.06
0.05
0.14
0.24
0.28
0.33
0.36
0.12
0.17
0.23
0.16
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.38
0.30
0.55
0.00
0.00
NA
0.70
NA
NA
NA
0.00
0.15
0.31
0.47
0.70
0.93
0.06
0.16
0.24
0.40
0.64
0.54
0.43
Malpractice
RVUs
0.01
0.00
0.00
0.05
0.05
0.00
0.00
0.00
0.02
0.02
0.02
0.00
0.01
0.01
0.01
0.03
0.03
0.03
0.03
0.02
0.03
0.03
0.04
0.05
0.01
0.01
0.02
0.01
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.05
0.04
0.08
0.00
0.00
0.10
0.16
0.04
0.45
0.02
0.00
0.03
0.05
0.09
0.12
0.15
0.01
0.03
0.03
0.05
0.08
0.06
0.06
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00235
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.75
0.00
0.00
1.37
1.73
0.00
0.00
0.00
0.74
0.80
0.93
0.00
0.44
0.43
0.17
0.72
0.59
0.77
0.65
0.78
1.08
1.40
1.65
1.90
0.68
0.95
1.24
0.65
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.69
1.59
3.55
0.00
0.00
1.26
5.60
0.86
2.07
0.90
0.00
0.99
1.74
2.57
3.63
4.61
0.56
1.03
1.40
2.20
3.18
NA
NA
Facility
total
NA
0.00
0.00
NA
NA
0.00
0.00
0.00
NA
NA
NA
0.00
NA
NA
NA
0.69
0.58
0.74
0.63
0.61
0.92
1.18
1.41
1.60
0.58
0.83
1.12
0.57
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.23
0.94
2.38
0.00
0.00
NA
3.21
NA
NA
NA
0.00
0.63
1.24
1.91
2.82
3.76
0.24
0.64
0.94
1.55
2.49
1.88
1.78
Global
XXX
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
ZZZ
000
000
000
000
000
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
ZZZ
XXX
XXX
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
45998
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
99219
99220
99221
99222
99223
99231
99232
99233
99234
99235
99236
99238
99239
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99261
99262
99263
99271
99272
99273
99274
99275
99281
99282
99283
99284
99285
99288
99289
99290
99291
99292
99293
99294
99295
99296
99298
99299
99301
99302
99303
99311
99312
99313
99315
99316
99321
99322
99323
99331
99332
99333
99341
99342
99343
99344
99345
99347
99348
99349
99350
99354
99355
99356
99357
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
..........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Physician
work
RVUs 3
Description
Observation care .........................................
Observation care .........................................
Initial hospital care ......................................
Initial hospital care ......................................
Initial hospital care ......................................
Subsequent hospital care ............................
Subsequent hospital care ............................
Subsequent hospital care ............................
Observ/hosp same date ..............................
Observ/hosp same date ..............................
Observ/hosp same date ..............................
Hospital discharge day ................................
Hospital discharge day ................................
Office consultation .......................................
Office consultation .......................................
Office consultation .......................................
Office consultation .......................................
Office consultation .......................................
Initial inpatient consult .................................
Initial inpatient consult .................................
Initial inpatient consult .................................
Initial inpatient consult .................................
Initial inpatient consult .................................
Follow-up inpatient consult ..........................
Follow-up inpatient consult ..........................
Follow-up inpatient consult ..........................
Confirmatory consultation ............................
Confirmatory consultation ............................
Confirmatory consultation ............................
Confirmatory consultation ............................
Confirmatory consultation ............................
Emergency dept visit ...................................
Emergency dept visit ...................................
Emergency dept visit ...................................
Emergency dept visit ...................................
Emergency dept visit ...................................
Direct advanced life support .......................
Ped crit care transport .................................
Ped crit care transport addl .........................
Critical care, first hour .................................
Critical care, addl 30 min ............................
Ped critical care, initial ................................
Ped critical care, subseq .............................
Neonate crit care, initial ..............................
Neonate critical care subseq .......................
Ic for lbw infant < 1500 gm .........................
Ic, lbw infant 1500-2500 gm ........................
Nursing facility care .....................................
Nursing facility care .....................................
Nursing facility care .....................................
Nursing fac care, subseq ............................
Nursing fac care, subseq ............................
Nursing fac care, subseq ............................
Nursing fac discharge day ..........................
Nursing fac discharge day ..........................
Rest home visit, new patient .......................
Rest home visit, new patient .......................
Rest home visit, new patient .......................
Rest home visit, est pat ..............................
Rest home visit, est pat ..............................
Rest home visit, est pat ..............................
Home visit, new patient ...............................
Home visit, new patient ...............................
Home visit, new patient ...............................
Home visit, new patient ...............................
Home visit, new patient ...............................
Home visit, est patient .................................
Home visit, est patient .................................
Home visit, est patient .................................
Home visit, est patient .................................
Prolonged service, office .............................
Prolonged service, office .............................
Prolonged service, inpatient ........................
Prolonged service, inpatient ........................
2.14
3.00
1.28
2.14
3.00
0.64
1.06
1.51
2.57
3.42
4.27
1.28
1.75
0.64
1.29
1.72
2.59
3.43
0.66
1.32
1.82
2.65
3.65
0.42
0.85
1.27
0.45
0.84
1.19
1.73
2.31
0.33
0.55
1.24
1.95
3.07
0.00
4.80
2.40
4.00
2.00
16.01
8.01
18.50
8.01
2.76
2.51
1.20
1.61
2.01
0.60
1.00
1.42
1.13
1.50
0.71
1.01
1.28
0.60
0.80
1.00
1.01
1.52
2.27
3.04
3.79
0.76
1.26
2.02
3.04
1.77
1.77
1.71
1.71
Nonfacility
PE
RVUs
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.65
1.07
1.42
1.85
2.29
NA
NA
NA
NA
NA
NA
NA
NA
0.55
0.84
1.11
1.37
1.65
NA
NA
NA
NA
NA
0.00
NA
NA
2.52
0.89
NA
NA
NA
NA
NA
NA
0.50
0.63
0.75
0.27
0.45
0.62
0.45
0.58
0.34
0.45
0.54
0.31
0.37
0.45
0.48
0.67
0.92
1.15
1.40
0.40
0.57
0.81
1.15
0.77
0.75
NA
NA
Facility
PE
RVUs
0.71
1.02
0.44
0.73
1.02
0.23
0.37
0.52
0.88
1.14
1.43
0.54
0.73
NA
NA
NA
NA
NA
0.24
0.50
0.69
0.98
1.35
0.15
0.31
0.45
0.16
0.31
0.45
0.64
0.83
0.09
0.14
0.30
0.46
0.70
0.00
1.42
0.81
1.26
0.63
4.66
2.35
5.27
2.47
0.92
0.84
0.50
0.63
0.75
0.27
0.45
0.62
0.45
0.58
0.32
0.44
0.52
0.29
0.35
0.43
0.45
0.65
0.90
1.13
1.37
0.37
0.54
0.79
1.12
0.65
0.61
0.61
0.62
Malpractice
RVUs
0.10
0.14
0.07
0.10
0.13
0.03
0.04
0.06
0.13
0.16
0.19
0.05
0.07
0.05
0.10
0.13
0.16
0.21
0.05
0.09
0.11
0.13
0.18
0.02
0.04
0.06
0.03
0.06
0.10
0.12
0.15
0.02
0.04
0.09
0.14
0.23
0.00
0.24
0.12
0.21
0.11
1.12
0.45
1.16
0.32
0.17
0.16
0.05
0.07
0.08
0.03
0.04
0.06
0.05
0.06
0.03
0.05
0.05
0.03
0.03
0.04
0.05
0.07
0.10
0.13
0.16
0.04
0.06
0.09
0.13
0.08
0.07
0.07
0.08
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00236
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.34
2.46
3.27
4.60
5.93
NA
NA
NA
NA
NA
NA
NA
NA
1.03
1.74
2.40
3.22
4.12
NA
NA
NA
NA
NA
0.00
NA
NA
6.73
3.01
NA
NA
NA
NA
NA
NA
1.75
2.32
2.84
0.90
1.49
2.10
1.63
2.14
1.08
1.52
1.87
0.94
1.20
1.49
1.54
2.27
3.30
4.32
5.34
1.20
1.89
2.93
4.32
2.63
2.59
NA
NA
Facility
total
2.95
4.16
1.80
2.97
4.15
0.90
1.47
2.09
3.58
4.71
5.89
1.87
2.55
NA
NA
NA
NA
NA
0.95
1.92
2.62
3.76
5.17
0.59
1.20
1.78
0.64
1.21
1.74
2.49
3.30
0.44
0.73
1.64
2.55
4.00
0.00
6.45
3.34
5.47
2.75
21.80
10.81
24.93
10.80
3.85
3.51
1.75
2.32
2.84
0.90
1.49
2.10
1.63
2.14
1.06
1.50
1.85
0.92
1.18
1.47
1.52
2.24
3.27
4.29
5.32
1.17
1.87
2.90
4.29
2.50
2.45
2.39
2.42
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
ZZZ
ZZZ
ZZZ
45999
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
Mod
99358 ..........
99359 ..........
99361 ..........
99362 ..........
99371 ..........
99372 ..........
99373 ..........
99374 ..........
99375 ..........
99377 ..........
99378 ..........
99379 ..........
99380 ..........
99381 ..........
99382 ..........
99383 ..........
99384 ..........
99385 ..........
99386 ..........
99387 ..........
99391 ..........
99392 ..........
99393 ..........
99394 ..........
99395 ..........
99396 ..........
99397 ..........
99401 ..........
99402 ..........
99403 ..........
99404 ..........
99411 ..........
99412 ..........
99420 ..........
99429 ..........
99431 ..........
99432 ..........
99433 ..........
99435 ..........
99436 ..........
99440 ..........
99450 ..........
99455 ..........
99456 ..........
99499 ..........
99500 ..........
99501 ..........
99502 ..........
99503 ..........
99504 ..........
99505 ..........
99506 ..........
99507 ..........
99509 ..........
99510 ..........
99511 ..........
99512 ..........
99600 ..........
99601 ..........
99602 ..........
A4890 .........
D0150 .........
D0240 .........
D0250 .........
D0260 .........
D0270 .........
D0272 .........
D0274 .........
D0277 .........
D0416 .........
D0421 .........
D0431 .........
D0460 .........
D0472 .........
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
B
B
B
B
B
B
B
B
I
B
I
B
B
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
A
A
A
A
A
A
N
R
R
C
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
R
R
R
R
R
R
R
R
R
R
R
R
R
R
Physician
work
RVUs 3
Description
Prolonged serv, w/o contact ........................
Prolonged serv, w/o contact ........................
Physician/team conference .........................
Physician/team conference .........................
Physician phone consultation ......................
Physician phone consultation ......................
Physician phone consultation ......................
Home health care supervision ....................
Home health care supervision ....................
Hospice care supervision ............................
Hospice care supervision ............................
Nursing fac care supervision .......................
Nursing fac care supervision .......................
Prev visit, new, infant ..................................
Prev visit, new, age 1-4 ..............................
Prev visit, new, age 5-11 ............................
Prev visit, new, age 12-17 ..........................
Prev visit, new, age 18-39 ..........................
Prev visit, new, age 40-64 ..........................
Prev visit, new, 65 & over ...........................
Prev visit, est, infant ....................................
Prev visit, est, age 1-4 ................................
Prev visit, est, age 5-11 ..............................
Prev visit, est, age 12-17 ............................
Prev visit, est, age 18-39 ............................
Prev visit, est, age 40-64 ............................
Prev visit, est, 65 & over .............................
Preventive counseling, indiv ........................
Preventive counseling, indiv ........................
Preventive counseling, indiv ........................
Preventive counseling, indiv ........................
Preventive counseling, group ......................
Preventive counseling, group ......................
Health risk assessment test ........................
Unlisted preventive service .........................
Initial care, normal newborn ........................
Newborn care, not in hosp ..........................
Normal newborn care/hospital ....................
Newborn discharge day hosp .....................
Attendance, birth .........................................
Newborn resuscitation .................................
Life/disability evaluation ..............................
Disability examination ..................................
Disability examination ..................................
Unlisted e&m service ..................................
Home visit, prenatal ....................................
Home visit, postnatal ...................................
Home visit, nb care .....................................
Home visit, resp therapy .............................
Home visit mech ventilator ..........................
Home visit, stoma care ...............................
Home visit, im injection ...............................
Home visit, cath maintain ............................
Home visit day life activity ...........................
Home visit, sing/m/fam couns .....................
Home visit, fecal/enema mgmt ....................
Home visit for hemodialysis ........................
Home visit nos .............................................
Home infusion/visit, 2 hrs ............................
Home infusion, each addtl hr ......................
Repair/maint cont hemo equip ....................
Comprehensve oral evaluation ...................
Intraoral occlusal film ..................................
Extraoral first film ........................................
Extraoral ea additional film ..........................
Dental bitewing single film ..........................
Dental bitewings two films ...........................
Dental bitewings four films ..........................
Vert bitewings-sev to eight ..........................
Viral culture .................................................
Gen tst suscept oral disease ......................
Diag tst detect mucos abnorm ....................
Pulp vitality test ...........................................
Gross exam, prep & report .........................
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.10
1.73
1.10
1.73
1.10
1.73
1.19
1.36
1.36
1.53
1.53
1.88
2.06
1.02
1.19
1.19
1.36
1.36
1.53
1.71
0.48
0.98
1.46
1.95
0.15
0.25
0.00
0.00
1.17
1.26
0.62
1.50
1.50
2.94
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.70
0.00
0.70
0.00
0.70
0.99
1.42
1.47
1.42
1.49
1.49
1.66
1.80
1.02
1.09
1.07
1.13
1.16
1.24
1.37
0.58
0.81
1.02
1.24
0.20
0.26
0.00
0.00
0.00
1.01
NA
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Facility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.42
0.00
0.42
0.00
0.42
0.66
0.45
0.52
0.52
0.59
0.59
0.72
0.78
0.39
0.45
0.45
0.52
0.52
0.59
0.65
0.19
0.37
0.56
0.74
0.06
0.10
0.00
0.00
0.37
NA
0.19
0.59
0.46
0.91
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Malpractice
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.05
0.07
0.05
0.07
0.04
0.06
0.05
0.05
0.05
0.06
0.06
0.07
0.07
0.04
0.05
0.05
0.05
0.05
0.06
0.06
0.01
0.02
0.04
0.05
0.01
0.01
0.00
0.00
0.05
0.07
0.02
0.06
0.06
0.12
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00237
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.85
1.80
1.85
1.80
1.84
2.79
2.67
2.88
2.83
3.08
3.08
3.62
3.94
2.08
2.33
2.31
2.55
2.57
2.83
3.14
1.07
1.81
2.52
3.24
0.36
0.52
0.00
0.00
1.22
2.34
NA
NA
NA
NA
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Facility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.57
1.80
1.57
1.80
1.56
2.45
1.69
1.93
1.93
2.18
2.18
2.67
2.92
1.45
1.69
1.69
1.93
1.93
2.18
2.43
0.68
1.37
2.06
2.75
0.22
0.36
0.00
0.00
1.59
NA
0.83
2.15
2.02
3.96
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Global
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
YYY
YYY
YYY
YYY
YYY
YYY
YYY
XXX
XXX
XXX
XXX
YYY
XXX
46000
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
D0473
D0474
D0475
D0476
D0477
D0478
D0479
D0480
D0481
D0482
D0483
D0484
D0485
D0502
D0999
D1510
D1515
D1520
D1525
D1550
D2999
D3460
D3999
D4260
D4263
D4264
D4268
D4270
D4271
D4273
D4355
D4381
D5911
D5912
D5951
D5983
D5984
D5985
D5987
D6920
D7111
D7140
D7210
D7220
D7230
D7240
D7241
D7250
D7260
D7261
D7283
D7288
D7291
D7321
D7511
D7521
D7940
D9110
D9230
D9248
D9630
D9930
D9940
D9950
D9951
D9952
G0008
G0009
G0010
G0030
G0030
G0030
G0031
G0031
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
Status
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
X
X
X
I
I
I
I
I
Physician
work
RVUs 3
Description
Micro exam, prep & report ..........................
Micro w exam of surg margins ....................
Decalcification procedure ............................
Spec stains for microorganis .......................
Spec stains not for microorg .......................
Immunohistochemical stains .......................
Tissue in-situ hybridization ..........................
Cytopath smear prep & report ....................
Electron microscopy diagnost .....................
Direct immunofluorescence .........................
Indirect immunofluorescence ......................
Consult slides prep elsewher ......................
Consult inc prep of slides ............................
Other oral pathology procedu .....................
Unspecified diagnostic proce ......................
Space maintainer fxd unilat .........................
Fixed bilat space maintainer .......................
Remove unilat space maintain ....................
Remove bilat space maintain ......................
Recement space maintainer .......................
Dental unspec restorative pr .......................
Endodontic endosseous implan ..................
Endodontic procedure .................................
Osseous surgery per quadrant ...................
Bone replce graft first site ...........................
Bone replce graft each add .........................
Surgical revision procedure .........................
Pedicle soft tissue graft pr ..........................
Free soft tissue graft proc ...........................
Subepithelial tissue graft .............................
Full mouth debridement ..............................
Localized delivery antimicro ........................
Facial moulage sectional .............................
Facial moulage complete ............................
Feeding aid ..................................................
Radiation applicator .....................................
Radiation shield ...........................................
Radiation cone locator ................................
Commissure splint .......................................
Dental connector bar ...................................
Extraction coronal remnants .......................
Extraction erupted tooth/exr ........................
Rem imp tooth w mucoper flp .....................
Impact tooth remov soft tiss ........................
Impact tooth remov part bony .....................
Impact tooth remov comp bony ..................
Impact tooth rem bony w/comp ...................
Tooth root removal ......................................
Oral antral fistula closure ............................
Primary closure sinus perf ..........................
Place device impacted tooth .......................
Brush biopsy ................................................
Transseptal fiberotomy ................................
Alveoloplasty not w/extracts ........................
Incision/drain abscess intra .........................
Incision/drain abscess extra ........................
Reshaping bone orthognathic .....................
Tx dental pain minor proc ...........................
Analgesia .....................................................
Sedation (non-iv) .........................................
Other drugs/medicaments ...........................
Treatment of complications .........................
Dental occlusal guard ..................................
Occlusion analysis .......................................
Limited occlusal adjustment ........................
Complete occlusal adjustment ....................
Admin influenza virus vac ...........................
Admin pneumococcal vaccine .....................
Admin hepatitis b vaccine ...........................
PET imaging prev PET single .....................
PET imaging prev PET single .....................
PET imaging prev PET single .....................
PET imaging prev PET multple ...................
PET imaging prev PET multple ...................
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.50
0.00
0.00
1.87
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.61
0.00
0.00
0.76
Facility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.61
0.00
0.00
0.76
Malpractice
RVUs
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.06
0.00
0.00
0.07
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00238
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.17
0.00
0.00
2.70
Facility
total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.17
0.00
0.00
2.70
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
XXX
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
YYY
XXX
XXX
YYY
YYY
YYY
YYY
YYY
YYY
YYY
XXX
XXX
XXX
YYY
XXX
XXX
XXX
YYY
YYY
YYY
XXX
YYY
YYY
YYY
YYY
YYY
YYY
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
46001
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
G0031
G0032
G0032
G0032
G0033
G0033
G0033
G0034
G0034
G0034
G0035
G0035
G0035
G0036
G0036
G0036
G0037
G0037
G0037
G0038
G0038
G0038
G0039
G0039
G0039
G0040
G0040
G0040
G0041
G0041
G0041
G0042
G0042
G0042
G0043
G0043
G0043
G0044
G0044
G0044
G0045
G0045
G0045
G0046
G0046
G0046
G0047
G0047
G0047
G0101
G0102
G0104
G0105
G0105
G0106
G0106
G0106
G0108
G0109
G0110
G0111
G0112
G0113
G0114
G0115
G0116
G0117
G0118
G0120
G0120
G0120
G0121
G0121
G0122
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Mod
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
53 .......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
53 .......
............
Status
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
A
A
A
A
A
A
A
A
A
A
R
R
R
R
R
R
R
T
T
A
A
A
A
A
N
Physician
work
RVUs 3
Description
PET imaging prev PET multple ...................
PET follow SPECT 78464 singl ..................
PET follow SPECT 78464 singl ..................
PET follow SPECT 78464 singl ..................
PET follow SPECT 78464 mult ...................
PET follow SPECT 78464 mult ...................
PET follow SPECT 78464 mult ...................
PET follow SPECT 76865 singl ..................
PET follow SPECT 76865 singl ..................
PET follow SPECT 76865 singl ..................
PET follow SPECT 78465 mult ...................
PET follow SPECT 78465 mult ...................
PET follow SPECT 78465 mult ...................
PET follow cornry angio sing ......................
PET follow cornry angio sing ......................
PET follow cornry angio sing ......................
PET follow cornry angio mult ......................
PET follow cornry angio mult ......................
PET follow cornry angio mult ......................
PET follow myocard perf sing .....................
PET follow myocard perf sing .....................
PET follow myocard perf sing .....................
PET follow myocard perf mult .....................
PET follow myocard perf mult .....................
PET follow myocard perf mult .....................
PET follow stress echo singl .......................
PET follow stress echo singl .......................
PET follow stress echo singl .......................
PET follow stress echo mult .......................
PET follow stress echo mult .......................
PET follow stress echo mult .......................
PET follow ventriculogm sing ......................
PET follow ventriculogm sing ......................
PET follow ventriculogm sing ......................
PET follow ventriculogm mult ......................
PET follow ventriculogm mult ......................
PET follow ventriculogm mult ......................
PET following rest ECG singl ......................
PET following rest ECG singl ......................
PET following rest ECG singl ......................
PET following rest ECG mult ......................
PET following rest ECG mult ......................
PET following rest ECG mult ......................
PET follow stress ECG singl .......................
PET follow stress ECG singl .......................
PET follow stress ECG singl .......................
PET follow stress ECG mult .......................
PET follow stress ECG mult .......................
PET follow stress ECG mult .......................
CA screen;pelvic/breast exam ....................
Prostate ca screening; dre ..........................
CA screen;flexi sigmoidscope .....................
Colorectal scrn; hi risk ind ...........................
Colorectal scrn; hi risk ind ...........................
Colon CA screen;barium enema .................
Colon CA screen;barium enema .................
Colon CA screen;barium enema .................
Diab manage trn per indiv ...........................
Diab manage trn ind/group .........................
Nett pulm-rehab educ; ind ...........................
Nett pulm-rehab educ; group ......................
Nett;nutrition guid, initial ..............................
Nett;nutrition guid,subseqnt .........................
Nett; psychosocial consult ...........................
Nett; psychological testing ..........................
Nett; psychosocial counsel ..........................
Glaucoma scrn hgh risk direc .....................
Glaucoma scrn hgh risk direc .....................
Colon ca scrn; barium enema .....................
Colon ca scrn; barium enema .....................
Colon ca scrn; barium enema .....................
Colon ca scrn not hi rsk ind ........................
Colon ca scrn not hi rsk ind ........................
Colon ca scrn; barium enema .....................
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.45
0.17
0.96
3.70
0.96
0.99
0.99
0.00
0.00
0.00
0.90
0.27
1.72
1.29
1.20
1.20
1.11
0.45
0.17
0.99
0.99
0.00
3.70
0.96
0.99
Nonfacility
PE
RVUs
0.00
0.00
0.57
0.00
0.00
0.78
0.00
0.00
0.60
0.00
0.00
0.76
0.00
0.00
0.59
0.00
0.00
0.74
0.00
0.00
0.51
0.00
0.00
0.74
0.00
0.00
0.61
0.00
0.00
0.76
0.00
0.00
0.63
0.00
0.00
0.79
0.00
0.00
0.62
0.00
0.00
0.75
0.00
0.00
0.62
0.00
0.00
0.76
0.00
0.51
0.38
2.33
6.60
2.33
3.35
0.34
3.02
0.83
0.48
0.68
0.30
1.26
0.81
0.46
0.78
0.94
0.73
0.55
3.35
0.34
3.02
6.60
2.33
3.51
Facility
PE
RVUs
0.00
0.00
0.57
0.00
0.00
0.78
0.00
0.00
0.60
0.00
0.00
0.76
0.00
0.00
0.59
0.00
0.00
0.74
0.00
0.00
0.51
0.00
0.00
0.74
0.00
0.00
0.61
0.00
0.00
0.76
0.00
0.00
0.63
0.00
0.00
0.79
0.00
0.00
0.62
0.00
0.00
0.75
0.00
0.00
0.62
0.00
0.00
0.76
0.00
0.17
0.06
0.55
1.58
0.55
NA
0.34
NA
NA
NA
NA
NA
0.65
0.40
NA
NA
0.32
0.19
0.06
NA
0.34
NA
1.58
0.55
NA
Malpractice
RVUs
0.00
0.00
0.06
0.00
0.00
0.07
0.00
0.00
0.05
0.00
0.00
0.06
0.00
0.00
0.05
0.00
0.00
0.06
0.00
0.00
0.07
0.00
0.00
0.07
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.05
0.00
0.00
0.07
0.00
0.00
0.05
0.00
0.00
0.06
0.00
0.00
0.05
0.00
0.00
0.06
0.00
0.02
0.01
0.08
0.30
0.08
0.17
0.04
0.13
0.01
0.01
0.04
0.01
0.04
0.05
0.05
0.03
0.05
0.01
0.01
0.17
0.04
0.13
0.30
0.08
0.18
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00239
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
2.13
0.00
0.00
2.72
0.00
0.00
2.15
0.00
0.00
2.70
0.00
0.00
2.14
0.00
0.00
2.67
0.00
0.00
2.09
0.00
0.00
2.69
0.00
0.00
2.18
0.00
0.00
2.70
0.00
0.00
2.18
0.00
0.00
2.73
0.00
0.00
2.17
0.00
0.00
2.69
0.00
0.00
2.17
0.00
0.00
2.70
0.00
0.98
0.56
3.37
10.59
3.37
4.51
1.37
3.15
0.84
0.49
1.62
0.58
3.02
2.15
1.71
2.01
2.10
1.19
0.73
4.51
1.37
3.15
10.59
3.37
4.68
Facility
total
0.00
0.00
2.13
0.00
0.00
2.72
0.00
0.00
2.15
0.00
0.00
2.70
0.00
0.00
2.14
0.00
0.00
2.67
0.00
0.00
2.09
0.00
0.00
2.69
0.00
0.00
2.18
0.00
0.00
2.70
0.00
0.00
2.18
0.00
0.00
2.73
0.00
0.00
2.17
0.00
0.00
2.69
0.00
0.00
2.17
0.00
0.00
2.70
0.00
0.64
0.24
1.59
5.57
1.59
NA
1.37
NA
NA
NA
NA
NA
2.41
1.74
NA
NA
1.49
0.65
0.24
NA
1.37
NA
5.57
1.59
NA
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
000
XXX
46002
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
G0122
G0122
G0124
G0125
G0125
G0125
G0127
G0128
G0130
G0130
G0130
G0141
G0166
G0168
G0179
G0180
G0181
G0182
G0186
G0202
G0202
G0202
G0204
G0204
G0204
G0206
G0206
G0206
G0210
G0210
G0210
G0211
G0211
G0211
G0212
G0212
G0212
G0213
G0213
G0213
G0214
G0214
G0214
G0215
G0215
G0215
G0216
G0216
G0216
G0217
G0217
G0217
G0218
G0218
G0218
G0219
G0219
G0219
G0220
G0220
G0220
G0221
G0221
G0221
G0222
G0222
G0222
G0223
G0223
G0223
G0224
G0224
G0224
G0225
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Mod
26 .......
TC ......
............
............
26 .......
TC ......
............
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
Status
N
N
A
I
I
I
R
R
A
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
N
N
N
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
Physician
work
RVUs 3
Description
Colon ca scrn; barium enema .....................
Colon ca scrn; barium enema .....................
Screen c/v thin layer by MD ........................
PET image pulmonary nodule .....................
PET image pulmonary nodule .....................
PET image pulmonary nodule .....................
Trim nail(s) ..................................................
CORF skilled nursing service ......................
Single energy x-ray study ...........................
Single energy x-ray study ...........................
Single energy x-ray study ...........................
Scr c/v cyto,autosys and md .......................
Extrnl counterpulse, per tx ..........................
Wound closure by adhesive ........................
MD recertification HHA PT ..........................
MD certification HHA patient .......................
Home health care supervision ....................
Hospice care supervision ............................
Dstry eye lesn,fdr vssl tech .........................
Screeningmammographydigital ...................
Screeningmammographydigital ...................
Screeningmammographydigital ...................
Diagnosticmammographydigital ..................
Diagnosticmammographydigital ..................
Diagnosticmammographydigital ..................
Diagnosticmammographydigital ..................
Diagnosticmammographydigital ..................
Diagnosticmammographydigital ..................
PET img wholebody dxlung ........................
PET img wholebody dxlung ........................
PET img wholebody dxlung ........................
PET img wholbody init lung ........................
PET img wholbody init lung ........................
PET img wholbody init lung ........................
PET img wholebod restag lung ...................
PET img wholebod restag lung ...................
PET img wholebod restag lung ...................
PET img wholbody dx .................................
PET img wholbody dx .................................
PET img wholbody dx .................................
PET img wholebod init ................................
PET img wholebod init ................................
PET img wholebod init ................................
PETimg wholebod restag ............................
PETimg wholebod restag ............................
PETimg wholebod restag ............................
PET img wholebod dx melanoma ...............
PET img wholebod dx melanoma ...............
PET img wholebod dx melanoma ...............
PET img wholebod init melan .....................
PET img wholebod init melan .....................
PET img wholebod init melan .....................
PET img wholebod restag mela ..................
PET img wholebod restag mela ..................
PET img wholebod restag mela ..................
PET img wholbod melano nonco ................
PET img wholbod melano nonco ................
PET img wholbod melano nonco ................
PET img wholebod dx lymphoma ...............
PET img wholebod dx lymphoma ...............
PET img wholebod dx lymphoma ...............
PET imag wholbod init lympho ...................
PET imag wholbod init lympho ...................
PET imag wholbod init lympho ...................
PET imag wholbod resta lymph ..................
PET imag wholbod resta lymph ..................
PET imag wholbod resta lymph ..................
PET imag wholbod reg dx head .................
PET imag wholbod reg dx head .................
PET imag wholbod reg dx head .................
PET imag wholbod reg ini hea ....................
PET imag wholbod reg ini hea ....................
PET imag wholbod reg ini hea ....................
PET whol restag headneckonly ..................
0.99
0.00
0.42
0.00
1.50
0.00
0.17
0.08
0.22
0.22
0.00
0.42
0.07
0.45
0.45
0.67
1.73
1.73
0.00
0.70
0.70
0.00
0.87
0.87
0.00
0.70
0.70
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
0.00
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
Nonfacility
PE
RVUs
0.38
3.13
0.23
0.00
0.54
0.00
0.27
0.03
0.88
0.08
0.80
0.23
3.93
1.80
0.94
1.15
1.38
1.54
0.00
2.78
0.23
2.55
2.79
0.28
2.51
2.25
0.23
2.02
0.00
0.54
0.00
0.00
0.53
0.00
0.00
0.54
0.00
0.00
0.53
0.00
0.00
0.53
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.00
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
Facility
PE
RVUs
0.38
NA
0.15
0.00
0.54
0.00
0.07
0.03
NA
0.08
NA
0.15
0.03
0.21
0.87
1.08
1.31
1.47
0.00
NA
0.23
NA
NA
0.28
NA
NA
0.23
NA
0.00
0.54
0.00
0.00
0.53
0.00
0.00
0.54
0.00
0.00
0.53
0.00
0.00
0.53
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.00
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
Malpractice
RVUs
0.05
0.13
0.02
0.00
0.06
0.00
0.01
0.01
0.06
0.01
0.05
0.02
0.01
0.03
0.02
0.03
0.07
0.07
0.00
0.10
0.03
0.07
0.11
0.04
0.07
0.09
0.03
0.06
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.00
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00240
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
1.42
3.26
0.67
0.00
2.11
0.00
0.45
0.12
1.16
0.31
0.85
0.67
4.01
2.28
1.41
1.85
3.18
3.34
0.00
3.58
0.96
2.62
3.77
1.19
2.58
3.05
0.96
2.08
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.11
0.00
0.00
0.00
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.11
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
Facility
total
1.42
NA
0.59
0.00
2.11
0.00
0.25
0.12
NA
0.31
NA
0.59
0.11
0.69
1.35
1.78
3.12
3.27
0.00
NA
0.96
NA
NA
1.19
NA
NA
0.96
NA
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.11
0.00
0.00
0.00
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.11
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
XXX
XXX
YYY
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
46003
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
G0225
G0225
G0226
G0226
G0226
G0227
G0227
G0227
G0228
G0228
G0228
G0229
G0229
G0229
G0230
G0230
G0230
G0231
G0231
G0231
G0232
G0232
G0232
G0233
G0233
G0233
G0234
G0234
G0234
G0235
G0235
G0235
G0237
G0238
G0239
G0244
G0245
G0246
G0247
G0248
G0249
G0250
G0251
G0252
G0252
G0252
G0253
G0253
G0253
G0254
G0254
G0254
G0255
G0255
G0255
G0257
G0258
G0259
G0260
G0263
G0264
G0268
G0269
G0270
G0271
G0275
G0278
G0279
G0280
G0281
G0282
G0283
G0288
G0289
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Mod
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
Status
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
N
N
N
A
A
A
E
R
R
R
R
R
R
E
N
N
N
I
I
I
I
I
I
N
N
N
E
E
E
E
E
E
A
B
A
A
A
A
C
C
A
N
A
A
A
Physician
work
RVUs 3
Description
PET whol restag headneckonly ..................
PET whol restag headneckonly ..................
PET img wholbody dx esophagl .................
PET img wholbody dx esophagl .................
PET img wholbody dx esophagl .................
PET img wholbod ini esophage ..................
PET img wholbod ini esophage ..................
PET img wholbod ini esophage ..................
PET img wholbod restg esopha ..................
PET img wholbod restg esopha ..................
PET img wholbod restg esopha ..................
PET img metaboloc brain pres ...................
PET img metaboloc brain pres ...................
PET img metaboloc brain pres ...................
PET myocard viability post ..........................
PET myocard viability post ..........................
PET myocard viability post ..........................
PET WhBD colorec; gamma cam ...............
PET WhBD colorec; gamma cam ...............
PET WhBD colorec; gamma cam ...............
PET whbd lymphoma; gamma cam ............
PET whbd lymphoma; gamma cam ............
PET whbd lymphoma; gamma cam ............
PET whbd melanoma; gamma cam ............
PET whbd melanoma; gamma cam ............
PET whbd melanoma; gamma cam ............
PET WhBD pulm nod; gamma cam ............
PET WhBD pulm nod; gamma cam ............
PET WhBD pulm nod; gamma cam ............
PET not otherwise specified .......................
PET not otherwise specified .......................
PET not otherwise specified .......................
Therapeutic procd strg endur ......................
Oth resp proc, indiv .....................................
Oth resp proc, group ...................................
Observ care by facility topt .........................
Initial foot exam pt lops ...............................
Followup eval of foot pt lop .........................
Routine footcare pt w lops ..........................
Demonstrate use home inr mon .................
Provide test material,equipm .......................
MD review interpret of test ..........................
Linear acc based stero radio ......................
PET imaging initial dx .................................
PET imaging initial dx .................................
PET imaging initial dx .................................
PET image brst dection recur .....................
PET image brst dection recur .....................
PET image brst dection recur .....................
PET image brst eval to tx ...........................
PET image brst eval to tx ...........................
PET image brst eval to tx ...........................
Current percep threshold tst .......................
Current percep threshold tst .......................
Current percep threshold tst .......................
Unsched dialysis ESRD pt hos ...................
IV infusion during obs stay ..........................
Inject for sacroiliac joint ...............................
Inj for sacroiliac jt anesth ............................
Adm with CHF, CP, asthma ........................
Assmt otr CHF, CP, asthma .......................
Removal of impacted wax md .....................
Occlusive device in vein art ........................
MNT subs tx for change dx .........................
Group MNT 2 or more 30 mins ...................
Renal angio, cardiac cath ...........................
Iliac art angio,cardiac cath ..........................
Excorp shock tx, elbow epi .........................
Excorp shock tx other than .........................
Elec stim unattend for press .......................
Elect stim wound care not pd .....................
Elec stim other than wound ........................
Recon, CTA for surg plan ...........................
Arthro, loose body + chondro ......................
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
1.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.88
0.45
0.50
0.00
0.00
0.18
0.00
0.00
1.50
0.00
0.00
1.87
0.00
0.00
1.87
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.61
0.00
0.00
0.00
0.25
0.25
0.00
0.00
0.18
0.00
0.18
0.00
1.48
Nonfacility
PE
RVUs
0.54
0.00
0.00
0.55
0.00
0.00
0.55
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.55
0.00
0.00
0.54
0.00
0.00
0.55
0.00
0.00
0.55
0.00
0.00
0.54
0.00
0.00
0.00
0.00
0.40
0.49
0.33
0.00
0.81
0.55
0.55
6.05
3.64
0.06
0.00
0.00
0.59
0.00
0.00
0.66
0.00
0.00
0.68
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.62
0.00
0.42
0.16
NA
NA
0.00
0.00
0.12
0.00
0.12
10.63
NA
Facility
PE
RVUs
0.54
0.00
0.00
0.55
0.00
0.00
0.55
0.00
0.00
0.54
0.00
0.00
0.54
0.00
0.00
0.55
0.00
0.00
0.54
0.00
0.00
0.55
0.00
0.00
0.55
0.00
0.00
0.54
0.00
0.00
0.00
0.00
NA
NA
NA
0.00
0.31
0.16
0.21
NA
NA
0.06
0.00
0.00
0.59
0.00
0.00
0.66
0.00
0.00
0.68
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.23
0.00
NA
NA
0.11
0.11
0.00
0.00
NA
0.00
NA
NA
0.78
Malpractice
RVUs
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.06
0.00
0.00
0.00
0.00
0.02
0.00
0.00
0.00
0.04
0.02
0.02
0.01
0.01
0.01
0.00
0.00
0.04
0.00
0.00
0.08
0.00
0.00
0.08
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.02
0.00
0.01
0.01
0.01
0.01
0.00
0.00
0.01
0.00
0.01
0.18
0.26
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00241
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
2.11
0.00
0.00
2.12
0.00
0.00
2.11
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.12
0.00
0.00
2.10
0.00
0.00
2.11
0.00
0.00
2.11
0.00
0.00
2.11
0.00
0.00
0.00
0.00
0.42
0.49
0.33
0.00
1.73
1.02
1.07
6.06
3.65
0.25
0.00
0.00
2.13
0.00
0.00
2.62
0.00
0.00
2.64
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.25
0.00
0.43
0.17
NA
NA
0.00
0.00
0.31
0.00
0.31
10.81
NA
Facility
total
2.11
0.00
0.00
2.12
0.00
0.00
2.11
0.00
0.00
2.10
0.00
0.00
2.10
0.00
0.00
2.12
0.00
0.00
2.10
0.00
0.00
2.11
0.00
0.00
2.11
0.00
0.00
2.11
0.00
0.00
0.00
0.00
NA
NA
NA
0.00
1.23
0.63
0.73
NA
NA
0.25
0.00
0.00
2.13
0.00
0.00
2.62
0.00
0.00
2.64
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.86
0.00
NA
NA
0.37
0.37
0.00
0.00
NA
0.00
NA
NA
2.52
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
XXX
ZZZ
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
46004
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
G0290
G0291
G0293
G0294
G0295
G0308
G0309
G0310
G0311
G0312
G0313
G0314
G0315
G0316
G0317
G0318
G0319
G0320
G0321
G0322
G0323
G0324
G0325
G0326
G0327
G0329
G0336
G0336
G0336
G0337
G0341
G0342
G0343
G0344
G0345
G0346
G0347
G0348
G0349
G0350
G0351
G0353
G0354
G0355
G0356
G0357
G0358
G0359
G0360
G0361
G0362
G0363
G0364
G0365
G0365
G0365
G0366
G0367
G0368
G0375
G0376
G9013
G9014
G9016
M0064
P3001
Q0035
Q0035
Q0035
Q0091
Q0092
Q3001
R0070
R0075
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Mod
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
............
............
............
............
............
............
............
............
............
............
26 .......
TC ......
............
............
............
............
............
Status
E
E
E
E
N
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
I
I
I
X
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
T
A
A
A
A
A
A
A
A
A
N
N
N
A
A
A
A
A
A
A
C
C
C
Physician
work
RVUs 3
Description
Drug-eluting stents, single ...........................
Drug-eluting stents,each add ......................
Non-cov surg proc,clin trial .........................
Non-cov proc, clinical trial ...........................
Electromagnetic therapy onc .......................
ESRD related svc 4+mo < 2yrs ..................
ESRD related svc 2-3mo <2yrs ..................
ESRD related svc 1 vst <2yrs .....................
ESRD related svs 4+mo 2-11yr ..................
ESRD relate svs 2-3 mo 2-11y ...................
ESRD related svs 1 mon 2-11y ..................
ESRD related svs 4+ mo 12-19 ..................
ESRD related svs 2-3mo/12-19 ..................
ESRD related svs 1vis/12-19y ....................
ESRD related svs 4+mo 20+yrs .................
ESRD related svs 2-3 mo 20+y ..................
ESRD related svs 1visit 20+y .....................
ESD related svs home undr 2 .....................
ESRDrelatedsvs home mo 2-11y ................
ESRD related svs hom mo12-19 ................
ESRD related svs home mo 20+ ................
ESRD related serv/dy,2y .............................
ESRD relate serv/dy 2-11yr ........................
ESRD relate serv/dy 12-19y .......................
ESRD relate serv/dy 20+yrs ........................
Electromagntic tx for ulcers .........................
PET imaging brain alzheimers ....................
PET imaging brain alzheimers ....................
PET imaging brain alzheimers ....................
Hospice evaluation preelecti .......................
Percutaneous islet celltrans ........................
Laparoscopy islet cell trans .........................
Laparotomy islet cell transp ........................
Initial preventive exam ................................
IV infuse hydration, initial ............................
Each additional infuse hour .........................
IV infusion therapy/diagnost ........................
Each additional hr up to 8hr ........................
Additional sequential infuse ........................
Concurrent infusion .....................................
Therapeutic/diagnostic injec ........................
IV push,single orinitial dru ...........................
Each addition sequential IV ........................
Chemo adminisrate subcut/IM ....................
Hormonal anti-neoplastic .............................
IV push single/initial subst ...........................
IV push each additional drug ......................
Chemotherapy IV one hr initi ......................
Each additional hr 1-8 hrs ...........................
Prolong chemo infuse>8hrs pu ...................
Each add sequential infusion ......................
Irrigate implanted venous de .......................
Bone marrow aspirate &biopsy ...................
Vessel mapping hemo access ....................
Vessel mapping hemo access ....................
Vessel mapping hemo access ....................
EKG for initial prevent exam .......................
EKG tracing for initial prev ..........................
EKG interpret & report preve ......................
Smoke/Tobacco counseling3-10 .................
Smoke/Tobacco counseling >10 .................
ESRD demo bundle level I ..........................
ESRD demo bundle-level II .........................
Demo-smoking cessation coun ...................
Visit for drug monitoring ..............................
Screening pap smear by phys ....................
Cardiokymography ......................................
Cardiokymography ......................................
Cardiokymography ......................................
Obtaining screen pap smear .......................
Set up port xray equipment .........................
Brachytherapy Radioelements ....................
Transport portable x-ray ..............................
Transport port x-ray multipl .........................
0.00
0.00
0.00
0.00
0.00
12.77
10.63
8.51
9.75
8.13
6.50
8.30
6.91
5.53
5.10
4.25
3.40
10.63
8.13
6.91
4.25
0.35
0.23
0.27
0.14
0.06
0.00
1.50
0.00
1.34
6.99
11.94
19.89
1.34
0.17
0.09
0.21
0.18
0.19
0.17
0.17
0.18
0.10
0.21
0.19
0.24
0.20
0.28
0.19
0.21
0.21
0.04
0.16
0.25
0.25
0.00
0.17
0.00
0.17
0.24
0.48
0.00
0.00
0.00
0.37
0.42
0.17
0.17
0.00
0.37
0.00
0.00
0.00
0.00
Nonfacility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
8.56
7.11
5.69
4.73
3.93
3.15
4.43
3.68
2.95
2.87
2.38
1.90
7.11
3.93
3.68
2.38
0.24
0.12
0.13
0.08
0.14
0.00
0.52
0.00
0.51
NA
NA
NA
1.14
1.43
0.40
1.76
0.46
0.90
0.44
0.31
1.30
0.57
1.15
0.75
2.94
1.62
4.22
0.78
4.63
1.95
0.70
0.14
4.13
0.09
4.03
0.47
0.41
0.06
0.00
0.00
0.00
0.00
0.00
0.38
0.23
0.41
0.06
0.35
0.68
0.33
0.00
0.00
0.00
Facility
PE
RVUs
0.00
0.00
0.00
0.00
0.00
8.56
7.11
5.69
4.73
3.93
3.15
4.43
3.68
2.95
2.87
2.38
1.90
7.11
3.93
3.68
2.38
0.24
0.12
0.13
0.08
NA
0.00
0.52
0.00
0.51
2.68
5.24
8.62
0.47
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.06
NA
0.09
NA
0.00
NA
0.06
0.00
0.00
0.00
0.00
0.00
0.12
0.15
NA
0.06
NA
NA
NA
0.00
0.00
0.00
Malpractice
RVUs
0.00
0.00
0.00
0.00
0.00
0.42
0.36
0.28
0.34
0.29
0.22
0.27
0.23
0.17
0.17
0.14
0.11
0.36
0.29
0.23
0.14
0.01
0.01
0.01
0.01
0.01
0.00
0.05
0.00
0.09
0.48
1.46
2.06
0.10
0.07
0.04
0.07
0.04
0.04
0.04
0.01
0.04
0.04
0.01
0.01
0.06
0.06
0.08
0.07
0.08
0.07
0.01
0.04
0.25
0.02
0.23
0.03
0.02
0.01
0.01
0.01
0.00
0.00
0.00
0.01
0.02
0.03
0.01
0.02
0.02
0.01
0.00
0.00
0.00
——————————
1 CPT
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00242
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
Nonfacility
total
0.00
0.00
0.00
0.00
0.00
21.74
18.11
14.48
14.82
12.34
9.87
13.00
10.82
8.65
8.14
6.77
5.41
18.11
12.34
10.82
6.77
0.60
0.36
0.41
0.23
0.21
0.00
2.07
0.00
1.94
NA
NA
NA
2.58
1.67
0.53
2.04
0.68
1.13
0.65
0.49
1.52
0.71
1.37
0.95
3.24
1.88
4.58
1.04
4.92
2.23
0.75
0.34
4.63
0.36
4.26
0.67
0.43
0.24
0.25
0.49
0.00
0.00
0.00
0.76
0.67
0.61
0.24
0.37
1.07
0.34
0.00
0.00
0.00
Facility
total
0.00
0.00
0.00
0.00
0.00
21.74
18.11
14.48
14.82
12.34
9.87
13.00
10.82
8.65
8.14
6.77
5.41
18.11
12.34
10.82
6.77
0.60
0.36
0.41
0.23
NA
0.00
2.07
0.00
1.94
10.15
18.64
30.57
1.92
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.26
NA
0.36
NA
0.20
NA
0.24
0.25
0.49
0.00
0.00
0.00
0.50
0.59
NA
0.24
NA
NA
NA
0.00
0.00
0.00
Global
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
090
090
XXX
XXX
ZZZ
XXX
ZZZ
ZZZ
ZZZ
XXX
XXX
ZZZ
XXX
XXX
XXX
ZZZ
XXX
ZZZ
XXX
ZZZ
XXX
ZZZ
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
46005
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued
CPT 1
HCPCS 2
Mod
R0076 .........
V5299 .........
............
............
1 CPT
Status
B
R
Physician
work
RVUs 3
Description
Transport portable EKG ..............................
Hearing service ...........................................
0.00
0.00
Nonfacility
PE
RVUs
0.00
0.00
Facility
PE
RVUs
0.00
0.00
Malpractice
RVUs
0.00
0.00
Nonfacility
total
0.00
0.00
codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply.
2005 American Dental Association. All rights reserved.
RVUs are not used for Medicare payment.
2 Copyright
3 +Indicates
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00243
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
Facility
total
0.00
0.00
Global
XXX
XXX
46006
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM C.—CODES FOR WHICH ADDENDUM C.—CODES FOR WHICH ADDENDUM C.—CODES FOR WHICH
WE RECEIVED PRACTICE EXPENSE
WE RECEIVED PRACTICE EXPENSE
WE RECEIVED PRACTICE EXPENSE
REVIEW COMMITTEE (PERC) RECREVIEW COMMITTEE (PERC) RECREVIEW COMMITTEE (PERC) RECOMMENDATIONS ON PRACTICE EXOMMENDATIONS ON PRACTICE EXOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS
PENSE DIRECT COST INPUTS—ConPENSE DIRECT COST INPUTS—Continued
tinued
CPT
Code
00104
00124
11100
11101
11950
11951
11952
11954
11975
11976
11977
12031
12034
12041
12042
12044
12051
12052
12053
12054
12055
12056
12057
13152
15775
15776
15851
15852
17250
17304
17305
17306
17307
17310
17360
19000
19396
20500
21300
21310
21480
31700
31730
32960
33960
33961
36522
36860
38230
38794
40490
41250
41251
41252
41800
41805
41806
41822
41825
41826
41828
41830
42100
42104
Short descriptors
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Anesth, electroshock
Anesth, ear exam
Biopsy, skin lesion
Biopsy, skin add-on
Therapy for contour defects
Therapy for contour defects
Therapy for contour defects
Therapy for contour defects
Insert contraceptive cap
Removal of contraceptive cap
Removal/reinsert contra cap
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Layer closure of wound(s)
Repair of wound or lesion
Hair transplant punch grafts
Hair transplant punch grafts
Removal of sutures
Dressing change not for burn
Chemical cautery, tissue
1 stage mohs, up to 5 spec
2 stage mohs, up to 5 spec
3 stage mohs, up to 5 spec
Mohs addl stage up to 5 spec
Mohs any stage > 5 spec each
Skin peel therapy
Drainage of breast lesion
Design custom breast implant
Injection of sinus tract
Treatment of skull fracture
Treatment of nose fracture
Reset dislocated jaw
Insertion of airway catheter
Intro, windpipe wire/tube
Therapeutic pneumothorax
External circulation assist
External circulation assist
Photopheresis
External cannula declotting
Bone marrow collection
Access thoracic lymph duct
Biopsy of lip
Repair tongue laceration
Repair tongue laceration
Repair tongue laceration
Drainage of gum lesion
Removal foreign body, gum
Removal foreign body,jawbone
Excision of gum lesion
Excision of gum lesion
Excision of gum lesion
Excision of gum lesion
Removal of gum tissue
Biopsy roof of mouth
Excision lesion, mouth roof
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
CPT
Code
42106
42107
42160
42280
43750
43760
47000
48102
49080
49081
49428
51000
51005
54450
56420
57150
57170
57180
58300
58323
59160
59300
60000
60001
61888
62194
67221
67225
68400
68420
68510
68530
69100
69300
76120
76940
76942
76975
78160
78162
78170
78172
78282
78350
78351
78455
79200
79300
79440
86585
88355
88356
89100
89105
89130
89132
89135
89136
89140
89141
90465
90466
90467
PO 00000
Short descriptors
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Excision lesion, mouth roof
Excision lesion, mouth roof
Treatment mouth roof lesion
Preparation, palate mold
Place gastrostomy tube
Change gastrostomy tube
Needle biopsy of liver
Needle biopsy, pancreas
Puncture, peritoneal cavity
Removal of abdominal fluid
Ligation of shunt
Drainage of bladder
Drainage of bladder
Preputial stretching
Drainage of gland abscess
Treat vagina infection
Fitting of diaphragm/cap
Treat vaginal bleeding
Insert intrauterine device
Sperm washing
D & c after delivery
Episiotomy or vaginal repair
Drain thyroid/tongue cyst
Aspirate/inject thyriod cyst
Revise/remove neuroreceiver
Replace/irrigate catheter
Ocular photodynamic ther
Eye photodynamic ther add-on
Incise/drain tear gland
Incise/drain tear sac
Biopsy of tear gland
Clearance of tear duct
Biopsy of external ear
Revise external ear
Cine/video x-rays
Us guide, tissue ablation
Echo guide for biopsy
GI endoscopic ultrasound
Plasma iron turnover
Radioiron absorption exam
Red cell iron utilization
Total body iron estimation
GI protein loss exam
Bone mineral, single photon
Bone mineral, dual photon
Venous thrombosis study
Nuclear rx, intracav admin
Nuclr rx, interstit colloid
Nuclear rx, intra-articular
TB tine test
Analysis, skeletal muscle
Analysis, nerve
Sample intestinal contents
Sample intestinal contents
Sample stomach contents
Sample stomach contents
Sample stomach contents
Sample stomach contents
Sample stomach contents
Sample stomach contents
Immune admin 1 inj, < 8 yrs
Immune admin addl inj, < 8 y
Immune admin o or n, < 8 yrs
Frm 00244
Fmt 4701
Sfmt 4701
CPT
Code
90468
90880
90997
92015
92230
92260
92265
92284
92287
92310
92311
92312
92313
92314
92315
92316
92317
92340
92341
92342
92370
92510
92551
93012
93271
93561
93562
94014
94015
94016
94200
94250
94350
94370
94400
94620
94660
94667
94668
94680
94681
94690
94725
94750
95060
95065
95071
95075
95078
95805
95812
95813
95816
95819
95822
95950
95954
95956
96900
96105
99185
99186
E:\FR\FM\08AUP2.SGM
Short descriptors
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Immune admin o/n, addl < 8 y
Hypnotherapy
Hemoperfusion
Refraction
Eye exam with photos
Ophthalmoscopy/dynamometry
Eye muscle evaluation
Dark adaptation eye exam
Internal eye photography
Contact lens fitting
Contact lens fitting
Contact lens fitting
Contact lens fitting
Prescription of contact lens
Prescription of contact lens
Prescription of contact lens
Prescription of contact lens
Fitting of spectacles
Fitting of spectacles
Fitting of spectacles
Repair & adjust spectacles
Rehab for ear implant
Pure tone hearing test, air
Transmission of ecg
Ecg/monitoring and analysis
Cardiac output measurement
Cardiac output measurement
Patient recorded spirometry
Patient recorded spirometry
Review patient spirometry
Lung function test (MBC/MVV)
Expired gas collection
Lung nitrogen washout curve
Breath airway closing volume
CO2 breathing response curve
Pulmonary stress test/simple
Pos airway pressure, CPAP
Chest wall manipulation
Chest wall manipulation
Exhaled air analysis, o2
Exhaled air analysis, o2/co2
Exhaled air analysis
Membrane diffusion capacity
Pulmonary compliance study
Eye allergy tests
Nose allergy test
Bronchial allergy tests
Ingestion challenge test
Provocative testing
Multiple sleep latency test
Eeg, 41-60 minutes
Eeg, over 1 hour
Eeg, awake and drowsy
Eeg, awake and asleep
Eeg, coma or sleep only
Ambulatory eeg monitoring
EEG monitoring/giving drugs
Eeg monitoring, cable/radio
Ultraviolet light therapy
Assessment of aphasia
Regional hypothermia
Total body hypothermia
08AUP2
46007
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM D—2006 GEOGRAPHIC PRACTICE COST INDICIES (GPCI) BY MEDICARE CARRIER AND LOCALITY
Carrier
00510
00831
00832
00520
31140
31140
31140
31140
31140
31140
31140
31146
31146
31146
31140
31146
00824
00591
00903
00902
00590
00590
00590
00511
00511
00833
05130
00952
00952
00952
00952
00630
00826
00650
00740
00660
00528
00528
31142
31142
00901
00901
31143
31143
00953
00953
00954
00512
00740
00523
00523
00740
00751
00655
00834
31144
00805
00805
00521
00801
00803
00803
00803
14330
05535
00820
00883
00522
00835
00835
00865
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
Work
GPCI
Locality
Locality name
00 .............
01 .............
00 .............
13 .............
03 .............
05 .............
06 .............
07 .............
09 .............
TBD** .......
99 .............
17 .............
18 .............
26 .............
TBD** .......
99 .............
01 .............
00 .............
01 .............
01 .............
03 .............
04 .............
99 .............
01 .............
99 .............
01 .............
00 .............
12 .............
15 .............
16 .............
99 .............
00 .............
00 .............
00 .............
04 .............
00 .............
01 .............
99 .............
03 .............
99 .............
01 .............
99 .............
01 .............
99 .............
01 .............
99 .............
00 .............
00 .............
02 .............
01 .............
99 .............
99 .............
01 .............
00 .............
00 .............
40 .............
01 .............
99 .............
05 .............
99 .............
01 .............
02 .............
03 .............
04 .............
00 .............
01 .............
00 .............
00 .............
01 .............
99 .............
01 .............
Alabama ..............................................................................................................................
Alaska ..................................................................................................................................
Arizona ................................................................................................................................
Arkansas ..............................................................................................................................
Marin/Napa/Solano, CA .......................................................................................................
San Francisco, CA ..............................................................................................................
San Mateo, CA ....................................................................................................................
Oakland/Berkley, CA ...........................................................................................................
Santa Clara, CA ..................................................................................................................
Santa Cruz, CA ...................................................................................................................
Rest of California* ...............................................................................................................
Ventura, CA .........................................................................................................................
Los Angeles, CA .................................................................................................................
Anaheim/Santa Ana, CA .....................................................................................................
Sonoma, CA ........................................................................................................................
Rest of California* ...............................................................................................................
Colorado ..............................................................................................................................
Connecticut ..........................................................................................................................
DC + MD/VA Suburbs .........................................................................................................
Delaware .............................................................................................................................
Fort Lauderdale, FL .............................................................................................................
Miami, FL .............................................................................................................................
Rest of Florida .....................................................................................................................
Atlanta, GA ..........................................................................................................................
Rest of Georgia ...................................................................................................................
Hawaii/Guam .......................................................................................................................
Idaho ....................................................................................................................................
East St. Louis, IL .................................................................................................................
Suburban Chicago, IL .........................................................................................................
Chicago, IL ..........................................................................................................................
Rest of Illinois ......................................................................................................................
Indiana .................................................................................................................................
Iowa .....................................................................................................................................
Kansas* ...............................................................................................................................
Kansas* ...............................................................................................................................
Kentucky ..............................................................................................................................
New Orleans, LA .................................................................................................................
Rest of Louisiana ................................................................................................................
Southern Maine ...................................................................................................................
Rest of Maine ......................................................................................................................
Baltimore/Surr. Cntys, MD ..................................................................................................
Rest of Maryland .................................................................................................................
Metropolitan Boston ............................................................................................................
Rest of Massachusetts ........................................................................................................
Detroit, MI ............................................................................................................................
Rest of Michigan .................................................................................................................
Minnesota ............................................................................................................................
Mississippi ...........................................................................................................................
Metropolitan Kansas City, MO ............................................................................................
Metropolitan St. Louis, MO .................................................................................................
Rest of Missouri* .................................................................................................................
Rest of Missouri* .................................................................................................................
Montana ...............................................................................................................................
Nebraska .............................................................................................................................
Nevada ................................................................................................................................
New Hampshire ...................................................................................................................
Northern NJ .........................................................................................................................
Rest of New Jersey .............................................................................................................
New Mexico .........................................................................................................................
Rest of New York ................................................................................................................
Manhattan, NY ....................................................................................................................
NYC Suburbs/Long I., NY ...................................................................................................
Poughkpsie/N NYC Suburbs, NY ........................................................................................
Queens, NY .........................................................................................................................
North Carolina .....................................................................................................................
North Dakota .......................................................................................................................
Ohio .....................................................................................................................................
Oklahoma ............................................................................................................................
Portland, OR ........................................................................................................................
Rest of Oregon ....................................................................................................................
Metropolitan Philadelphia, PA .............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00245
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
1.000
1.017
1.000
1.000
1.035
1.060
1.073
1.054
1.083
1.014
1.010
1.028
1.041
1.034
1.017
1.010
1.000
1.038
1.048
1.012
1.000
1.000
1.000
1.010
1.000
1.005
1.000
1.000
1.018
1.025
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.012
1.000
1.030
1.007
1.037
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.003
1.000
1.058
1.043
1.000
1.000
1.065
1.052
1.014
1.032
1.000
1.000
1.000
1.000
1.002
1.000
1.016
PE
GPCI
0.846
1.103
0.992
0.831
1.340
1.543
1.536
1.371
1.540
1.218
1.042
1.179
1.156
1.236
1.230
1.042
1.014
1.170
1.250
1.018
0.988
1.046
0.934
1.089
0.872
1.111
0.868
0.939
1.115
1.126
0.872
0.906
0.868
0.878
0.878
0.854
0.946
0.847
1.013
0.886
1.078
0.980
1.329
1.103
1.054
0.921
1.005
0.839
0.975
0.955
0.802
0.802
0.844
0.875
1.043
1.027
1.220
1.119
0.887
0.917
1.298
1.280
1.074
1.228
0.920
0.860
0.933
0.854
1.057
0.925
1.104
MP
GPCI
0.752
1.029
1.069
0.438
0.651
0.651
0.639
0.651
0.604
0.717
0.717
0.744
0.954
0.954
0.717
0.717
0.803
0.900
0.926
0.892
1.703
2.269
1.272
0.966
0.966
0.800
0.459
1.750
1.652
1.867
1.193
0.436
0.589
0.721
0.721
0.873
1.197
1.058
0.637
0.637
0.947
0.760
0.823
0.823
2.744
1.518
0.410
0.722
0.946
0.941
0.892
0.892
0.904
0.454
1.068
0.942
0.973
0.973
0.895
0.677
1.504
1.785
1.167
1.710
0.640
0.602
0.976
0.382
0.441
0.441
1.386
46008
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM D—2006 GEOGRAPHIC PRACTICE COST INDICIES (GPCI) BY MEDICARE CARRIER AND LOCALITY—Continued
Carrier
00865
00973
00870
00880
00820
05440
00900
00900
00900
00900
00900
00900
00900
00900
00910
31145
00973
00904
00836
00836
00884
00951
00825
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
Locality
99
20
01
01
02
35
09
11
15
18
20
28
31
99
09
50
50
00
02
99
16
00
21
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
Work
GPCI
Locality name
Rest of Pennsylvania ..........................................................................................................
Puerto Rico ..........................................................................................................................
Rhode Island .......................................................................................................................
South Carolina .....................................................................................................................
South Dakota .......................................................................................................................
Tennessee ...........................................................................................................................
Brazoria, TX ........................................................................................................................
Dallas, TX ............................................................................................................................
Galveston, TX ......................................................................................................................
Houston, TX ........................................................................................................................
Beaumont, TX .....................................................................................................................
Fort Worth, TX .....................................................................................................................
Austin, TX ............................................................................................................................
Rest of Texas ......................................................................................................................
Utah .....................................................................................................................................
Vermont ...............................................................................................................................
Virgin Islands .......................................................................................................................
Virginia .................................................................................................................................
Seattle (King Cnty), WA ......................................................................................................
Rest of Washington .............................................................................................................
West Virginia .......................................................................................................................
Wisconsin ............................................................................................................................
Wyoming ..............................................................................................................................
1.000
1.000
1.045
1.000
1.000
1.000
1.020
1.009
1.000
1.016
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.014
1.000
1.000
1.000
1.000
PE
GPCI
0.902
0.698
0.989
0.893
0.876
0.879
0.961
1.062
0.952
1.014
0.860
0.989
1.046
0.865
0.937
0.968
1.014
0.940
1.131
0.978
0.819
0.918
0.853
MP
GPCI
0.806
0.261
0.909
0.394
0.365
0.631
1.298
1.061
1.298
1.297
1.298
1.061
0.986
1.138
0.662
0.514
1.003
0.579
0.819
0.819
1.547
0.790
0.935
For 2005 and 2006, if the work GPCI falls below a 1.0 work index, then the work GPCI equals 1.0.
For 2005, if the Work, PE and MP GPCI for Alaska falls below 1.67, then the Work, PE and MP GPCIs equal 1.67.
* states are served by more than one carrier
** locality numbers not assigned to proposed localities
ADDENDUM E.—PROPOSED 2006 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)
Carrier
31140
31140
31140
00803
00803
31140
31140
31143
14330
00903
00805
31146
31140
00953
00952
31140
00591
31146
00952
31146
00805
00865
00590
00836
00831
00803
00833
00511
31143
00901
00900
00900
00834
00590
00900
31146
31140
31144
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
2006
GAF
Locality
Locality name
06 .............
05 .............
09 .............
01 .............
02 .............
07 .............
03 .............
01 .............
04 .............
01 .............
01 .............
26 .............
TBD* * ......
01 .............
16 .............
TBD* * ......
00 .............
18 .............
15 .............
17 .............
99 .............
01 .............
04 .............
02 .............
01 .............
03 .............
01 .............
01 .............
99 .............
01 .............
11 .............
18 .............
00 .............
03 .............
31 .............
99 .............
99 .............
40 .............
San Mateo, CA ....................................................................................................................................................
San Francisco, CA ...............................................................................................................................................
Santa Clara, CA ...................................................................................................................................................
Manhattan, NY .....................................................................................................................................................
NYC Suburbs/Long I., NY ...................................................................................................................................
Oakland/Berkley, CA ...........................................................................................................................................
Marin/Napa/Solano, CA .......................................................................................................................................
Metropolitan Boston .............................................................................................................................................
Queens, NY .........................................................................................................................................................
DC + MD/VA Suburbs .........................................................................................................................................
Northern NJ .........................................................................................................................................................
Anaheim/Santa Ana, CA ......................................................................................................................................
Santa Cruz, CA ....................................................................................................................................................
Detroit, MI ............................................................................................................................................................
Chicago, IL ...........................................................................................................................................................
Sonoma, CA ........................................................................................................................................................
Connecticut ..........................................................................................................................................................
Los Angeles, CA ..................................................................................................................................................
Suburban Chicago, IL ..........................................................................................................................................
Ventura, CA .........................................................................................................................................................
Rest of New Jersey .............................................................................................................................................
Metropolitan Philadelphia, PA .............................................................................................................................
Miami, FL .............................................................................................................................................................
Seattle (King Cnty), WA ......................................................................................................................................
Alaska ..................................................................................................................................................................
Poughkpsie/N NYC Suburbs, NY ........................................................................................................................
Hawaii/Guam .......................................................................................................................................................
Atlanta, GA ..........................................................................................................................................................
Rest of Massachusetts ........................................................................................................................................
Baltimore/Surr. Cntys, MD ...................................................................................................................................
Dallas, TX ............................................................................................................................................................
Houston, TX .........................................................................................................................................................
Nevada .................................................................................................................................................................
Fort Lauderdale, FL .............................................................................................................................................
Austin, TX ............................................................................................................................................................
Rest of California * ...............................................................................................................................................
Rest of California * ...............................................................................................................................................
New Hampshire ...................................................................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00246
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
1.259
1.256
1.256
1.184
1.180
1.177
1.154
1.153
1.144
1.132
1.126
1.119
1.119
1.111
1.102
1.098
1.091
1.088
1.085
1.083
1.074
1.069
1.069
1.058
1.055
1.046
1.044
1.043
1.042
1.039
1.034
1.026
1.023
1.022
1.020
1.014
1.014
1.010
46009
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM E.—PROPOSED 2006 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)—Continued
Carrier
00902
00973
00900
00835
00952
00832
00824
00900
31142
00900
00740
00953
00836
00528
00901
00590
00954
00523
00883
31145
00910
00904
00951
00952
00801
05535
00900
00865
00900
00521
00835
00511
00884
00630
31142
00740
00650
00528
00825
05440
00660
00880
00870
00751
00826
00655
00820
00510
05130
00820
00512
00522
00740
00523
00520
00973
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
Locality
01
50
09
01
12
00
01
28
03
15
02
99
99
01
99
99
00
01
00
50
09
00
00
99
99
00
20
99
99
05
99
99
16
00
99
04
00
99
21
35
00
01
01
01
00
00
01
00
00
02
00
00
99
99
13
20
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
2006
GAF
Locality name
Delaware ..............................................................................................................................................................
Virgin Islands .......................................................................................................................................................
Brazoria, TX .........................................................................................................................................................
Portland, OR ........................................................................................................................................................
East St. Louis, IL .................................................................................................................................................
Arizona .................................................................................................................................................................
Colorado ..............................................................................................................................................................
Fort Worth, TX .....................................................................................................................................................
Southern Maine ...................................................................................................................................................
Galveston, TX ......................................................................................................................................................
Metropolitan Kansas City, MO .............................................................................................................................
Rest of Michigan ..................................................................................................................................................
Rest of Washington .............................................................................................................................................
New Orleans, LA .................................................................................................................................................
Rest of Maryland .................................................................................................................................................
Rest of Florida .....................................................................................................................................................
Minnesota ............................................................................................................................................................
Metropolitan St. Louis, MO ..................................................................................................................................
Ohio .....................................................................................................................................................................
Vermont ...............................................................................................................................................................
Utah .....................................................................................................................................................................
Virginia .................................................................................................................................................................
Wisconsin .............................................................................................................................................................
Rest of Illinois ......................................................................................................................................................
Rest of New York ................................................................................................................................................
North Carolina ......................................................................................................................................................
Beaumont, TX ......................................................................................................................................................
Rest of Pennsylvania ...........................................................................................................................................
Rest of Texas ......................................................................................................................................................
New Mexico .........................................................................................................................................................
Rest of Oregon ....................................................................................................................................................
Rest of Georgia ...................................................................................................................................................
West Virginia ........................................................................................................................................................
Indiana .................................................................................................................................................................
Rest of Maine ......................................................................................................................................................
Kansas * ...............................................................................................................................................................
Kansas * ...............................................................................................................................................................
Rest of Louisiana .................................................................................................................................................
Wyoming ..............................................................................................................................................................
Tennessee ...........................................................................................................................................................
Kentucky ..............................................................................................................................................................
South Carolina .....................................................................................................................................................
Rhode Island ........................................................................................................................................................
Montana ...............................................................................................................................................................
Iowa .....................................................................................................................................................................
Nebraska ..............................................................................................................................................................
North Dakota ........................................................................................................................................................
Alabama ...............................................................................................................................................................
Idaho ....................................................................................................................................................................
South Dakota .......................................................................................................................................................
Mississippi ............................................................................................................................................................
Oklahoma .............................................................................................................................................................
Rest of Missouri * .................................................................................................................................................
Rest of Missouri * .................................................................................................................................................
Arkansas ..............................................................................................................................................................
Puerto Rico ..........................................................................................................................................................
1.010
1.007
1.005
1.005
1.003
0.999
0.999
0.998
0.992
0.991
0.987
0.986
0.984
0.984
0.982
0.982
0.980
0.978
0.970
0.968
0.960
0.958
0.956
0.952
0.952
0.951
0.951
0.950
0.947
0.947
0.946
0.943
0.942
0.937
0.936
0.936
0.936
0.936
0.934
0.933
0.932
0.930
0.930
0.928
0.927
0.925
0.924
0.923
0.922
0.922
0.919
0.913
0.910
0.910
0.905
0.840
For 2005 and 2006, if the work GPCI falls below a 1.0 work index, the work GPCI equals 1.0.
* states are served by more than one carrier
** locality numbers not assigned to proposed localities
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK
SSA state/county
code
01000
01010
01020
01030
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Autauga County, Alabama ..................................................................................................
Baldwin County, Alabama ...................................................................................................
Barbour County, Alabama ...................................................................................................
Bibb County, Alabama ........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00247
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
5240
5160
01
01
CBSA No.
33860
01
01
13820
46010
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
01040
01050
01060
01070
01080
01090
01100
01110
01120
01130
01140
01150
01160
01170
01180
01190
01200
01210
01220
01230
01240
01250
01260
01270
01280
01290
01300
01310
01320
01330
01340
01350
01360
01370
01380
01390
01400
01410
01420
01430
01440
01450
01460
01470
01480
01490
01500
01510
01520
01530
01540
01550
01560
01570
01580
01590
01600
01610
01620
01630
01640
01650
01660
02013
02016
02020
02030
02040
02050
02060
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Blount County, Alabama .....................................................................................................
Bullock County, Alabama ....................................................................................................
Butler County, Alabama ......................................................................................................
Calhoun County, Alabama ..................................................................................................
Chambers County, Alabama ...............................................................................................
Cherokee County, Alabama ................................................................................................
Chilton County, Alabama ....................................................................................................
Choctaw County, Alabama ..................................................................................................
Clarke County, Alabama .....................................................................................................
Clay County, Alabama ........................................................................................................
Cleburne County, Alabama .................................................................................................
Coffee County, Alabama .....................................................................................................
Colbert County, Alabama ....................................................................................................
Conecuh County, Alabama .................................................................................................
Coosa County, Alabama .....................................................................................................
Covington County, Alabama ...............................................................................................
Crenshaw County, Alabama ...............................................................................................
Cullman County, Alabama ..................................................................................................
Dale County, Alabama ........................................................................................................
Dallas County, Alabama ......................................................................................................
De Kalb County, Alabama ...................................................................................................
Elmore County, Alabama ....................................................................................................
Escambia County, Alabama ................................................................................................
Etowah County, Alabama ....................................................................................................
Fayette County, Alabama ....................................................................................................
Franklin County, Alabama ...................................................................................................
Geneva County, Alabama ...................................................................................................
Greene County, Alabama ....................................................................................................
Hale County, Alabama ........................................................................................................
Henry County, Alabama ......................................................................................................
Houston County, Alabama ..................................................................................................
Jackson County, Alabama ..................................................................................................
Jefferson County, Alabama .................................................................................................
Lamar County, Alabama .....................................................................................................
Lauderdale County, Alabama ..............................................................................................
Lawrence County, Alabama ................................................................................................
Lee County, Alabama ..........................................................................................................
Limestone County, Alabama ...............................................................................................
Lowndes County, Alabama .................................................................................................
Macon County, Alabama .....................................................................................................
Madison County, Alabama ..................................................................................................
Marengo County, Alabama .................................................................................................
Marion County, Alabama .....................................................................................................
Marshall County, Alabama ..................................................................................................
Mobile County, Alabama .....................................................................................................
Monroe County, Alabama ...................................................................................................
Montgomery County, Alabama ............................................................................................
Morgan County, Alabama ...................................................................................................
Perry County, Alabama .......................................................................................................
Pickens County, Alabama ...................................................................................................
Pike County, Alabama .........................................................................................................
Randolph County, Alabama ................................................................................................
Russell County, Alabama ....................................................................................................
St Clair County, Alabama ....................................................................................................
Shelby County, Alabama .....................................................................................................
Sumter County, Alabama ....................................................................................................
Talladega County, Alabama ................................................................................................
Tallapoosa County, Alabama ..............................................................................................
Tuscaloosa County, Alabama .............................................................................................
Walker County, Alabama ....................................................................................................
Washington County, Alabama .............................................................................................
Wilcox County, Alabama .....................................................................................................
Winston County, Alabama ...................................................................................................
Aleutians County East, Alaska ............................................................................................
Aleutians County West, Alaska ...........................................................................................
Anchorage County, Alaska ..................................................................................................
Angoon County, Alaska .......................................................................................................
Barrow-North Slope County, Alaska ...................................................................................
Bethel County, Alaska .........................................................................................................
Bristol Bay Borough County, Alaska ...................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00248
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
1000
01
01
0450
01
01
01
01
01
01
01
01
2650
01
01
01
01
01
2180
01
01
5240
01
2880
01
01
01
01
01
01
2180
01
1000
01
2650
01
01
01
01
01
3440
01
01
01
5160
01
5240
01
01
01
01
01
1800
1000
1000
01
01
01
8600
1000
01
01
01
02
02
0380
02
02
02
02
CBSA No.
13820
01
01
11500
01
01
13820
01
01
01
01
01
22520
01
01
01
01
01
01
01
01
33860
01
23460
01
01
20020
46220
46220
20020
20020
01
13820
01
22520
19460
12220
26620
33860
01
26620
01
01
01
33660
01
33860
19460
01
01
01
01
17980
13820
13820
01
01
01
46220
13820
01
01
01
02
02
11260
02
02
02
02
46011
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
02068
02070
02080
02090
02100
02110
02120
02122
02130
02140
02150
02160
02164
02170
02180
02185
02188
02190
02200
02201
02210
02220
02230
02231
02232
02240
02250
02260
02261
02270
02280
02282
02290
03000
03010
03020
03030
03040
03050
03055
03060
03070
03080
03090
03100
03110
03120
03130
04000
04010
04020
04030
04040
04050
04060
04070
04080
04090
04100
04110
04120
04130
04140
04150
04160
04170
04180
04190
04200
04210
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Denali County, Alaska .........................................................................................................
Bristol Bay County, Alaska ..................................................................................................
Cordova-Mc Carthy County, Alaska ....................................................................................
Fairbanks County, Alaska ...................................................................................................
Haines County, Alaska ........................................................................................................
Juneau County, Alaska .......................................................................................................
Kenai-Cook Inlet County, Alaska ........................................................................................
Kenai Peninsula Borough, Alaska .......................................................................................
Ketchikan County, Alaska ...................................................................................................
Kobuk County, Alaska .........................................................................................................
Kodiak County, Alaska ........................................................................................................
Kuskokwin County, Alaska ..................................................................................................
Lake and Peninsula Borough, Alaska .................................................................................
Matanuska County, Alaska .................................................................................................
Nome County, Alaska .........................................................................................................
North Slope Borough, Alaska ..............................................................................................
Northwest Arctic Borough, Alaska ......................................................................................
Outer Ketchikan County, Alaska .........................................................................................
Prince Of Wales County, Alaska .........................................................................................
Prince of Wales-Outer Ketchikan Census Area, Alaska .....................................................
Seward County, Alaska .......................................................................................................
Sitka County, Alaska ...........................................................................................................
Skagway-Yakutat County, Alaska .......................................................................................
Skagway-Yakutat-Angoon Census Area, Alaska ................................................................
Skagway-Hoonah-Angoon Census Area, Alaska ...............................................................
Southeast Fairbanks County, Alaska ..................................................................................
Upper Yukon County, Alaska ..............................................................................................
Valdz-Chitna-Whitier County, Alaska ..................................................................................
Valdex-Cordove Census Area, Alaska ................................................................................
Wade Hampton County, Alaska ..........................................................................................
Wrangell-Petersburg County, Alaska ..................................................................................
Yakutat Borough, Alaska .....................................................................................................
Yukon-Koyukuk County, Alaska ..........................................................................................
Apache County, Arizona .....................................................................................................
Cochise County, Arizona .....................................................................................................
Coconino County, Arizona ..................................................................................................
Gila County, Arizona ...........................................................................................................
Graham County, Arizona .....................................................................................................
Greenlee County, Arizona ...................................................................................................
La Paz County, Arizona ......................................................................................................
Maricopa County, Arizona ...................................................................................................
Mohave County, Arizona .....................................................................................................
Navajo County, Arizona ......................................................................................................
Pima County, Arizona .........................................................................................................
Pinal County, Arizona ..........................................................................................................
Santa Cruz County, Arizona ...............................................................................................
Yavapai County, Arizona .....................................................................................................
Yuma County, Arizona ........................................................................................................
Arkansas County, Arkansas ................................................................................................
Ashley County, Arkansas ....................................................................................................
Baxter County, Arkansas ....................................................................................................
Benton County, Arkansas ...................................................................................................
Boone County, Arkansas ....................................................................................................
Bradley County, Arkansas ...................................................................................................
Calhoun County, Arkansas .................................................................................................
Carroll County, Arkansas ....................................................................................................
Chicot County, Arkansas .....................................................................................................
Clark County, Arkansas ......................................................................................................
Clay County, Arkansas ........................................................................................................
Cleburne County, Arkansas ................................................................................................
Cleveland County, Arkansas ...............................................................................................
Columbia County, Arkansas ................................................................................................
Conway County, Arkansas ..................................................................................................
Craighead County, Arkansas ..............................................................................................
Crawford County, Arkansas ................................................................................................
Crittenden County, Arkansas ..............................................................................................
Cross County, Arkansas .....................................................................................................
Dallas County, Arkansas .....................................................................................................
Desha County, Arkansas ....................................................................................................
Drew County, Arkansas ......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00249
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
03
03
03
03
03
03
03
6200
03
03
8520
03
03
03
03
04
04
04
04
04
04
04
04
04
04
04
04
04
04
04
04
2720
4920
04
04
04
04
CBSA No.
02
02
02
21820
02
02
02
02
02
02
02
02
02
11260
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
03
03
22380
03
03
03
03
38060
03
03
46060
38060
03
39140
49740
04
04
04
22220
04
04
04
04
04
04
04
04
38220
04
04
27860
22900
32820
04
04
04
04
46012
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
04220
04230
04240
04250
04260
04270
04280
04290
04300
04310
04320
04330
04340
04350
04360
04370
04380
04390
04400
04410
04420
04430
04440
04450
04460
04470
04480
04490
04500
04510
04520
04530
04540
04550
04560
04570
04580
04590
04600
04610
04620
04630
04640
04650
04660
04670
04680
04690
04700
04710
04720
04730
04740
05000
05010
05020
05030
05040
05050
05060
05070
05080
05090
05100
05110
05120
05130
05140
05150
05160
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Faulkner County, Arkansas .................................................................................................
Franklin County, Arkansas ..................................................................................................
Fulton County, Arkansas .....................................................................................................
Garland County, Arkansas ..................................................................................................
Grant County, Arkansas ......................................................................................................
Greene County, Arkansas ...................................................................................................
Hempstead County, Arkansas ............................................................................................
Hot Spring County, Arkansas ..............................................................................................
Howard County, Arkansas ..................................................................................................
Independence County, Arkansas ........................................................................................
Izard County, Arkansas .......................................................................................................
Jackson County, Arkansas ..................................................................................................
Jefferson County, Arkansas ................................................................................................
Johnson County, Arkansas .................................................................................................
Lafayette County, Arkansas ................................................................................................
Lawrence County, Arkansas ...............................................................................................
Lee County, Arkansas .........................................................................................................
Lincoln County, Arkansas ...................................................................................................
Little River County, Arkansas ..............................................................................................
Logan County, Arkansas .....................................................................................................
Lonoke County, Arkansas ...................................................................................................
Madison County, Arkansas .................................................................................................
Marion County, Arkansas ....................................................................................................
Miller County, Arkansas ......................................................................................................
Mississippi County, Arkansas .............................................................................................
Monroe County, Arkansas ...................................................................................................
Montgomery County, Arkansas ...........................................................................................
Nevada County, Arkansas ..................................................................................................
Newton County, Arkansas ...................................................................................................
Ouachita County, Arkansas ................................................................................................
Perry County, Arkansas ......................................................................................................
Phillips County, Arkansas ...................................................................................................
Pike County, Arkansas ........................................................................................................
Poinsett County, Arkansas ..................................................................................................
Polk County, Arkansas ........................................................................................................
Pope County, Arkansas ......................................................................................................
Prairie County, Arkansas ....................................................................................................
Pulaski County, Arkansas ...................................................................................................
Randolph County, Arkansas ...............................................................................................
St Francis County, Arkansas ..............................................................................................
Saline County, Arkansas .....................................................................................................
Scott County, Arkansas .......................................................................................................
Searcy County, Arkansas ....................................................................................................
Sebastian County, Arkansas ...............................................................................................
Sevier County, Arkansas .....................................................................................................
Sharp County, Arkansas .....................................................................................................
Stone County, Arkansas .....................................................................................................
Union County, Arkansas .....................................................................................................
Van Buren County, Arkansas ..............................................................................................
Washington County, Arkansas ............................................................................................
White County, Arkansas ......................................................................................................
Woodruff County, Arkansas ................................................................................................
Yell County, Arkansas .........................................................................................................
Alameda County, California ................................................................................................
Alpine County, California .....................................................................................................
Amador County, California ..................................................................................................
Butte County, California ......................................................................................................
Calaveras County, California ..............................................................................................
Colusa County, California ...................................................................................................
Contra Costa County, California .........................................................................................
Del Norte County, California ...............................................................................................
Eldorado County, California ................................................................................................
Fresno County, California ...................................................................................................
Glenn County, California .....................................................................................................
Humboldt County, California ...............................................................................................
Imperial County, California ..................................................................................................
Inyo County, California ........................................................................................................
Kern County, California .......................................................................................................
Kings County, California ......................................................................................................
Lake County, California .......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00250
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
4400
04
04
04
04
04
04
04
04
04
04
04
6240
04
04
04
04
04
04
04
4400
04
04
8360
04
04
04
04
04
04
04
04
04
04
04
04
04
4400
04
04
4400
04
04
2720
04
04
04
04
04
2580
04
04
04
5775
05
05
1620
05
05
5775
05
6920
2840
05
05
05
05
0680
05
05
CBSA No.
30780
22900
04
26300
30780
04
04
04
04
04
04
04
38220
04
04
04
04
38220
04
04
30780
22220
04
45500
04
04
04
04
04
04
30780
04
04
27860
04
04
04
30780
04
04
30780
04
04
22900
04
04
04
04
04
22220
04
04
04
36084
05
05
17020
05
05
36084
05
40900
23420
05
05
20940
05
12540
25260
05
46013
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
05170
05200
05210
05300
05310
05320
05330
05340
05350
05360
05370
05380
05390
05400
05410
05420
05430
05440
05450
05460
05470
05480
05490
05500
05510
05520
05530
05540
05550
05560
05570
05580
05590
05600
05610
05620
05630
05640
05650
05660
05670
05680
06000
06010
06020
06030
06040
06050
06060
06070
06080
06090
06100
06110
06120
06130
06140
06150
06160
06170
06180
06190
06200
06210
06220
06230
06240
06250
06260
06270
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Lassen County, California ...................................................................................................
Los Angeles County, California ...........................................................................................
Los Angeles County, California ...........................................................................................
Madera County, California ..................................................................................................
Marin County, California ......................................................................................................
Mariposa County, California ................................................................................................
Mendocino County, California .............................................................................................
Merced County, California ...................................................................................................
Modoc County, California ....................................................................................................
Mono County, California ......................................................................................................
Monterey County, California ................................................................................................
Napa County, California ......................................................................................................
Nevada County, California ..................................................................................................
Orange County, California ...................................................................................................
Placer County, California ....................................................................................................
Plumas County, California ...................................................................................................
Riverside County, California ................................................................................................
Sacramento County, California ...........................................................................................
San Benito County, California .............................................................................................
San Bernardino County, California .....................................................................................
San Diego County, California ..............................................................................................
San Francisco County, California .......................................................................................
San Joaquin County, California ..........................................................................................
San Luis Obispo County, California ....................................................................................
San Mateo County, California .............................................................................................
Santa Barbara County, California .......................................................................................
Santa Clara County, California ...........................................................................................
Santa Cruz County, California ............................................................................................
Shasta County, California ...................................................................................................
Sierra County, California .....................................................................................................
Siskiyou County, California .................................................................................................
Solano County, California ...................................................................................................
Sonoma County, California .................................................................................................
Stanislaus County, California ..............................................................................................
Sutter County, California .....................................................................................................
Tehama County, California .................................................................................................
Trinity County, California .....................................................................................................
Tulare County, California ....................................................................................................
Tuolumne County, California ...............................................................................................
Ventura County, California ..................................................................................................
Yolo County, California .......................................................................................................
Yuba County, California ......................................................................................................
Adams County, Colorado ....................................................................................................
Alamosa County, Colorado .................................................................................................
Arapahoe County, Colorado ................................................................................................
Archuleta County, Colorado ................................................................................................
Baca County, Colorado .......................................................................................................
Bent County, Colorado ........................................................................................................
Boulder County, Colorado ...................................................................................................
Chaffee County, Colorado ...................................................................................................
Cheyenne County, Colorado ...............................................................................................
Clear Creek County, Colorado ............................................................................................
Conejos County, Colorado ..................................................................................................
Costilla County, Colorado ...................................................................................................
Crowley County, Colorado ..................................................................................................
Custer County, Colorado .....................................................................................................
Delta County, Colorado .......................................................................................................
Denver County, Colorado ....................................................................................................
Dolores County, Colorado ...................................................................................................
Douglas County, Colorado ..................................................................................................
Eagle County, Colorado ......................................................................................................
Elbert County, Colorado ......................................................................................................
El Paso County, Colorado ...................................................................................................
Fremont County, Colorado ..................................................................................................
Garfield County, Colorado ...................................................................................................
Gilpin County, Colorado ......................................................................................................
Grand County, Colorado .....................................................................................................
Gunnison County, Colorado ................................................................................................
Hinsdale County, Colorado .................................................................................................
Huerfano County, Colorado ................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00251
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
05
4480
4480
05
7360
05
05
4940
05
05
7120
8720
05
0360
6920
05
6780
6920
05
6780
7320
7360
8120
05
7360
7480
7400
7485
6690
05
05
8720
7500
5170
9340
05
05
8780
05
6000
6920
9340
2080
06
2080
06
06
06
1125
06
06
06
06
06
06
06
06
2080
06
2080
06
06
1720
06
06
06
06
06
06
06
CBSA No.
05
31084
31084
31460
41884
05
05
32900
05
05
41500
34900
05
42044
40900
05
40140
40900
41940
40140
41740
41884
44700
42020
41884
42060
41940
42100
39820
05
05
46700
42220
33700
49700
05
05
47300
05
37100
40900
49700
19740
06
19740
06
06
06
14500
06
06
19740
06
06
06
06
06
19740
06
19740
06
19740
17820
06
06
19740
06
06
06
06
46014
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
06280
06290
06300
06310
06320
06330
06340
06350
06360
06370
06380
06390
06400
06410
06420
06430
06440
06450
06460
06470
06480
06490
06500
06510
06520
06530
06540
06550
06560
06570
06580
06590
06600
06610
06620
06630
07000
07010
07020
07030
07040
07050
07060
07070
08000
08010
08020
09000
10000
10010
10020
10030
10040
10050
10060
10070
10080
10090
10100
10110
10120
10130
10140
10150
10160
10170
10180
10190
10200
10210
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Jackson County, Colorado ..................................................................................................
Jefferson County, Colorado ................................................................................................
Kiowa County, Colorado .....................................................................................................
Kit Carson County, Colorado ..............................................................................................
Lake County, Colorado .......................................................................................................
La Plata County, Colorado ..................................................................................................
Larimer County, Colorado ...................................................................................................
Las Animas County, Colorado ............................................................................................
Lincoln County, Colorado ....................................................................................................
Logan County, Colorado .....................................................................................................
Mesa County, Colorado ......................................................................................................
Mineral County, Colorado ...................................................................................................
Moffat County, Colorado .....................................................................................................
Montezuma County, Colorado ............................................................................................
Montrose County, Colorado ................................................................................................
Morgan County, Colorado ...................................................................................................
Otero County, Colorado ......................................................................................................
Ouray County, Colorado .....................................................................................................
Park County, Colorado ........................................................................................................
Phillips County, Colorado ....................................................................................................
Pitkin County, Colorado ......................................................................................................
Prowers County, Colorado ..................................................................................................
Pueblo County, Colorado ....................................................................................................
Rio Blanco County, Colorado ..............................................................................................
Rio Grande County, Colorado .............................................................................................
Routt County, Colorado .......................................................................................................
Saguache County, Colorado ...............................................................................................
San Juan County, Colorado ................................................................................................
San Miguel County, Colorado .............................................................................................
Sedgwick County, Colorado ................................................................................................
Summit County, Colorado ...................................................................................................
Teller County, Colorado ......................................................................................................
Washington County, Colorado ............................................................................................
Weld County, Colorado .......................................................................................................
Yuma County, Colorado ......................................................................................................
Broomfield County, Colorado ..............................................................................................
Fairfield County, Connecticut ..............................................................................................
Hartford County, Connecticut ..............................................................................................
Litchfield County, Connecticut .............................................................................................
Middlesex County, Connecticut ...........................................................................................
New Haven County, Connecticut ........................................................................................
New London County, Connecticut ......................................................................................
Tolland County, Connecticut ...............................................................................................
Windham County, Connecticut ............................................................................................
Kent County, Delaware .......................................................................................................
New Castle County, Delaware ............................................................................................
Sussex County, Delaware ...................................................................................................
Washington DC County, Dist Of Col ...................................................................................
Alachua County, Florida ......................................................................................................
Baker County, Florida .........................................................................................................
Bay County, Florida .............................................................................................................
Bradford County, Florida .....................................................................................................
Brevard County, Florida ......................................................................................................
Broward County, Florida .....................................................................................................
Calhoun County, Florida .....................................................................................................
Charlotte County, Florida ....................................................................................................
Citrus County, Florida .........................................................................................................
Clay County, Florida ............................................................................................................
Collier County, Florida .........................................................................................................
Columbia County, Florida ....................................................................................................
Dade County, Florida ..........................................................................................................
De Soto County, Florida ......................................................................................................
Dixie County, Florida ...........................................................................................................
Duval County, Florida ..........................................................................................................
Escambia County, Florida ...................................................................................................
Flagler County, Florida ........................................................................................................
Franklin County, Florida ......................................................................................................
Gadsden County, Florida ....................................................................................................
Gilchrist County, Florida ......................................................................................................
Glades County, Florida .......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00252
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
06
2080
06
06
06
06
2670
06
06
06
06
06
06
06
06
06
06
06
06
06
06
06
6560
06
06
06
06
06
06
06
06
06
06
3060
06
06
1163
3283
3283
3283
5483
5523
3283
07
07
9160
08
8840
2900
10
6015
10
4900
2680
10
10
10
3600
5345
10
5000
10
10
3600
6080
10
10
8240
10
10
CBSA No.
06
19740
06
06
06
06
22660
06
06
06
24300
06
06
06
06
06
06
06
19740
06
06
06
39380
06
06
06
06
06
06
06
06
17820
06
24540
06
19740
14860
25540
25540
25540
35300
35980
25540
07
20100
48864
08
47894
23540
27260
37460
10
37340
22744
10
39460
10
27260
34940
10
33124
10
10
27260
37860
10
10
45220
23540
10
46015
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
10220
10230
10240
10250
10260
10270
10280
10290
10300
10310
10320
10330
10340
10350
10360
10370
10380
10390
10400
10410
10420
10430
10440
10450
10460
10470
10480
10490
10500
10510
10520
10530
10540
10550
10560
10570
10580
10590
10600
10610
10620
10630
10640
10650
10660
11000
11010
11011
11020
11030
11040
11050
11060
11070
11080
11090
11100
11110
11120
11130
11140
11150
11160
11161
11170
11180
11190
11200
11210
11220
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Gulf County, Florida ............................................................................................................
Hamilton County, Florida .....................................................................................................
Hardee County, Florida .......................................................................................................
Hendry County, Florida .......................................................................................................
Hernando County, Florida ...................................................................................................
Highlands County, Florida ...................................................................................................
Hillsborough County, Florida ...............................................................................................
Holmes County, Florida .......................................................................................................
Indian River County, Florida ...............................................................................................
Jackson County, Florida ......................................................................................................
Jefferson County, Florida ....................................................................................................
Lafayette County, Florida ....................................................................................................
Lake County, Florida ...........................................................................................................
Lee County, Florida .............................................................................................................
Leon County, Florida ...........................................................................................................
Levy County, Florida ...........................................................................................................
Liberty County, Florida ........................................................................................................
Madison County, Florida .....................................................................................................
Manatee County, Florida .....................................................................................................
Marion County, Florida ........................................................................................................
Martin County, Florida .........................................................................................................
Monroe County, Florida .......................................................................................................
Nassau County, Florida .......................................................................................................
Okaloosa County, Florida ....................................................................................................
Okeechobee County, Florida ..............................................................................................
Orange County, Florida .......................................................................................................
Osceola County, Florida ......................................................................................................
Palm Beach County, Florida ...............................................................................................
Pasco County, Florida .........................................................................................................
Pinellas County, Florida ......................................................................................................
Polk County, Florida ............................................................................................................
Putnam County, Florida ......................................................................................................
St. Johns County, Florida ....................................................................................................
St Lucie County, Florida ......................................................................................................
Santa Rosa County, Florida ................................................................................................
Sarasota County, Florida ....................................................................................................
Seminole County, Florida ....................................................................................................
Sumter County, Florida .......................................................................................................
Suwannee County, Florida ..................................................................................................
Taylor County, Florida .........................................................................................................
Union County, Florida .........................................................................................................
Volusia County, Florida .......................................................................................................
Wakulla County, Florida ......................................................................................................
Walton County, Florida ........................................................................................................
Washington County, Florida ................................................................................................
Appling County, Georgia .....................................................................................................
Atkinson County, Georgia ...................................................................................................
Bacon County, Georgia .......................................................................................................
Baker County, Georgia ........................................................................................................
Baldwin County, Georgia ....................................................................................................
Banks County, Georgia .......................................................................................................
Barrow County, Georgia ......................................................................................................
Bartow County, Georgia ......................................................................................................
Ben Hill County, Georgia ....................................................................................................
Berrien County, Georgia .....................................................................................................
Bibb County, Georgia ..........................................................................................................
Bleckley County, Georgia ....................................................................................................
Brantley County, Georgia ....................................................................................................
Brooks County, Georgia ......................................................................................................
Bryan County, Georgia ........................................................................................................
Bulloch County, Georgia .....................................................................................................
Burke County, Georgia ........................................................................................................
Butts County, Georgia .........................................................................................................
Calhoun County, Georgia ....................................................................................................
Camden County, Georgia ...................................................................................................
Candler County, Georgia ....................................................................................................
Carroll County, Georgia ......................................................................................................
Catoosa County, Georgia ....................................................................................................
Charlton County, Georgia ...................................................................................................
Chatham County, Georgia ..................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00253
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
10
10
10
10
8280
10
8280
10
10
10
10
10
10
2700
8240
10
10
10
1140
5790
2710
10
3600
2750
10
5960
5960
8960
8280
8280
3980
10
3600
2710
6080
7510
5960
10
10
10
10
2020
10
10
10
11
11
11
11
11
11
0520
11
11
11
4680
11
11
11
11
11
11
0520
11
11
11
11
1560
11
7520
CBSA No.
10
10
10
10
45300
10
45300
10
46940
10
45220
10
36740
15980
45220
10
10
10
42260
36100
38940
10
27260
23020
10
36740
36740
48424
45300
45300
29460
10
27260
38940
37860
42260
36740
10
10
10
10
19660
45220
10
10
11
11
11
10500
11
11
12060
12060
11
11
31420
11
15260
46660
42340
11
12260
12060
11
11
11
12060
16860
11
42340
46016
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
11230
11240
11250
11260
11270
11280
11281
11290
11291
11300
11310
11311
11320
11330
11340
11341
11350
11360
11370
11380
11381
11390
11400
11410
11420
11421
11430
11440
11441
11450
11451
11460
11461
11462
11470
11471
11480
11490
11500
11510
11520
11530
11540
11550
11560
11570
11580
11581
11590
11591
11600
11601
11610
11611
11612
11620
11630
11640
11650
11651
11652
11660
11670
11680
11690
11691
11700
11701
11702
11703
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Chattahoochee County, Georgia .........................................................................................
Chattooga County, Georgia ................................................................................................
Cherokee County, Georgia .................................................................................................
Clarke County, Georgia .......................................................................................................
Clay County, Georgia ..........................................................................................................
Clayton County, Georgia .....................................................................................................
Clinch County, Georgia .......................................................................................................
Cobb County, Georgia ........................................................................................................
Coffee County, Georgia ......................................................................................................
Colquitt County, Georgia .....................................................................................................
Columbia County, Georgia ..................................................................................................
Cook County, Georgia .........................................................................................................
Coweta County, Georgia .....................................................................................................
Crawford County, Georgia ..................................................................................................
Crisp County, Georgia .........................................................................................................
Dade County, Georgia ........................................................................................................
Dawson County, Georgia ....................................................................................................
Decatur County, Georgia ....................................................................................................
De Kalb County, Georgia ....................................................................................................
Dodge County, Georgia ......................................................................................................
Dooly County, Georgia ........................................................................................................
Dougherty County, Georgia ................................................................................................
Douglas County, Georgia ....................................................................................................
Early County, Georgia .........................................................................................................
Echols County, Georgia ......................................................................................................
Effingham County, Georgia .................................................................................................
Elbert County, Georgia ........................................................................................................
Emanuel County, Georgia ...................................................................................................
Evans County, Georgia .......................................................................................................
Fannin County, Georgia ......................................................................................................
Fayette County, Georgia .....................................................................................................
Floyd County, Georgia ........................................................................................................
Forsyth County, Georgia .....................................................................................................
Franklin County, Georgia ....................................................................................................
Fulton County, Georgia .......................................................................................................
Gilmer County, Georgia ......................................................................................................
Glascock County, Georgia ..................................................................................................
Glynn County, Georgia ........................................................................................................
Gordon County, Georgia .....................................................................................................
Grady County, Georgia .......................................................................................................
Greene County, Georgia .....................................................................................................
Gwinnett County, Georgia ...................................................................................................
Habersham County, Georgia ..............................................................................................
Hall County, Georgia ...........................................................................................................
Hancock County, Georgia ...................................................................................................
Haralson County, Georgia ...................................................................................................
Harris County, Georgia .......................................................................................................
Hart County, Georgia ..........................................................................................................
Heard County, Georgia .......................................................................................................
Henry County, Georgia .......................................................................................................
Houston County, Georgia ....................................................................................................
Irwin County, Georgia .........................................................................................................
Jackson County, Georgia ....................................................................................................
Jasper County, Georgia ......................................................................................................
Jeff Davis County, Georgia .................................................................................................
Jefferson County, Georgia ..................................................................................................
Jenkins County, Georgia .....................................................................................................
Johnson County, Georgia ...................................................................................................
Jones County, Georgia .......................................................................................................
Lamar County, Georgia .......................................................................................................
Lanier County, Georgia .......................................................................................................
Laurens County, Georgia ....................................................................................................
Lee County, Georgia ...........................................................................................................
Liberty County, Georgia ......................................................................................................
Lincoln County, Georgia ......................................................................................................
Long County, Georgia .........................................................................................................
Lowndes County, Georgia ...................................................................................................
Lumpkin County, Georgia ...................................................................................................
Mc Duffie County, Georgia ..................................................................................................
Mc Intosh County, Georgia .................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00254
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
1800
11
0520
0500
11
0520
11
0520
11
11
0600
11
0520
11
11
1560
11
11
0520
11
11
0120
0520
11
11
7520
11
11
11
11
0520
11
0520
11
0520
11
11
11
11
11
11
0520
11
11
11
11
11
11
11
0520
4680
11
0500
11
11
11
11
11
4680
11
11
11
0120
11
11
11
11
11
0600
11
CBSA No.
17980
11
12060
12020
11
12060
11
12060
11
11
12260
11
12060
31420
11
16860
12060
11
12060
11
11
10500
12060
11
46660
42340
11
11
11
11
12060
40660
12060
11
12060
11
11
15260
11
11
11
12060
11
23580
11
12060
17980
11
12060
12060
47580
11
11
12060
11
11
11
11
31420
12060
46660
11
10500
25980
11
25980
46660
11
12260
15260
46017
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
11710
11720
11730
11740
11741
11750
11760
11770
11771
11772
11780
11790
11800
11801
11810
11811
11812
11820
11821
11830
11831
11832
11833
11834
11835
11840
11841
11842
11850
11851
11860
11861
11862
11870
11880
11881
11882
11883
11884
11885
11890
11900
11901
11902
11903
11910
11911
11912
11913
11920
11921
11930
11940
11941
11950
11960
11961
11962
11963
11970
11971
11972
11973
11980
12005
12010
12020
12040
12050
13000
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Macon County, Georgia ......................................................................................................
Madison County, Georgia ...................................................................................................
Marion County, Georgia ......................................................................................................
Meriwether County, Georgia ...............................................................................................
Miller County, Georgia ........................................................................................................
Mitchell County, Georgia .....................................................................................................
Monroe County, Georgia .....................................................................................................
Montgomery County, Georgia .............................................................................................
Morgan County, Georgia .....................................................................................................
Murray County, Georgia ......................................................................................................
Muscogee County, Georgia ................................................................................................
Newton County, Georgia .....................................................................................................
Oconee County, Georgia ....................................................................................................
Oglethorpe County, Georgia ...............................................................................................
Paulding County, Georgia ...................................................................................................
Peach County, Georgia .......................................................................................................
Pickens County, Georgia ....................................................................................................
Pierce County, Georgia .......................................................................................................
Pike County, Georgia ..........................................................................................................
Polk County, Georgia ..........................................................................................................
Pulaski County, Georgia .....................................................................................................
Putnam County, Georgia .....................................................................................................
Quitman County, Georgia ...................................................................................................
Rabun County, Georgia ......................................................................................................
Randolph County, Georgia ..................................................................................................
Richmond County, Georgia .................................................................................................
Rockdale County, Georgia ..................................................................................................
Schley County, Georgia ......................................................................................................
Screven County, Georgia ....................................................................................................
Seminole County, Georgia ..................................................................................................
Spalding County, Georgia ...................................................................................................
Stephens County, Georgia ..................................................................................................
Stewart County, Georgia .....................................................................................................
Sumter County, Georgia .....................................................................................................
Talbot County, Georgia .......................................................................................................
Taliaferro County, Georgia ..................................................................................................
Tattnall County, Georgia .....................................................................................................
Taylor County, Georgia .......................................................................................................
Telfair County, Georgia .......................................................................................................
Terrell County, Georgia .......................................................................................................
Thomas County, Georgia ....................................................................................................
Tift County, Georgia ............................................................................................................
Toombs County, Georgia ....................................................................................................
Towns County, Georgia ......................................................................................................
Treutlen County, Georgia ....................................................................................................
Troup County, Georgia ........................................................................................................
Turner County, Georgia ......................................................................................................
Twiggs County, Georgia ......................................................................................................
Union County, Georgia ........................................................................................................
Upson County, Georgia .......................................................................................................
Walker County, Georgia ......................................................................................................
Walton County, Georgia ......................................................................................................
Ware County, Georgia ........................................................................................................
Warren County, Georgia .....................................................................................................
Washington County, Georgia ..............................................................................................
Wayne County, Georgia ......................................................................................................
Webster County, Georgia ....................................................................................................
Wheeler County, Georgia ....................................................................................................
White County, Georgia ........................................................................................................
Whitfield County, Georgia ...................................................................................................
Wilcox County, Georgia ......................................................................................................
Wilkes County, Georgia ......................................................................................................
Wilkinson County, Georgia ..................................................................................................
Worth County, Georgia .......................................................................................................
Kalawao County, Hawaii .....................................................................................................
Hawaii County, Hawaii ........................................................................................................
Honolulu County, Hawaii .....................................................................................................
Kauai County, Hawaii ..........................................................................................................
Maui County, Hawaii ...........................................................................................................
Ada County, Idaho ..............................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00255
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
11
0500
11
11
11
11
11
11
11
11
1800
0520
0500
11
0520
4680
11
11
11
11
11
11
11
11
11
0600
0520
11
11
11
0520
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
1560
0520
11
11
11
11
11
11
11
11
11
11
11
11
12
12
3320
12
12
1080
CBSA No.
11
12020
17980
12060
11
11
31420
11
11
19140
17980
12060
12020
12020
12060
11
12060
11
12060
11
11
11
11
11
11
12260
12060
11
11
11
12060
11
11
11
11
11
11
11
11
10500
11
11
11
11
11
11
11
31420
11
11
16860
12060
11
11
11
11
11
11
11
19140
11
11
11
10500
12
12
26180
12
12
14260
46018
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
13010
13020
13030
13040
13050
13060
13070
13080
13090
13100
13110
13120
13130
13140
13150
13160
13170
13180
13190
13200
13210
13220
13230
13240
13250
13260
13270
13280
13290
13300
13310
13320
13330
13340
13350
13360
13370
13380
13390
13400
13410
13420
13430
14000
14010
14020
14030
14040
14050
14060
14070
14080
14090
14100
14110
14120
14130
14140
14141
14150
14160
14170
14180
14190
14250
14310
14320
14330
14340
14350
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Adams County, Idaho ..........................................................................................................
Bannock County, Idaho .......................................................................................................
Bear Lake County, Idaho ....................................................................................................
Benewah County, Idaho ......................................................................................................
Bingham County, Idaho .......................................................................................................
Blaine County, Idaho ...........................................................................................................
Boise County, Idaho ............................................................................................................
Bonner County, Idaho .........................................................................................................
Bonneville County, Idaho ....................................................................................................
Boundary County, Idaho .....................................................................................................
Butte County, Idaho ............................................................................................................
Camas County, Idaho .........................................................................................................
Canyon County, Idaho ........................................................................................................
Caribou County, Idaho ........................................................................................................
Cassia County, Idaho ..........................................................................................................
Clark County, Idaho ............................................................................................................
Clearwater County, Idaho ...................................................................................................
Custer County, Idaho ..........................................................................................................
Elmore County, Idaho .........................................................................................................
Franklin County, Idaho ........................................................................................................
Fremont County, Idaho .......................................................................................................
Gem County, Idaho .............................................................................................................
Gooding County, Idaho .......................................................................................................
Idaho County, Idaho ............................................................................................................
Jefferson County, Idaho ......................................................................................................
Jerome County, Idaho .........................................................................................................
Kootenai County, Idaho .......................................................................................................
Latah County, Idaho ............................................................................................................
Lemhi County, Idaho ...........................................................................................................
Lewis County, Idaho ............................................................................................................
Lincoln County, Idaho .........................................................................................................
Madison County, Idaho .......................................................................................................
Minidoka County, Idaho ......................................................................................................
Nez Perce County, Idaho ....................................................................................................
Oneida County, Idaho .........................................................................................................
Owyhee County, Idaho ........................................................................................................
Payette County, Idaho .........................................................................................................
Power County, Idaho ...........................................................................................................
Shoshone County, Idaho .....................................................................................................
Teton County, Idaho ............................................................................................................
Twin Falls County, Idaho ....................................................................................................
Valley County, Idaho ...........................................................................................................
Washington County, Idaho ..................................................................................................
Adams County, Illinois .........................................................................................................
Alexander County, Illinois ....................................................................................................
Bond County, Illinois ...........................................................................................................
Boone County, Illinois .........................................................................................................
Brown County, Illinois ..........................................................................................................
Bureau County, Illinois ........................................................................................................
Calhoun County, Illinois ......................................................................................................
Carroll County, Illinois .........................................................................................................
Cass County, Illinois ............................................................................................................
Champaign County, Illinois .................................................................................................
Christian County, Illinois ......................................................................................................
Clark County, Illinois ...........................................................................................................
Clay County, Illinois .............................................................................................................
Clinton County, Illinois .........................................................................................................
Coles County, Illinois ...........................................................................................................
Cook County, Illinois ...........................................................................................................
Crawford County, Illinois .....................................................................................................
Cumberland County, Illinois ................................................................................................
De Kalb County, Illinois .......................................................................................................
De Witt County, Illinois ........................................................................................................
Douglas County, Illinois .......................................................................................................
Du Page County, Illinois ......................................................................................................
Edgar County, Illinois ..........................................................................................................
Edwards County, Illinois ......................................................................................................
Effingham County, Illinois ....................................................................................................
Fayette County, Illinois ........................................................................................................
Ford County, Illinois ............................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00256
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
14
14
14
6880
14
14
14
14
14
1400
14
14
14
7040
14
1600
14
14
14
14
14
1600
14
14
14
14
14
CBSA No.
13
38540
13
13
13
13
14260
13
26820
13
13
13
14260
13
13
13
13
13
13
30860
13
14260
13
13
26820
13
17660
13
13
13
13
13
13
30300
13
14260
13
38540
13
13
13
13
13
14
14
41180
40420
14
14
41180
14
14
16580
14
14
14
41180
14
16974
14
14
16974
14
14
16974
14
14
14
14
16580
46019
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
14360
14370
14380
14390
14400
14410
14420
14421
14440
14450
14460
14470
14480
14490
14500
14510
14520
14530
14540
14550
14560
14570
14580
14590
14600
14610
14620
14630
14640
14650
14660
14670
14680
14690
14700
14710
14720
14730
14740
14750
14760
14770
14780
14790
14800
14810
14820
14830
14831
14850
14860
14870
14880
14890
14900
14910
14920
14921
14940
14950
14960
14970
14980
14981
14982
14983
14984
14985
14986
14987
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Franklin County, Illinois .......................................................................................................
Fulton County, Illinois ..........................................................................................................
Gallatin County, Illinois ........................................................................................................
Greene County, Illinois ........................................................................................................
Grundy County, Illinois ........................................................................................................
Hamilton County, Illinois ......................................................................................................
Hancock County, Illinois ......................................................................................................
Hardin County, Illinois .........................................................................................................
Henderson County, Illinois ..................................................................................................
Henry County, Illinois ..........................................................................................................
Iroquois County, Illinois .......................................................................................................
Jackson County, Illinois .......................................................................................................
Jasper County, Illinois .........................................................................................................
Jefferson County, Illinois .....................................................................................................
Jersey County, Illinois .........................................................................................................
Jo Daviess County, Illinois ..................................................................................................
Johnson County, Illinois ......................................................................................................
Kane County, Illinois ...........................................................................................................
Kankakee County, Illinois ....................................................................................................
Kendall County, Illinois ........................................................................................................
Knox County, Illinois ............................................................................................................
Lake County, Illinois ............................................................................................................
La Salle County, Illinois .......................................................................................................
Lawrence County, Illinois ....................................................................................................
Lee County, Illinois ..............................................................................................................
Livingston County, Illinois ....................................................................................................
Logan County, Illinois ..........................................................................................................
Mc Donough County, Illinois ...............................................................................................
Mc Henry County, Illinois ....................................................................................................
Mclean County, Illinois ........................................................................................................
Macon County, Illinois .........................................................................................................
Macoupin County, Illinois ....................................................................................................
Madison County, Illinois ......................................................................................................
Marion County, Illinois .........................................................................................................
Marshall County, Illinois ......................................................................................................
Mason County, Illinois .........................................................................................................
Massac County, Illinois .......................................................................................................
Menard County, Illinois ........................................................................................................
Mercer County, Illinois .........................................................................................................
Monroe County, Illinois ........................................................................................................
Montgomery County, Illinois ................................................................................................
Morgan County, Illinois ........................................................................................................
Moultrie County, Illinois .......................................................................................................
Ogle County, Illinois ............................................................................................................
Peoria County, Illinois .........................................................................................................
Perry County, Illinois ...........................................................................................................
Piatt County, Illinois .............................................................................................................
Pike County, Illinois .............................................................................................................
Pope County, Illinois ...........................................................................................................
Pulaski County, Illinois ........................................................................................................
Putnam County, Illinois .......................................................................................................
Randolph County, Illinois ....................................................................................................
Richland County, Illinois ......................................................................................................
Rock Island County, Illinois .................................................................................................
St Clair County, Illinois ........................................................................................................
Saline County, Illinois ..........................................................................................................
Sangamon County, Illinois ..................................................................................................
Schuyler County, Illinois ......................................................................................................
Scott County, Illinois ............................................................................................................
Shelby County, Illinois .........................................................................................................
Stark County, Illinois ...........................................................................................................
Stephenson County, Illinois .................................................................................................
Tazewell County, Illinois ......................................................................................................
Union County, Illinois ..........................................................................................................
Vermilion County, Illinois .....................................................................................................
Wabash County, Illinois .......................................................................................................
Warren County, Illinois ........................................................................................................
Washington County, Illinois .................................................................................................
Wayne County, Illinois .........................................................................................................
White County, Illinois ...........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00257
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
14
14
14
14
3690
14
14
14
14
1960
14
14
14
14
7040
14
14
0620
3740
0620
14
3965
14
14
14
14
14
14
1600
1040
2040
14
7040
14
14
14
14
7880
14
7040
14
14
14
14
6120
14
14
14
14
14
14
14
14
1960
7040
14
7880
14
14
14
14
14
6120
14
14
14
14
14
14
14
CBSA No.
14
14
14
14
16974
14
14
14
14
19340
14
14
14
14
41180
14
14
16974
28100
16974
14
29404
14
14
14
14
14
14
16974
14060
19500
41180
41180
14
37900
14
14
44100
19340
41180
14
14
14
14
37900
14
16580
14
14
14
14
14
14
19340
41180
14
44100
14
14
14
37900
14
37900
14
19180
14
14
14
14
14
46020
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
14988
14989
14990
14991
14992
15000
15010
15020
15030
15040
15050
15060
15070
15080
15090
15100
15110
15120
15130
15140
15150
15160
15170
15180
15190
15200
15210
15220
15230
15240
15250
15260
15270
15280
15290
15300
15310
15320
15330
15340
15350
15360
15370
15380
15390
15400
15410
15420
15430
15440
15450
15460
15470
15480
15490
15500
15510
15520
15530
15540
15550
15560
15570
15580
15590
15600
15610
15620
15630
15640
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Whiteside County, Illinois ....................................................................................................
Will County, Illinois ..............................................................................................................
Williamson County, Illinois ..................................................................................................
Winnebago County, Illinois ..................................................................................................
Woodford County, Illinois ....................................................................................................
Adams County, Indiana .......................................................................................................
Allen County, Indiana ..........................................................................................................
Bartholomew County, Indiana .............................................................................................
Benton County, Indiana .......................................................................................................
Blackford County, Indiana ...................................................................................................
Boone County, Indiana ........................................................................................................
Brown County, Indiana ........................................................................................................
Carroll County, Indiana .......................................................................................................
Cass County, Indiana ..........................................................................................................
Clark County, Indiana ..........................................................................................................
Clay County, Indiana ...........................................................................................................
Clinton County, Indiana .......................................................................................................
Crawford County, Indiana ...................................................................................................
Daviess County, Indiana .....................................................................................................
Dearborn County, Indiana ...................................................................................................
Decatur County, Indiana .....................................................................................................
De Kalb County, Indiana .....................................................................................................
Delaware County, Indiana ...................................................................................................
Dubois County, Indiana .......................................................................................................
Elkhart County, Indiana .......................................................................................................
Fayette County, Indiana ......................................................................................................
Floyd County, Indiana .........................................................................................................
Fountain County, Indiana ....................................................................................................
Franklin County, Indiana .....................................................................................................
Fulton County, Indiana ........................................................................................................
Gibson County, Indiana .......................................................................................................
Grant County, Indiana .........................................................................................................
Greene County, Indiana ......................................................................................................
Hamilton County, Indiana ....................................................................................................
Hancock County, Indiana ....................................................................................................
Harrison County, Indiana ....................................................................................................
Hendricks County, Indiana ..................................................................................................
Henry County, Indiana ........................................................................................................
Howard County, Indiana ......................................................................................................
Huntington County, Indiana .................................................................................................
Jackson County, Indiana .....................................................................................................
Jasper County, Indiana .......................................................................................................
Jay County, Indiana ............................................................................................................
Jefferson County, Indiana ...................................................................................................
Jennings County, Indiana ....................................................................................................
Johnson County, Indiana ....................................................................................................
Knox County, Indiana ..........................................................................................................
Kosciusko County, Indiana ..................................................................................................
Lagrange County, Indiana ...................................................................................................
Lake County, Indiana ..........................................................................................................
La Porte County, Indiana ....................................................................................................
Lawrence County, Indiana ..................................................................................................
Madison County, Indiana ....................................................................................................
Marion County, Indiana .......................................................................................................
Marshall County, Indiana ....................................................................................................
Martin County, Indiana ........................................................................................................
Miami County, Indiana ........................................................................................................
Monroe County, Indiana ......................................................................................................
Montgomery County, Indiana ..............................................................................................
Morgan County, Indiana ......................................................................................................
Newton County, Indiana ......................................................................................................
Noble County, Indiana .........................................................................................................
Ohio County, Indiana ..........................................................................................................
Orange County, Indiana ......................................................................................................
Owen County, Indiana .........................................................................................................
Parke County, Indiana .........................................................................................................
Perry County, Indiana .........................................................................................................
Pike County, Indiana ...........................................................................................................
Porter County, Indiana ........................................................................................................
Posey County, Indiana ........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00258
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
14
3690
14
6880
6120
15
2760
15
15
15
3480
15
15
15
4520
8320
15
15
15
1640
15
2760
5280
15
2330
15
4520
15
15
15
15
15
15
3480
3480
4520
3480
15
3850
15
15
15
15
15
15
3480
15
15
15
2960
15
15
0400
3480
15
15
15
1020
15
3480
15
15
15
15
15
15
15
15
2960
2440
CBSA No.
14
16974
14
40420
37900
15
23060
18020
29140
15
26900
26900
29140
15
31140
45460
15
15
15
17140
15
15
34620
15
21140
15
31140
15
17140
15
21780
15
14020
26900
26900
31140
26900
15
29020
15
15
23844
15
15
15
26900
15
15
15
23844
33140
15
11300
26900
15
15
15
14020
15
26900
23844
15
17140
15
14020
15
15
15
23844
21780
46021
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
15650
15660
15670
15680
15690
15700
15710
15720
15730
15740
15750
15760
15770
15780
15790
15800
15810
15820
15830
15840
15850
15860
15870
15880
15890
15900
15910
16000
16010
16020
16030
16040
16050
16060
16070
16080
16090
16100
16110
16120
16130
16140
16150
16160
16170
16180
16190
16200
16210
16220
16230
16240
16250
16260
16270
16280
16290
16300
16310
16320
16330
16340
16350
16360
16370
16380
16390
16400
16410
16420
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Pulaski County, Indiana ......................................................................................................
Putnam County, Indiana ......................................................................................................
Randolph County, Indiana ...................................................................................................
Ripley County, Indiana ........................................................................................................
Rush County, Indiana ..........................................................................................................
St Joseph County, Indiana ..................................................................................................
Scott County, Indiana ..........................................................................................................
Shelby County, Indiana .......................................................................................................
Spencer County, Indiana .....................................................................................................
Starke County, Indiana ........................................................................................................
Steuben County, Indiana .....................................................................................................
Sullivan County, Indiana .....................................................................................................
Switzerland County, Indiana ...............................................................................................
Tippecanoe County, Indiana ...............................................................................................
Tipton County, Indiana ........................................................................................................
Union County, Indiana .........................................................................................................
Vanderburgh County, Indiana .............................................................................................
Vermillion County, Indiana ..................................................................................................
Vigo County, Indiana ...........................................................................................................
Wabash County, Indiana .....................................................................................................
Warren County, Indiana ......................................................................................................
Warrick County, Indiana ......................................................................................................
Washington County, Indiana ...............................................................................................
Wayne County, Indiana .......................................................................................................
Wells County, Indiana .........................................................................................................
White County, Indiana .........................................................................................................
Whitley County, Indiana ......................................................................................................
Adair County, Iowa ..............................................................................................................
Adams County, Iowa ...........................................................................................................
Allamakee County, Iowa .....................................................................................................
Appanoose County, Iowa ....................................................................................................
Audubon County, Iowa ........................................................................................................
Benton County, Iowa ...........................................................................................................
Black Hawk County, Iowa ...................................................................................................
Boone County, Iowa ............................................................................................................
Bremer County, Iowa ..........................................................................................................
Buchanan County, Iowa ......................................................................................................
Buena Vista County, Iowa ...................................................................................................
Butler County, Iowa .............................................................................................................
Calhoun County, Iowa .........................................................................................................
Carroll County, Iowa ............................................................................................................
Cass County, Iowa ..............................................................................................................
Cedar County, Iowa ............................................................................................................
Cerro Gordo County, Iowa ..................................................................................................
Cherokee County, Iowa .......................................................................................................
Chickasaw County, Iowa .....................................................................................................
Clarke County, Iowa ............................................................................................................
Clay County, Iowa ...............................................................................................................
Clayton County, Iowa ..........................................................................................................
Clinton County, Iowa ...........................................................................................................
Crawford County, Iowa ........................................................................................................
Dallas County, Iowa ............................................................................................................
Davis County, Iowa .............................................................................................................
Decatur County, Iowa ..........................................................................................................
Delaware County, Iowa .......................................................................................................
Des Moines County, Iowa ...................................................................................................
Dickinson County, Iowa .......................................................................................................
Dubuque County, Iowa ........................................................................................................
Emmet County, Iowa ...........................................................................................................
Fayette County, Iowa ..........................................................................................................
Floyd County, Iowa .............................................................................................................
Franklin County, Iowa .........................................................................................................
Fremont County, Iowa .........................................................................................................
Greene County, Iowa ..........................................................................................................
Grundy County, Iowa ..........................................................................................................
Guthrie County, Iowa ..........................................................................................................
Hamilton County, Iowa ........................................................................................................
Hancock County, Iowa ........................................................................................................
Hardin County, Iowa ............................................................................................................
Harrison County, Iowa .........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00259
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
15
15
15
15
15
7800
15
3480
15
15
15
15
15
3920
3850
15
2440
15
8320
15
15
2440
15
15
15
15
2760
16
16
16
16
16
16
8920
16
8920
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
2120
16
16
16
16
16
2200
16
16
16
16
16
16
16
16
16
16
16
16
CBSA No.
15
26900
15
15
15
43780
15
26900
15
15
15
45460
15
29140
29020
15
21780
45460
45460
15
15
21780
31140
15
23060
15
23060
16
16
16
16
16
16300
47940
16
47940
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
19780
16
16
16
16
16
20220
16
16
16
16
16
16
47940
19780
16
16
16
36540
46022
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
16430
16440
16450
16460
16470
16480
16490
16500
16510
16520
16530
16540
16550
16560
16570
16580
16590
16600
16610
16620
16630
16640
16650
16660
16670
16680
16690
16700
16710
16720
16730
16740
16750
16760
16770
16780
16790
16800
16810
16820
16830
16840
16850
16860
16870
16880
16890
16900
16910
16920
16930
16940
16950
16960
16970
16980
17000
17010
17020
17030
17040
17050
17060
17070
17080
17090
17100
17110
17120
17130
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Henry County, Iowa .............................................................................................................
Howard County, Iowa ..........................................................................................................
Humboldt County, Iowa .......................................................................................................
Ida County, Iowa .................................................................................................................
Iowa County, Iowa ...............................................................................................................
Jackson County, Iowa .........................................................................................................
Jasper County, Iowa ...........................................................................................................
Jefferson County, Iowa .......................................................................................................
Johnson County, Iowa .........................................................................................................
Jones County, Iowa .............................................................................................................
Keokuk County, Iowa ..........................................................................................................
Kossuth County, Iowa .........................................................................................................
Lee County, Iowa ................................................................................................................
Linn County, Iowa ...............................................................................................................
Louisa County, Iowa ............................................................................................................
Lucas County, Iowa .............................................................................................................
Lyon County, Iowa ..............................................................................................................
Madison County, Iowa .........................................................................................................
Mahaska County, Iowa ........................................................................................................
Marion County, Iowa ...........................................................................................................
Marshall County, Iowa .........................................................................................................
Mills County, Iowa ...............................................................................................................
Mitchell County, Iowa ..........................................................................................................
Monona County, Iowa .........................................................................................................
Monroe County, Iowa ..........................................................................................................
Montgomery County, Iowa ..................................................................................................
Muscatine County, Iowa ......................................................................................................
O Brien County, Iowa ..........................................................................................................
Osceola County, Iowa .........................................................................................................
Page County, Iowa ..............................................................................................................
Palo Alto County, Iowa ........................................................................................................
Plymouth County, Iowa .......................................................................................................
Pocahontas County, Iowa ...................................................................................................
Polk County, Iowa ...............................................................................................................
Pottawattamie County, Iowa ...............................................................................................
Poweshiek County, Iowa .....................................................................................................
Ringgold County, Iowa ........................................................................................................
Sac County, Iowa ................................................................................................................
Scott County, Iowa ..............................................................................................................
Shelby County, Iowa ...........................................................................................................
Sioux County, Iowa .............................................................................................................
Story County, Iowa ..............................................................................................................
Tama County, Iowa .............................................................................................................
Taylor County, Iowa ............................................................................................................
Union County, Iowa .............................................................................................................
Van Buren County, Iowa .....................................................................................................
Wapello County, Iowa .........................................................................................................
Warren County, Iowa ..........................................................................................................
Washington County, Iowa ...................................................................................................
Wayne County, Iowa ...........................................................................................................
Webster County, Iowa .........................................................................................................
Winnebago County, Iowa ....................................................................................................
Winneshiek County, Iowa ....................................................................................................
Woodbury County, Iowa ......................................................................................................
Worth County, Iowa .............................................................................................................
Wright County, Iowa ............................................................................................................
Allen County, Kansas ..........................................................................................................
Anderson County, Kansas ..................................................................................................
Atchison County, Kansas ....................................................................................................
Barber County, Kansas .......................................................................................................
Barton County, Kansas .......................................................................................................
Bourbon County, Kansas ....................................................................................................
Brown County, Kansas ........................................................................................................
Butler County, Kansas ........................................................................................................
Chase County, Kansas .......................................................................................................
Chautauqua County, Kansas ..............................................................................................
Cherokee County, Kansas ..................................................................................................
Cheyenne County, Kansas .................................................................................................
Clark County, Kansas .........................................................................................................
Clay County, Kansas ...........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00260
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
16
16
16
16
16
16
16
16
3500
16
16
16
16
1360
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
2120
5920
16
16
16
1960
16
16
16
16
16
16
16
16
2120
16
16
16
16
16
7720
16
16
17
17
17
17
17
17
17
9040
17
17
17
17
17
17
CBSA No.
16
16
16
16
16
16
16
16
26980
16300
16
16
16
16300
16
16
16
19780
16
16
16
36540
16
16
16
16
16
16
16
16
16
16
16
19780
36540
16
16
16
19340
16
16
11180
16
16
16
16
16
19780
26980
16
16
16
16
43580
16
16
17
17
17
17
17
17
17
48620
17
17
17
17
17
17
46023
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
17140
17150
17160
17170
17180
17190
17200
17210
17220
17230
17240
17250
17260
17270
17280
17290
17300
17310
17320
17330
17340
17350
17360
17370
17380
17390
17391
17410
17420
17430
17440
17450
17451
17470
17480
17490
17500
17510
17520
17530
17540
17550
17560
17570
17580
17590
17600
17610
17620
17630
17640
17650
17660
17670
17680
17690
17700
17710
17720
17730
17740
17750
17760
17770
17780
17790
17800
17810
17820
17830
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Cloud County, Kansas ........................................................................................................
Coffey County, Kansas .......................................................................................................
Comanche County, Kansas ................................................................................................
Cowley County, Kansas ......................................................................................................
Crawford County, Kansas ...................................................................................................
Decatur County, Kansas .....................................................................................................
Dickinson County, Kansas ..................................................................................................
Doniphan County, Kansas ..................................................................................................
Douglas County, Kansas .....................................................................................................
Edwards County, Kansas ....................................................................................................
Elk County, Kansas .............................................................................................................
Ellis County, Kansas ...........................................................................................................
Ellsworth County, Kansas ...................................................................................................
Finney County, Kansas .......................................................................................................
Ford County, Kansas ..........................................................................................................
Franklin County, Kansas .....................................................................................................
Geary County, Kansas ........................................................................................................
Gove County, Kansas .........................................................................................................
Graham County, Kansas .....................................................................................................
Grant County, Kansas .........................................................................................................
Gray County, Kansas ..........................................................................................................
Greeley County, Kansas .....................................................................................................
Greenwood County, Kansas ...............................................................................................
Hamilton County, Kansas ....................................................................................................
Harper County, Kansas .......................................................................................................
Harvey County, Kansas ......................................................................................................
Haskell County, Kansas ......................................................................................................
Hodgeman County, Kansas ................................................................................................
Jackson County, Kansas .....................................................................................................
Jefferson County, Kansas ...................................................................................................
Jewell County, Kansas ........................................................................................................
Johnson County, Kansas ....................................................................................................
Kearny County, Kansas ......................................................................................................
Kingman County, Kansas ....................................................................................................
Kiowa County, Kansas ........................................................................................................
Labette County, Kansas ......................................................................................................
Lane County, Kansas ..........................................................................................................
Leavenworth County, Kansas .............................................................................................
Lincoln County, Kansas ......................................................................................................
Linn County, Kansas ...........................................................................................................
Logan County, Kansas ........................................................................................................
Lyon County, Kansas ..........................................................................................................
Mc Pherson County, Kansas ..............................................................................................
Marion County, Kansas .......................................................................................................
Marshall County, Kansas ....................................................................................................
Meade County, Kansas .......................................................................................................
Miami County, Kansas ........................................................................................................
Mitchell County, Kansas ......................................................................................................
Montgomery County, Kansas ..............................................................................................
Morris County, Kansas ........................................................................................................
Morton County, Kansas .......................................................................................................
Nemaha County, Kansas ....................................................................................................
Neosho County, Kansas .....................................................................................................
Ness County, Kansas ..........................................................................................................
Norton County, Kansas .......................................................................................................
Osage County, Kansas .......................................................................................................
Osborne County, Kansas ....................................................................................................
Ottawa County, Kansas ......................................................................................................
Pawnee County, Kansas .....................................................................................................
Phillips County, Kansas ......................................................................................................
Pottawatomie County, Kansas ............................................................................................
Pratt County, Kansas ..........................................................................................................
Rawlins County, Kansas .....................................................................................................
Reno County, Kansas .........................................................................................................
Republic County, Kansas ....................................................................................................
Rice County, Kansas ...........................................................................................................
Riley County, Kansas ..........................................................................................................
Rooks County, Kansas ........................................................................................................
Rush County, Kansas .........................................................................................................
Russell County, Kansas ......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00261
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
17
17
17
17
17
17
17
17
4150
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
3760
17
17
17
17
17
3760
17
17
17
17
17
17
17
17
3760
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
CBSA No.
17
17
17
17
17
17
17
41140
29940
17
17
17
17
17
17
28140
17
17
17
17
17
17
17
17
17
48620
17
17
45820
45820
17
28140
17
17
17
17
17
28140
17
28140
17
17
17
17
17
17
28140
17
17
17
17
17
17
17
17
45820
17
17
17
17
17
17
17
17
17
17
17
17
17
17
46024
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
17840
17841
17860
17870
17880
17890
17900
17910
17920
17921
17940
17950
17960
17970
17980
17981
17982
17983
17984
17985
17986
18000
18010
18020
18030
18040
18050
18060
18070
18080
18090
18100
18110
18120
18130
18140
18150
18160
18170
18180
18190
18191
18210
18220
18230
18240
18250
18260
18270
18271
18290
18291
18310
18320
18330
18340
18350
18360
18361
18362
18390
18400
18410
18420
18421
18440
18450
18460
18470
18480
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Saline County, Kansas ........................................................................................................
Scott County, Kansas ..........................................................................................................
Sedgwick County, Kansas ..................................................................................................
Seward County, Kansas ......................................................................................................
Shawnee County, Kansas ...................................................................................................
Sheridan County, Kansas ...................................................................................................
Sherman County, Kansas ...................................................................................................
Smith County, Kansas .........................................................................................................
Stafford County, Kansas .....................................................................................................
Stanton County, Kansas .....................................................................................................
Stevens County, Kansas .....................................................................................................
Sumner County, Kansas .....................................................................................................
Thomas County, Kansas .....................................................................................................
Trego County, Kansas ........................................................................................................
Wabaunsee County, Kansas ...............................................................................................
Wallace County, Kansas .....................................................................................................
Washington County, Kansas ...............................................................................................
Wichita County, Kansas ......................................................................................................
Wilson County, Kansas .......................................................................................................
Woodson County, Kansas ...................................................................................................
Wyandotte County, Kansas .................................................................................................
Adair County, Kentucky .......................................................................................................
Allen County, Kentucky .......................................................................................................
Anderson County, Kentucky ................................................................................................
Ballard County, Kentucky ....................................................................................................
Barren County, Kentucky ....................................................................................................
Bath County, Kentucky ........................................................................................................
Bell County, Kentucky .........................................................................................................
Boone County, Kentucky .....................................................................................................
Bourbon County, Kentucky .................................................................................................
Boyd County, Kentucky .......................................................................................................
Boyle County, Kentucky ......................................................................................................
Bracken County, Kentucky ..................................................................................................
Breathitt County, Kentucky ..................................................................................................
Breckinridge County, Kentucky ...........................................................................................
Bullitt County, Kentucky ......................................................................................................
Butler County, Kentucky ......................................................................................................
Caldwell County, Kentucky .................................................................................................
Calloway County, Kentucky ................................................................................................
Campbell County, Kentucky ................................................................................................
Carlisle County, Kentucky ...................................................................................................
Carroll County, Kentucky ....................................................................................................
Carter County, Kentucky .....................................................................................................
Casey County, Kentucky .....................................................................................................
Christian County, Kentucky .................................................................................................
Clark County, Kentucky .......................................................................................................
Clay County, Kentucky ........................................................................................................
Clinton County, Kentucky ....................................................................................................
Crittenden County, Kentucky ..............................................................................................
Cumberland County, Kentucky ...........................................................................................
Daviess County, Kentucky ..................................................................................................
Edmonson County, Kentucky ..............................................................................................
Elliott County, Kentucky ......................................................................................................
Estill County, Kentucky .......................................................................................................
Fayette County, Kentucky ...................................................................................................
Fleming County, Kentucky ..................................................................................................
Floyd County, Kentucky ......................................................................................................
Franklin County, Kentucky ..................................................................................................
Fulton County, Kentucky .....................................................................................................
Gallatin County, Kentucky ...................................................................................................
Garrard County, Kentucky ...................................................................................................
Grant County, Kentucky ......................................................................................................
Graves County, Kentucky ...................................................................................................
Grayson County, Kentucky .................................................................................................
Green County, Kentucky .....................................................................................................
Greenup County, Kentucky .................................................................................................
Hancock County, Kentucky .................................................................................................
Hardin County, Kentucky ....................................................................................................
Harlan County, Kentucky ....................................................................................................
Harrison County, Kentucky .................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00262
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
17
17
9040
17
8440
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
3760
18
18
18
18
18
18
18
1640
4280
3400
18
18
18
18
4520
18
18
18
1640
18
18
3400
18
1660
4280
18
18
18
18
5990
18
18
18
4280
18
18
18
18
18
18
18
18
18
18
3400
18
18
18
18
CBSA No.
17
17
48620
17
45820
17
17
17
17
17
17
48620
17
17
17
17
17
17
17
17
28140
18
18
18
18
18
18
18
17140
30460
26580
18
17140
18
18
31140
18
18
18
17140
18
18
18
18
17300
30460
18
18
18
18
36980
14540
18
18
30460
18
18
18
18
17140
18
17140
18
18
18
26580
36980
21060
18
18
46025
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
18490
18500
18510
18511
18530
18540
18550
18560
18570
18580
18590
18600
18610
18620
18630
18640
18650
18660
18670
18680
18690
18700
18710
18720
18730
18740
18750
18760
18770
18780
18790
18800
18801
18802
18830
18831
18850
18860
18861
18880
18890
18900
18910
18920
18930
18931
18932
18960
18970
18971
18972
18973
18974
18975
18976
18977
18978
18979
18980
18981
18982
18983
18984
18985
18986
18987
18988
18989
18990
18991
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Hart County, Kentucky ........................................................................................................
Henderson County, Kentucky .............................................................................................
Henry County, Kentucky .....................................................................................................
Hickman County, Kentucky .................................................................................................
Hopkins County, Kentucky ..................................................................................................
Jackson County, Kentucky ..................................................................................................
Jefferson County, Kentucky ................................................................................................
Jessamine County, Kentucky ..............................................................................................
Johnson County, Kentucky .................................................................................................
Kenton County, Kentucky ....................................................................................................
Knott County, Kentucky .......................................................................................................
Knox County, Kentucky .......................................................................................................
Larue County, Kentucky ......................................................................................................
Laurel County, Kentucky .....................................................................................................
Lawrence County, Kentucky ...............................................................................................
Lee County, Kentucky .........................................................................................................
Leslie County, Kentucky ......................................................................................................
Letcher County, Kentucky ...................................................................................................
Lewis County, Kentucky ......................................................................................................
Lincoln County, Kentucky ....................................................................................................
Livingston County, Kentucky ...............................................................................................
Logan County, Kentucky .....................................................................................................
Lyon County, Kentucky .......................................................................................................
Mc Cracken County, Kentucky ............................................................................................
Mc Creary County, Kentucky ..............................................................................................
Mc Lean County, Kentucky .................................................................................................
Madison County, Kentucky .................................................................................................
Magoffin County, Kentucky .................................................................................................
Marion County, Kentucky ....................................................................................................
Marshall County, Kentucky .................................................................................................
Martin County, Kentucky .....................................................................................................
Mason County, Kentucky ....................................................................................................
Meade County, Kentucky ....................................................................................................
Menifee County, Kentucky ..................................................................................................
Mercer County, Kentucky ....................................................................................................
Metcalfe County, Kentucky .................................................................................................
Monroe County, Kentucky ...................................................................................................
Montgomery County, Kentucky ...........................................................................................
Morgan County, Kentucky ...................................................................................................
Muhlenberg County, Kentucky ............................................................................................
Nelson County, Kentucky ....................................................................................................
Nicholas County, Kentucky .................................................................................................
Ohio County, Kentucky .......................................................................................................
Oldham County, Kentucky ..................................................................................................
Owen County, Kentucky ......................................................................................................
Owsley County, Kentucky ...................................................................................................
Pendleton County, Kentucky ...............................................................................................
Perry County, Kentucky ......................................................................................................
Pike County, Kentucky ........................................................................................................
Powell County, Kentucky ....................................................................................................
Pulaski County, Kentucky ...................................................................................................
Robertson County, Kentucky ..............................................................................................
Rockcastle County, Kentucky .............................................................................................
Rowan County, Kentucky ....................................................................................................
Russell County, Kentucky ...................................................................................................
Scott County, Kentucky .......................................................................................................
Shelby County, Kentucky ....................................................................................................
Simpson County, Kentucky .................................................................................................
Spencer County, Kentucky ..................................................................................................
Taylor County, Kentucky .....................................................................................................
Todd County, Kentucky .......................................................................................................
Trigg County, Kentucky .......................................................................................................
Trimble County, Kentucky ...................................................................................................
Union County, Kentucky ......................................................................................................
Warren County, Kentucky ...................................................................................................
Washington County, Kentucky ............................................................................................
Wayne County, Kentucky ....................................................................................................
Webster County, Kentucky ..................................................................................................
Whitley County, Kentucky ...................................................................................................
Wolfe County, Kentucky ......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00263
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
18
2440
18
18
18
18
4520
4280
18
1640
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
4520
18
18
18
18
18
18
18
18
18
18
18
4280
4520
18
18
18
18
18
18
18
18
18
18
18
18
18
CBSA No.
18
21780
31140
18
18
18
31140
30460
18
17140
18
18
21060
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
31140
18
18
18
18
18
18
18
31140
18
18
31140
18
18
17140
18
18
18
18
18
18
18
18
30460
31140
18
31140
18
18
17300
31140
18
14540
18
18
21780
18
18
46026
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
18992
19000
19010
19020
19030
19040
19050
19060
19070
19080
19090
19100
19110
19120
19130
19140
19150
19160
19170
19180
19190
19200
19210
19220
19230
19240
19250
19260
19270
19280
19290
19300
19310
19320
19330
19340
19350
19360
19370
19380
19390
19400
19410
19420
19430
19440
19450
19460
19470
19480
19490
19500
19510
19520
19530
19540
19550
19560
19570
19580
19590
19600
19610
19620
19630
20000
20010
20020
20030
20040
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Woodford County, Kentucky ...............................................................................................
Acadia County, Louisiana ...................................................................................................
Allen County, Louisiana ......................................................................................................
Ascension County, Louisiana ..............................................................................................
Assumption County, Louisiana ............................................................................................
Avoyelles County, Louisiana ...............................................................................................
Beauregard County, Louisiana ............................................................................................
Bienville County, Louisiana .................................................................................................
Bossier County, Louisiana ..................................................................................................
Caddo County, Louisiana ....................................................................................................
Calcasieu County, Louisiana ...............................................................................................
Caldwell County, Louisiana .................................................................................................
Cameron County, Louisiana ................................................................................................
Catahoula County, Louisiana ..............................................................................................
Claiborne County, Louisiana ...............................................................................................
Concordia County, Louisiana ..............................................................................................
De Soto County, Louisiana .................................................................................................
East Baton Rouge County, Louisiana .................................................................................
East Carroll County, Louisiana ...........................................................................................
East Feliciana County, Louisiana ........................................................................................
Evangeline County, Louisiana .............................................................................................
Franklin County, Louisiana ..................................................................................................
Grant County, Louisiana .....................................................................................................
Iberia County, Louisiana .....................................................................................................
Iberville County, Louisiana ..................................................................................................
Jackson County, Louisiana .................................................................................................
Jefferson County, Louisiana ................................................................................................
Jefferson Davis County, Louisiana .....................................................................................
Lafayette County, Louisiana ................................................................................................
Lafourche County, Louisiana ..............................................................................................
La Salle County, Louisiana .................................................................................................
Lincoln County, Louisiana ...................................................................................................
Livingston County, Louisiana ..............................................................................................
Madison County, Louisiana .................................................................................................
Morehouse County, Louisiana ............................................................................................
Natchitoches County, Louisiana ..........................................................................................
Orleans County, Louisiana ..................................................................................................
Ouachita County, Louisiana ................................................................................................
Plaquemines County, Louisiana ..........................................................................................
Pointe Coupee County, Louisiana ......................................................................................
Rapides County, Louisiana .................................................................................................
Red River County, Louisiana ..............................................................................................
Richland County, Louisiana ................................................................................................
Sabine County, Louisiana ...................................................................................................
St Bernard County, Louisiana .............................................................................................
St Charles County, Louisiana .............................................................................................
St Helena County, Louisiana ..............................................................................................
St James County, Louisiana ...............................................................................................
St John Baptist County, Louisiana ......................................................................................
St Landry County, Louisiana ...............................................................................................
St Martin County, Louisiana ................................................................................................
St Mary County, Louisiana ..................................................................................................
St Tammany County, Louisiana ..........................................................................................
Tangipahoa County, Louisiana ...........................................................................................
Tensas County, Louisiana ...................................................................................................
Terrebonne County, Louisiana ............................................................................................
Union County, Louisiana .....................................................................................................
Vermilion County, Louisiana ...............................................................................................
Vernon County, Louisiana ...................................................................................................
Washington County, Louisiana ...........................................................................................
Webster County, Louisiana .................................................................................................
West Baton Rouge County, Louisiana ................................................................................
West Carroll County, Louisiana ..........................................................................................
West Feliciana County, Louisiana .......................................................................................
Winn County, Louisiana ......................................................................................................
Androscoggin County, Maine ..............................................................................................
Aroostook County, Maine ....................................................................................................
Cumberland County, Maine ................................................................................................
Franklin County, Maine .......................................................................................................
Hancock County, Maine ......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00264
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
4280
19
19
0760
19
19
19
19
7680
7680
3960
19
19
19
19
19
19
0760
19
19
19
19
19
19
19
19
5560
19
3880
3350
19
19
0760
19
19
19
5560
5200
19
19
0220
19
19
19
5560
5560
19
19
5560
.19
3880
19
5560
19
19
3350
19
19
19
19
19
0760
19
19
19
4243
20
6403
20
20
CBSA No.
30460
19
19
12940
19
19
19
19
43340
43340
29340
19
29340
19
19
19
43340
12940
19
12940
19
19
10780
19
12940
19
35380
19
29180
26380
19
19
12940
19
19
19
35380
33740
35380
12940
10780
19
19
19
35380
35380
12940
19
35380
19
29180
19
35380
19
19
26380
33740
19
19
19
19
12940
19
12940
19
30340
20
38860
20
20
46027
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
20050
20060
20070
20080
20090
20100
20110
20120
20130
20140
20150
21000
21010
21020
21030
21040
21050
21060
21070
21080
21090
21100
21110
21120
21130
21140
21150
21160
21170
21180
21190
21200
21210
21220
21230
22000
22010
22020
22030
22040
22060
22070
22080
22090
22120
22130
22150
22160
22170
23000
23010
23020
23030
23040
23050
23060
23070
23080
23090
23100
23110
23120
23130
23140
23150
23160
23170
23180
23190
23200
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Kennebec County, Maine ....................................................................................................
Knox County, Maine ............................................................................................................
Lincoln County, Maine .........................................................................................................
Oxford County, Maine .........................................................................................................
Penobscot County, Maine ...................................................................................................
Piscataquis County, Maine ..................................................................................................
Sagadahoc County, Maine ..................................................................................................
Somerset County, Maine .....................................................................................................
Waldo County, Maine ..........................................................................................................
Washington County, Maine .................................................................................................
York County, Maine .............................................................................................................
Allegany County, Maryland .................................................................................................
Anne Arundel County, Maryland .........................................................................................
Baltimore County, Maryland ................................................................................................
Baltimore City County, Maryland ........................................................................................
Calvert County, Maryland ....................................................................................................
Caroline County, Maryland ..................................................................................................
Carroll County, Maryland ....................................................................................................
Cecil County, Maryland .......................................................................................................
Charles County, Maryland ...................................................................................................
Dorchester County, Maryland .............................................................................................
Frederick County, Maryland ................................................................................................
Garrett County, Maryland ....................................................................................................
Harford County, Maryland ...................................................................................................
Howard County, Maryland ...................................................................................................
Kent County, Maryland ........................................................................................................
Montgomery County, Maryland ...........................................................................................
Prince Georges County, Maryland ......................................................................................
Queen Annes County, Maryland .........................................................................................
St Marys County, Maryland .................................................................................................
Somerset County, Maryland ................................................................................................
Talbot County, Maryland .....................................................................................................
Washington County, Maryland ............................................................................................
Wicomico County, Maryland ...............................................................................................
Worcester County, Maryland ...............................................................................................
Barnstable County, Massachusetts .....................................................................................
Berkshire County, Massachusetts .......................................................................................
Bristol County, Massachusetts ............................................................................................
Dukes County, Massachusetts ............................................................................................
Essex County, Massachusetts ............................................................................................
Franklin County, Massachusetts .........................................................................................
Hampden County, Massachusetts ......................................................................................
Hampshire County, Massachusetts ....................................................................................
Middlesex County, Massachusetts ......................................................................................
Nantucket County, Massachusetts ......................................................................................
Norfolk County, Massachusetts ..........................................................................................
Plymouth County, Massachusetts .......................................................................................
Suffolk County, Massachusetts ...........................................................................................
Worcester County, Massachusetts .....................................................................................
Alcona County, Michigan ....................................................................................................
Alger County, Michigan .......................................................................................................
Allegan County, Michigan ...................................................................................................
Alpena County, Michigan ....................................................................................................
Antrim County, Michigan .....................................................................................................
Arenac County, Michigan ....................................................................................................
Baraga County, Michigan ....................................................................................................
Barry County, Michigan .......................................................................................................
Bay County, Michigan .........................................................................................................
Benzie County, Michigan ....................................................................................................
Berrien County, Michigan ....................................................................................................
Branch County, Michigan ....................................................................................................
Calhoun County, Michigan ..................................................................................................
Cass County, Michigan .......................................................................................................
Charlevoix County, Michigan ..............................................................................................
Cheboygan County, Michigan .............................................................................................
Chippewa County, Michigan ...............................................................................................
Clare County, Michigan .......................................................................................................
Clinton County, Michigan ....................................................................................................
Crawford County, Michigan .................................................................................................
Delta County, Michigan .......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00265
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
20
20
20
20
0733
20
6403
20
20
20
6403
1900
0720
0720
0720
8840
21
0720
9160
8840
21
8840
21
0720
0720
21
8840
8840
0720
21
21
21
3180
21
21
0743
6323
5403
22
1123
22
8003
8003
1123
22
1123
1123
1123
9243
23
23
23
23
23
23
23
23
6960
23
0870
23
0780
23
23
23
23
23
4040
23
23
CBSA No.
20
20
20
20
12620
20
38860
20
20
20
38860
19060
12580
12580
12580
47894
21
12580
48864
47894
21
13644
21
12580
12580
21
13644
47894
12580
21
41540
21
25180
41540
21
12700
38340
39300
22
21604
44140
44140
44140
15764
22
14484
14484
14484
49340
23
23
23
23
23
23
23
24340
13020
23
35660
23
12980
43780
23
23
23
23
29620
23
23
46028
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
23210
23220
23230
23240
23250
23260
23270
23280
23290
23300
23310
23320
23330
23340
23350
23360
23370
23380
23390
23400
23410
23420
23430
23440
23450
23460
23470
23480
23490
23500
23510
23520
23530
23540
23550
23560
23570
23580
23590
23600
23610
23620
23630
23640
23650
23660
23670
23680
23690
23700
23710
23720
23730
23740
23750
23760
23770
23780
23790
23800
23810
23830
24000
24010
24020
24030
24040
24050
24060
24070
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Dickinson County, Michigan ................................................................................................
Eaton County, Michigan ......................................................................................................
Emmet County, Michigan ....................................................................................................
Genesee County, Michigan .................................................................................................
Gladwin County, Michigan ..................................................................................................
Gogebic County, Michigan ..................................................................................................
Grand Traverse County, Michigan ......................................................................................
Gratiot County, Michigan .....................................................................................................
Hillsdale County, Michigan ..................................................................................................
Houghton County, Michigan ................................................................................................
Huron County, Michigan ......................................................................................................
Ingham County, Michigan ...................................................................................................
Ionia County, Michigan ........................................................................................................
Iosco County, Michigan .......................................................................................................
Iron County, Michigan .........................................................................................................
Isabella County, Michigan ...................................................................................................
Jackson County, Michigan ..................................................................................................
Kalamazoo County, Michigan .............................................................................................
Kalkaska County, Michigan .................................................................................................
Kent County, Michigan ........................................................................................................
Keweenaw County, Michigan ..............................................................................................
Lake County, Michigan ........................................................................................................
Lapeer County, Michigan ....................................................................................................
Leelanau County, Michigan .................................................................................................
Lenawee County, Michigan .................................................................................................
Livingston County, Michigan ...............................................................................................
Luce County, Michigan ........................................................................................................
Mackinac County, Michigan ................................................................................................
Macomb County, Michigan ..................................................................................................
Manistee County, Michigan .................................................................................................
Marquette County, Michigan ...............................................................................................
Mason County, Michigan .....................................................................................................
Mecosta County, Michigan ..................................................................................................
Menominee County, Michigan .............................................................................................
Midland County, Michigan ...................................................................................................
Missaukee County, Michigan ..............................................................................................
Monroe County, Michigan ...................................................................................................
Montcalm County, Michigan ................................................................................................
Montmorency County, Michigan ..........................................................................................
Muskegon County, Michigan ...............................................................................................
Newaygo County, Michigan ................................................................................................
Oakland County, Michigan ..................................................................................................
Oceana County, Michigan ...................................................................................................
Ogemaw County, Michigan .................................................................................................
Ontonagon County, Michigan ..............................................................................................
Osceola County, Michigan ..................................................................................................
Oscoda County, Michigan ...................................................................................................
Otsego County, Michigan ....................................................................................................
Ottawa County, Michigan ....................................................................................................
Presque Isle County, Michigan ...........................................................................................
Roscommon County, Michigan ...........................................................................................
Saginaw County, Michigan ..................................................................................................
St Clair County, Michigan ...................................................................................................
St Joseph County, Michigan ...............................................................................................
Sanilac County, Michigan ....................................................................................................
Schoolcraft County, Michigan .............................................................................................
Shiawassee County, Michigan ............................................................................................
Tuscola County, Michigan ...................................................................................................
Van Buren County, Michigan ..............................................................................................
Washtenaw County, Michigan .............................................................................................
Wayne County, Michigan ....................................................................................................
Wexford County, Michigan ..................................................................................................
Aitkin County, Minnesota ....................................................................................................
Anoka County, Minnesota ...................................................................................................
Becker County, Minnesota ..................................................................................................
Beltrami County, Minnesota ................................................................................................
Benton County, Minnesota ..................................................................................................
Big Stone County, Minnesota .............................................................................................
Blue Earth County, Minnesota ............................................................................................
Brown County, Minnesota ...................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00266
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
23
4040
23
2640
23
23
23
23
23
23
23
4040
23
23
23
23
3520
3720
23
3000
23
23
2160
23
23
2160
23
23
2160
23
23
23
23
23
6960
23
2160
23
23
5320
23
2160
23
23
23
23
23
23
3000
23
23
6960
2160
23
23
23
23
23
23
0440
2160
23
24
5120
24
24
6980
24
24
24
CBSA No.
23
29620
23
22420
23
23
23
23
23
23
23
29620
24340
23
23
23
27100
28020
23
24340
23
23
47644
23
23
47644
23
23
47644
23
23
23
23
23
23
23
33780
23
23
34740
24340
47644
23
23
23
23
23
23
26100
23
23
40980
47644
23
23
23
23
23
28020
11460
19804
23
24
33460
24
24
41060
24
24
24
46029
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
24080
24090
24100
24110
24120
24130
24140
24150
24160
24170
24180
24190
24200
24210
24220
24230
24240
24250
24260
24270
24280
24290
24300
24310
24320
24330
24340
24350
24360
24370
24380
24390
24400
24410
24420
24430
24440
24450
24460
24470
24480
24490
24500
24510
24520
24530
24540
24550
24560
24570
24580
24590
24600
24610
24620
24630
24640
24650
24660
24670
24680
24690
24700
24710
24720
24730
24740
24750
24760
24770
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Carlton County, Minnesota ..................................................................................................
Carver County, Minnesota ..................................................................................................
Cass County, Minnesota .....................................................................................................
Chippewa County, Minnesota .............................................................................................
Chisago County, Minnesota ................................................................................................
Clay County, Minnesota ......................................................................................................
Clearwater County, Minnesota ............................................................................................
Cook County, Minnesota .....................................................................................................
Cottonwood County, Minnesota ..........................................................................................
Crow Wing County, Minnesota ...........................................................................................
Dakota County, Minnesota ..................................................................................................
Dodge County, Minnesota ...................................................................................................
Douglas County, Minnesota ................................................................................................
Faribault County, Minnesota ...............................................................................................
Fillmore County, Minnesota ................................................................................................
Freeborn County, Minnesota ...............................................................................................
Goodhue County, Minnesota ..............................................................................................
Grant County, Minnesota ....................................................................................................
Hennepin County, Minnesota ..............................................................................................
Houston County, Minnesota ................................................................................................
Hubbard County, Minnesota ...............................................................................................
Isanti County, Minnesota .....................................................................................................
Itasca County, Minnesota ....................................................................................................
Jackson County, Minnesota ................................................................................................
Kanabec County, Minnesota ...............................................................................................
Kandiyohi County, Minnesota .............................................................................................
Kittson County, Minnesota ..................................................................................................
Koochiching County, Minnesota ..........................................................................................
Lac Qui Parle County, Minnesota .......................................................................................
Lake County, Minnesota .....................................................................................................
Lake Of Woods County, Minnesota ....................................................................................
Le Sueur County, Minnesota ..............................................................................................
Lincoln County, Minnesota ..................................................................................................
Lyon County, Minnesota .....................................................................................................
Mc Leod County, Minnesota ...............................................................................................
Mahnomen County, Minnesota ...........................................................................................
Marshall County, Minnesota ................................................................................................
Martin County, Minnesota ...................................................................................................
Meeker County, Minnesota .................................................................................................
Mille Lacs County, Minnesota .............................................................................................
Morrison County, Minnesota ...............................................................................................
Mower County, Minnesota ..................................................................................................
Murray County, Minnesota ..................................................................................................
Nicollet County, Minnesota .................................................................................................
Nobles County, Minnesota ..................................................................................................
Norman County, Minnesota ................................................................................................
Olmsted County, Minnesota ................................................................................................
Otter Tail County, Minnesota ..............................................................................................
Pennington County, Minnesota ...........................................................................................
Pine County, Minnesota ......................................................................................................
Pipestone County, Minnesota .............................................................................................
Polk County, Minnesota ......................................................................................................
Pope County, Minnesota .....................................................................................................
Ramsey County, Minnesota ................................................................................................
Red Lake County, Minnesota ..............................................................................................
Redwood County, Minnesota ..............................................................................................
Renville County, Minnesota ................................................................................................
Rice County, Minnesota ......................................................................................................
Rock County, Minnesota .....................................................................................................
Roseau County, Minnesota .................................................................................................
St Louis County, Minnesota ................................................................................................
Scott County, Minnesota .....................................................................................................
Sherburne County, Minnesota ............................................................................................
Sibley County, Minnesota ...................................................................................................
Stearns County, Minnesota .................................................................................................
Steele County, Minnesota ...................................................................................................
Stevens County, Minnesota ................................................................................................
Swift County, Minnesota .....................................................................................................
Todd County, Minnesota .....................................................................................................
Traverse County, Minnesota ...............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00267
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
24
5120
24
24
5120
2520
24
24
24
24
5120
24
24
24
24
24
24
24
5120
24
24
5120
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
6820
24
24
24
24
24
24
5120
24
24
24
24
24
24
2240
5120
6980
24
6980
24
24
24
24
24
CBSA No.
20260
33460
24
24
33460
22020
24
24
24
24
33460
40340
24
24
24
24
24
24
33460
29100
24
33460
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
40340
24
24
24
24
24220
24
33460
24
24
24
24
24
24
20260
33460
33460
24
41060
24
24
24
24
24
46030
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
24780
24790
24800
24810
24820
24830
24840
24850
24860
25000
25010
25020
25030
25040
25050
25060
25070
25080
25090
25100
25110
25120
25130
25140
25150
25160
25170
25180
25190
25200
25210
25220
25230
25240
25250
25260
25270
25280
25290
25300
25310
25320
25330
25340
25350
25360
25370
25380
25390
25400
25410
25420
25430
25440
25450
25460
25470
25480
25490
25500
25510
25520
25530
25540
25550
25560
25570
25580
25590
25600
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Wabasha County, Minnesota ..............................................................................................
Wadena County, Minnesota ................................................................................................
Waseca County, Minnesota ................................................................................................
Washington County, Minnesota ..........................................................................................
Watonwan County, Minnesota ............................................................................................
Wilkin County, Minnesota ....................................................................................................
Winona County, Minnesota .................................................................................................
Wright County, Minnesota ...................................................................................................
Yellow Medicine County, Minnesota ...................................................................................
Adams County, Mississippi .................................................................................................
Alcorn County, Mississippi ..................................................................................................
Amite County, Mississippi ...................................................................................................
Attala County, Mississippi ...................................................................................................
Benton County, Mississippi .................................................................................................
Bolivar County, Mississippi .................................................................................................
Calhoun County, Mississippi ...............................................................................................
Carroll County, Mississippi ..................................................................................................
Chickasaw County, Mississippi ...........................................................................................
Choctaw County, Mississippi ..............................................................................................
Claiborne County, Mississippi .............................................................................................
Clarke County, Mississippi ..................................................................................................
Clay County, Mississippi .....................................................................................................
Coahoma County, Mississippi .............................................................................................
Copiah County, Mississippi .................................................................................................
Covington County, Mississippi ............................................................................................
Desoto County, Mississippi .................................................................................................
Forrest County, Mississippi .................................................................................................
Franklin County, Mississippi ................................................................................................
George County, Mississippi ................................................................................................
Greene County, Mississippi ................................................................................................
Grenada County, Mississippi ..............................................................................................
Hancock County, Mississippi ..............................................................................................
Harrison County, Mississippi ...............................................................................................
Hinds County, Mississippi ...................................................................................................
Holmes County, Mississippi ................................................................................................
Humphreys County, Mississippi ..........................................................................................
Issaquena County, Mississippi ............................................................................................
Itawamba County, Mississippi .............................................................................................
Jackson County, Mississippi ...............................................................................................
Jasper County, Mississippi ..................................................................................................
Jefferson County, Mississippi ..............................................................................................
Jefferson Davis County, Mississippi ...................................................................................
Jones County, Mississippi ...................................................................................................
Kemper County, Mississippi ................................................................................................
Lafayette County, Mississippi ..............................................................................................
Lamar County, Mississippi ..................................................................................................
Lauderdale County, Mississippi ..........................................................................................
Lawrence County, Mississippi .............................................................................................
Leake County, Mississippi ...................................................................................................
Lee County, Mississippi ......................................................................................................
Leflore County, Mississippi .................................................................................................
Lincoln County, Mississippi .................................................................................................
Lowndes County, Mississippi ..............................................................................................
Madison County, Mississippi ...............................................................................................
Marion County, Mississippi .................................................................................................
Marshall County, Mississippi ...............................................................................................
Monroe County, Mississippi ................................................................................................
Montgomery County, Mississippi ........................................................................................
Neshoba County, Mississippi ..............................................................................................
Newton County, Mississippi ................................................................................................
Noxubee County, Mississippi ..............................................................................................
Oktibbeha County, Mississippi ............................................................................................
Panola County, Mississippi .................................................................................................
Pearl River County, Mississippi ..........................................................................................
Perry County, Mississippi ....................................................................................................
Pike County, Mississippi .....................................................................................................
Pontotoc County, Mississippi ..............................................................................................
Prentiss County, Mississippi ...............................................................................................
Quitman County, Mississippi ...............................................................................................
Rankin County, Mississippi .................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00268
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
24
24
24
5120
24
24
24
5120
24
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
4920
25
25
25
25
25
0920
0920
3560
25
25
25
25
6025
25
25
25
25
25
25
25
25
25
25
25
25
25
25
3560
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
3560
CBSA No.
40340
24
24
33460
24
24
24
33460
24
25
25
25
25
25
25
25
25
25
25
25
25
25
25
27140
25
32820
25620
25
37700
25
25
25060
25060
27140
25
25
25
25
37700
25
25
25
25
25
25
25620
25
25
25
25
25
25
25
27140
25
32820
25
25
25
25
25
25
25
25
25620
25
25
25
25
27140
46031
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
25610
25620
25630
25640
25650
25660
25670
25680
25690
25700
25710
25720
25730
25740
25750
25760
25770
25780
25790
25800
25810
26000
26010
26020
26030
26040
26050
26060
26070
26080
26090
26100
26110
26120
26130
26140
26150
26160
26170
26180
26190
26200
26210
26220
26230
26240
26250
26260
26270
26280
26290
26300
26310
26320
26330
26340
26350
26360
26370
26380
26390
26400
26410
26411
26412
26440
26450
26460
26470
26480
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Scott County, Mississippi ....................................................................................................
Sharkey County, Mississippi ...............................................................................................
Simpson County, Mississippi ..............................................................................................
Smith County, Mississippi ...................................................................................................
Stone County, Mississippi ...................................................................................................
Sunflower County, Mississippi ............................................................................................
Tallahatchie County, Mississippi .........................................................................................
Tate County, Mississippi .....................................................................................................
Tippah County, Mississippi .................................................................................................
Tishomingo County, Mississippi ..........................................................................................
Tunica County, Mississippi ..................................................................................................
Union County, Mississippi ...................................................................................................
Walthall County, Mississippi ................................................................................................
Warren County, Mississippi .................................................................................................
Washington County, Mississippi .........................................................................................
Wayne County, Mississippi .................................................................................................
Webster County, Mississippi ...............................................................................................
Wilkinson County, Mississippi .............................................................................................
Winston County, Mississippi ...............................................................................................
Yalobusha County, Mississippi ...........................................................................................
Yazoo County, Mississippi ..................................................................................................
Adair County, Missouri ........................................................................................................
Andrew County, Missouri ....................................................................................................
Atchison County, Missouri ...................................................................................................
Audrain County, Missouri ....................................................................................................
Barry County, Missouri ........................................................................................................
Barton County, Missouri ......................................................................................................
Bates County, Missouri .......................................................................................................
Benton County, Missouri .....................................................................................................
Bollinger County, Missouri ..................................................................................................
Boone County, Missouri ......................................................................................................
Buchanan County, Missouri ................................................................................................
Butler County, Missouri .......................................................................................................
Caldwell County, Missouri ...................................................................................................
Callaway County, Missouri ..................................................................................................
Camden County, Missouri ...................................................................................................
Cape Girardeau County, Missouri .......................................................................................
Carroll County, Missouri ......................................................................................................
Carter County, Missouri ......................................................................................................
Cass County, Missouri ........................................................................................................
Cedar County, Missouri .......................................................................................................
Chariton County, Missouri ...................................................................................................
Christian County, Missouri ..................................................................................................
Clark County, Missouri ........................................................................................................
Clay County, Missouri .........................................................................................................
Clinton County, Missouri .....................................................................................................
Cole County, Missouri .........................................................................................................
Cooper County, Missouri .....................................................................................................
Crawford County, Missouri ..................................................................................................
Dade County, Missouri ........................................................................................................
Dallas County, Missouri ......................................................................................................
Daviess County, Missouri ....................................................................................................
De Kalb County, Missouri ...................................................................................................
Dent County, Missouri .........................................................................................................
Douglas County, Missouri ...................................................................................................
Dunklin County, Missouri ....................................................................................................
Franklin County, Missouri ....................................................................................................
Gasconade County, Missouri ..............................................................................................
Gentry County, Missouri ......................................................................................................
Greene County, Missouri ....................................................................................................
Grundy County, Missouri .....................................................................................................
Harrison County, Missouri ...................................................................................................
Henry County, Missouri .......................................................................................................
Hickory County, Missouri ....................................................................................................
Holt County, Missouri ..........................................................................................................
Howard County, Missouri ....................................................................................................
Howell County, Missouri ......................................................................................................
Iron County, Missouri ..........................................................................................................
Jackson County, Missouri ...................................................................................................
Jasper County, Missouri ......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00269
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
26
26
26
26
26
26
26
26
26
1740
7000
26
26
26
26
26
26
26
3760
26
26
7920
26
3760
26
26
26
26
26
26
26
26
26
26
26
7040
26
26
7920
26
26
26
26
26
26
26
26
3760
3710
CBSA No.
25
25
27140
25
25060
25
25
32820
25
25
32820
25
25
25
25
25
25
25
25
25
25
26
41140
26
26
26
26
28140
26
26
17860
41140
26
28140
27620
26
26
26
26
28140
26
26
44180
26
28140
28140
27620
26
41180
26
44180
26
41140
26
26
26
41180
26
26
44180
26
26
26
26
26
17860
26
26
28140
27900
46032
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
26490
26500
26510
26520
26530
26540
26541
26560
26570
26580
26590
26600
26601
26620
26630
26631
26650
26660
26670
26680
26690
26700
26710
26720
26730
26740
26750
26751
26770
26780
26790
26800
26810
26820
26821
26840
26850
26860
26870
26880
26881
26900
26910
26911
26930
26940
26950
26960
26970
26980
26981
26982
26983
26984
26985
26986
26987
26988
26989
26990
26991
26992
26993
26994
26995
26996
27000
27010
27020
27030
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Jefferson County, Missouri ..................................................................................................
Johnson County, Missouri ...................................................................................................
Knox County, Missouri ........................................................................................................
Laclede County, Missouri ....................................................................................................
Lafayette County, Missouri ..................................................................................................
Lawrence County, Missouri .................................................................................................
Lewis County, Missouri .......................................................................................................
Lincoln County, Missouri .....................................................................................................
Linn County, Missouri ..........................................................................................................
Livingston County, Missouri ................................................................................................
Mc Donald County, Missouri ...............................................................................................
Macon County, Missouri ......................................................................................................
Madison County, Missouri ...................................................................................................
Maries County, Missouri ......................................................................................................
Marion County, Missouri .....................................................................................................
Mercer County, Missouri .....................................................................................................
Miller County, Missouri ........................................................................................................
Mississippi County, Missouri ...............................................................................................
Moniteau County, Missouri ..................................................................................................
Monroe County, Missouri ....................................................................................................
Montgomery County, Missouri ............................................................................................
Morgan County, Missouri ....................................................................................................
New Madrid County, Missouri .............................................................................................
Newton County, Missouri ....................................................................................................
Nodaway County, Missouri .................................................................................................
Oregon County, Missouri ....................................................................................................
Osage County, Missouri ......................................................................................................
Ozark County, Missouri .......................................................................................................
Pemiscot County, Missouri ..................................................................................................
Perry County, Missouri ........................................................................................................
Pettis County, Missouri .......................................................................................................
Phelps County, Missouri .....................................................................................................
Pike County, Missouri .........................................................................................................
Platte County, Missouri .......................................................................................................
Polk County, Missouri .........................................................................................................
Pulaski County, Missouri .....................................................................................................
Putnam County, Missouri ....................................................................................................
Ralls County, Missouri ........................................................................................................
Randolph County, Missouri .................................................................................................
Ray County, Missouri ..........................................................................................................
Reynolds County, Missouri .................................................................................................
Ripley County, Missouri ......................................................................................................
St Charles County, Missouri ...............................................................................................
St Clair County, Missouri ....................................................................................................
St Francois County, Missouri ..............................................................................................
St Louis County, Missouri ...................................................................................................
St Louis City County, Missouri ............................................................................................
Ste Genevieve County, Missouri .........................................................................................
Saline County, Missouri ......................................................................................................
Schuyler County, Missouri ..................................................................................................
Scotland County, Missouri ..................................................................................................
Scott County, Missouri ........................................................................................................
Shannon County, Missouri ..................................................................................................
Shelby County, Missouri .....................................................................................................
Stoddard County, Missouri ..................................................................................................
Stone County, Missouri .......................................................................................................
Sullivan County, Missouri ....................................................................................................
Taney County, Missouri ......................................................................................................
Texas County, Missouri .......................................................................................................
Vernon County, Missouri .....................................................................................................
Warren County, Missouri .....................................................................................................
Washington County, Missouri .............................................................................................
Wayne County, Missouri .....................................................................................................
Webster County, Missouri ...................................................................................................
Worth County, Missouri .......................................................................................................
Wright County, Missouri ......................................................................................................
Beaverhead County, Montana ............................................................................................
Big Horn County, Montana ..................................................................................................
Blaine County, Montana ......................................................................................................
Broadwater County, Montana .............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00270
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
7040
26
26
26
3760
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
3710
26
26
26
26
26
26
26
26
26
3760
26
26
26
26
26
3760
26
26
7040
26
26
7040
7040
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
27
27
27
27
CBSA No.
41180
26
26
26
28140
26
26
41180
26
26
22220
26
26
26
26
26
26
26
27620
26
26
26
26
27900
26
26
27620
26
26
26
26
26
26
28140
44180
26
26
26
26
28140
26
26
41180
26
26
41180
41180
26
26
26
26
26
26
26
26
26
26
26
26
26
41180
41180
26
44180
26
26
27
27
27
27
46033
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
27040
27050
27060
27070
27080
27090
27100
27110
27113
27120
27130
27140
27150
27160
27170
27180
27190
27200
27210
27220
27230
27240
27250
27260
27270
27280
27290
27300
27310
27320
27330
27340
27350
27360
27370
27380
27390
27400
27410
27420
27430
27440
27450
27460
27470
27480
27490
27500
27510
27520
27530
27540
27550
28000
28010
28020
28030
28040
28050
28060
28070
28080
28090
28100
28110
28120
28130
28140
28150
28160
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Carbon County, Montana ....................................................................................................
Carter County, Montana ......................................................................................................
Cascade County, Montana ..................................................................................................
Chouteau County, Montana ................................................................................................
Custer County, Montana .....................................................................................................
Daniels County, Montana ....................................................................................................
Dawson County, Montana ...................................................................................................
Deer Lodge County, Montana .............................................................................................
Yellowstone National Park, Montana ..................................................................................
Fallon County, Montana ......................................................................................................
Fergus County, Montana .....................................................................................................
Flathead County, Montana ..................................................................................................
Gallatin County, Montana ....................................................................................................
Garfield County, Montana ...................................................................................................
Glacier County, Montana ....................................................................................................
Golden Valley County, Montana .........................................................................................
Granite County, Montana ....................................................................................................
Hill County, Montana ...........................................................................................................
Jefferson County, Montana .................................................................................................
Judith Basin County, Montana ............................................................................................
Lake County, Montana ........................................................................................................
Lewis And Clark County, Montana .....................................................................................
Liberty County, Montana .....................................................................................................
Lincoln County, Montana ....................................................................................................
Mc Cone County, Montana .................................................................................................
Madison County, Montana ..................................................................................................
Meagher County, Montana ..................................................................................................
Mineral County, Montana ....................................................................................................
Missoula County, Montana ..................................................................................................
Musselshell County, Montana .............................................................................................
Park County, Montana ........................................................................................................
Petroleum County, Montana ...............................................................................................
Phillips County, Montana ....................................................................................................
Pondera County, Montana ..................................................................................................
Powder River County, Montana ..........................................................................................
Powell County, Montana .....................................................................................................
Prairie County, Montana .....................................................................................................
Ravalli County, Montana .....................................................................................................
Richland County, Montana ..................................................................................................
Roosevelt County, Montana ................................................................................................
Rosebud County, Montana .................................................................................................
Sanders County, Montana ..................................................................................................
Sheridan County, Montana .................................................................................................
Silver Bow County, Montana ...............................................................................................
Stillwater County, Montana .................................................................................................
Sweet Grass County, Montana ...........................................................................................
Teton County, Montana .......................................................................................................
Toole County, Montana .......................................................................................................
Treasure County, Montana .................................................................................................
Valley County, Montana ......................................................................................................
Wheatland County, Montana ...............................................................................................
Wibaux County, Montana ....................................................................................................
Yellowstone County, Montana ............................................................................................
Adams County, Nebraska ...................................................................................................
Antelope County, Nebraska ................................................................................................
Arthur County, Nebraska .....................................................................................................
Banner County, Nebraska ...................................................................................................
Blaine County, Nebraska ....................................................................................................
Boone County, Nebraska ....................................................................................................
Box Butte County, Nebraska ...............................................................................................
Boyd County, Nebraska ......................................................................................................
Brown County, Nebraska ....................................................................................................
Buffalo County, Nebraska ...................................................................................................
Burt County, Nebraska ........................................................................................................
Butler County, Nebraska .....................................................................................................
Cass County, Nebraska ......................................................................................................
Cedar County, Nebraska .....................................................................................................
Chase County, Nebraska ....................................................................................................
Cherry County, Nebraska ....................................................................................................
Cheyenne County, Nebraska ..............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00271
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
27
27
3040
27
27
27
27
27
0880
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
0880
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
CBSA No.
13740
27
24500
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
33540
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
13740
28
28
28
28
28
28
28
28
28
28
28
28
36540
28
28
28
28
46034
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
28170
28180
28190
28200
28210
28220
28230
28240
28250
28260
28270
28280
28290
28300
28310
28320
28330
28340
28350
28360
28370
28380
28390
28400
28410
28420
28430
28440
28450
28460
28470
28480
28490
28500
28510
28520
28530
28540
28550
28560
28570
28580
28590
28600
28610
28620
28630
28640
28650
28660
28670
28680
28690
28700
28710
28720
28730
28740
28750
28760
28770
28780
28790
28800
28810
28820
28830
28840
28850
28860
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Clay County, Nebraska .......................................................................................................
Colfax County, Nebraska ....................................................................................................
Cuming County, Nebraska ..................................................................................................
Custer County, Nebraska ....................................................................................................
Dakota County, Nebraska ...................................................................................................
Dawes County, Nebraska ...................................................................................................
Dawson County, Nebraska .................................................................................................
Deuel County, Nebraska .....................................................................................................
Dixon County, Nebraska .....................................................................................................
Dodge County, Nebraska ....................................................................................................
Douglas County, Nebraska .................................................................................................
Dundy County, Nebraska ....................................................................................................
Fillmore County, Nebraska ..................................................................................................
Franklin County, Nebraska ..................................................................................................
Frontier County, Nebraska ..................................................................................................
Furnas County, Nebraska ...................................................................................................
Gage County, Nebraska ......................................................................................................
Garden County, Nebraska ..................................................................................................
Garfield County, Nebraska ..................................................................................................
Gosper County, Nebraska ...................................................................................................
Grant County, Nebraska .....................................................................................................
Greeley County, Nebraska ..................................................................................................
Hall County, Nebraska ........................................................................................................
Hamilton County, Nebraska ................................................................................................
Harlan County, Nebraska ....................................................................................................
Hayes County, Nebraska ....................................................................................................
Hitchcock County, Nebraska ...............................................................................................
Holt County, Nebraska ........................................................................................................
Hooker County, Nebraska ...................................................................................................
Howard County, Nebraska ..................................................................................................
Jefferson County, Nebraska ................................................................................................
Johnson County, Nebraska .................................................................................................
Kearney County, Nebraska .................................................................................................
Keith County, Nebraska ......................................................................................................
Keya Paha County, Nebraska .............................................................................................
Kimball County, Nebraska ...................................................................................................
Knox County, Nebraska ......................................................................................................
Lancaster County, Nebraska ...............................................................................................
Lincoln County, Nebraska ...................................................................................................
Logan County, Nebraska ....................................................................................................
Loup County, Nebraska ......................................................................................................
Mc Pherson County, Nebraska ...........................................................................................
Madison County, Nebraska .................................................................................................
Merrick County, Nebraska ...................................................................................................
Morrill County, Nebraska .....................................................................................................
Nance County, Nebraska ....................................................................................................
Nemaha County, Nebraska .................................................................................................
Nuckolls County, Nebraska .................................................................................................
Otoe County, Nebraska .......................................................................................................
Pawnee County, Nebraska .................................................................................................
Perkins County, Nebraska ..................................................................................................
Phelps County, Nebraska ...................................................................................................
Pierce County, Nebraska ....................................................................................................
Platte County, Nebraska .....................................................................................................
Polk County, Nebraska .......................................................................................................
Redwillow County, Nebraska ..............................................................................................
Richardson County, Nebraska ............................................................................................
Rock County, Nebraska ......................................................................................................
Saline County, Nebraska ....................................................................................................
Sarpy County, Nebraska .....................................................................................................
Saunders County, Nebraska ...............................................................................................
Scotts Bluff County, Nebraska ............................................................................................
Seward County, Nebraska ..................................................................................................
Sheridan County, Nebraska ................................................................................................
Sherman County, Nebraska ................................................................................................
Sioux County, Nebraska .....................................................................................................
Stanton County, Nebraska ..................................................................................................
Thayer County, Nebraska ...................................................................................................
Thomas County, Nebraska .................................................................................................
Thurston County, Nebraska ................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00272
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
28
28
28
28
7720
28
28
28
28
28
5920
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
4360
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
5920
28
28
28
28
28
28
28
28
28
28
CBSA No.
28
28
28
28
43580
28
28
28
43580
28
36540
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
30700
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
36540
36540
28
30700
28
28
28
28
28
28
28
46035
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
28870
28880
28890
28900
28910
28920
29000
29010
29020
29030
29040
29050
29060
29070
29080
29090
29100
29110
29120
29130
29140
29150
29160
30000
30010
30020
30030
30040
30050
30060
30070
30080
30090
31000
31100
31150
31160
31180
31190
31200
31220
31230
31250
31260
31270
31290
31300
31310
31320
31340
31350
31360
31370
31390
32000
32010
32020
32025
32030
32040
32050
32060
32070
32080
32090
32100
32110
32120
32130
32131
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Valley County, Nebraska .....................................................................................................
Washington County, Nebraska ...........................................................................................
Wayne County, Nebraska ...................................................................................................
Webster County, Nebraska .................................................................................................
Wheeler County, Nebraska .................................................................................................
York County, Nebraska .......................................................................................................
Churchill County, Nevada ...................................................................................................
Clark County, Nevada .........................................................................................................
Douglas County, Nevada ....................................................................................................
Elko County, Nevada ..........................................................................................................
Esmeralda County, Nevada ................................................................................................
Eureka County, Nevada ......................................................................................................
Humboldt County, Nevada ..................................................................................................
Lander County, Nevada ......................................................................................................
Lincoln County, Nevada ......................................................................................................
Lyon County, Nevada ..........................................................................................................
Mineral County, Nevada ......................................................................................................
Nye County, Nevada ...........................................................................................................
Carson City County, Nevada ..............................................................................................
Pershing County, Nevada ...................................................................................................
Storey County, Nevada .......................................................................................................
Washoe County, Nevada ....................................................................................................
White Pine County, Nevada ................................................................................................
Belknap County, New Hampshire .......................................................................................
Carroll County, New Hampshire .........................................................................................
Cheshire County, New Hampshire ......................................................................................
Coos County, New Hampshire ............................................................................................
Grafton County, New Hampshire ........................................................................................
Hillsboro County, New Hampshire ......................................................................................
Merrimack County, New Hampshire ...................................................................................
Rockingham County, New Hampshire ................................................................................
Strafford County, New Hampshire ......................................................................................
Sullivan County, New Hampshire .......................................................................................
Atlantic County, New Jersey ...............................................................................................
Bergen County, New Jersey ...............................................................................................
Burlington County, New Jersey ...........................................................................................
Camden County, New Jersey .............................................................................................
Cape May County, New Jersey ..........................................................................................
Cumberland County, New Jersey .......................................................................................
Essex County, New Jersey .................................................................................................
Gloucester County, New Jersey .........................................................................................
Hudson County, New Jersey ..............................................................................................
Hunterdon County, New Jersey ..........................................................................................
Mercer County, New Jersey ................................................................................................
Middlesex County, New Jersey ...........................................................................................
Monmouth County, New Jersey ..........................................................................................
Morris County, New Jersey .................................................................................................
Ocean County, New Jersey ................................................................................................
Passaic County, New Jersey ..............................................................................................
Salem County, New Jersey .................................................................................................
Somerset County, New Jersey ...........................................................................................
Sussex County, New Jersey ...............................................................................................
Union County, New Jersey .................................................................................................
Warren County, New Jersey ...............................................................................................
Bernalillo County, New Mexico ...........................................................................................
Catron County, New Mexico ...............................................................................................
Chaves County, New Mexico ..............................................................................................
Cibola County, New Mexico ................................................................................................
Colfax County, New Mexico ................................................................................................
Curry County, New Mexico .................................................................................................
De Baca County, New Mexico ............................................................................................
Dona Ana County, New Mexico ..........................................................................................
Eddy County, New Mexico ..................................................................................................
Grant County, New Mexico .................................................................................................
Guadalupe County, New Mexico ........................................................................................
Harding County, New Mexico .............................................................................................
Hidalgo County, New Mexico ..............................................................................................
Lea County, New Mexico ....................................................................................................
Lincoln County, New Mexico ...............................................................................................
Los Alamos County, New Mexico .......................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00273
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
28
5920
28
28
28
28
29
4120
29
29
29
29
29
29
29
29
29
29
29
29
29
6720
29
30
30
30
30
30
4763
4763
6453
6453
30
0560
0875
6160
6160
0560
8760
5640
6160
3640
5015
8480
5015
5190
5640
5190
0875
9160
5015
5640
5640
0240
0200
32
32
32
32
32
32
4100
32
32
32
32
32
32
32
7490
CBSA No.
28
36540
28
28
28
28
29
29820
29
29
29
29
29
29
29
29
29
29
16180
29
39900
39900
29
30
30
30
30
30
31700
31700
40484
40484
30
12100
35644
15804
15804
36140
47220
35084
15804
35644
35084
45940
20764
20764
35084
20764
35644
48864
20764
35084
35084
10900
10740
32
32
32
32
32
32
29740
32
32
32
32
32
32
32
32
46036
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
32140
32150
32160
32170
32180
32190
32200
32210
32220
32230
32240
32250
32260
32270
32280
32290
32300
33000
33010
33020
33030
33040
33050
33060
33070
33080
33090
33200
33210
33220
33230
33240
33260
33270
33280
33290
33300
33310
33320
33330
33331
33340
33350
33360
33370
33380
33400
33420
33500
33510
33520
33530
33540
33550
33560
33570
33580
33590
33600
33610
33620
33630
33640
33650
33660
33670
33680
33690
33700
33710
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Luna County, New Mexico ..................................................................................................
Mc Kinley County, New Mexico ..........................................................................................
Mora County, New Mexico ..................................................................................................
Otero County, New Mexico .................................................................................................
Quay County, New Mexico .................................................................................................
Rio Arriba County, New Mexico ..........................................................................................
Roosevelt County, New Mexico ..........................................................................................
Sandoval County, New Mexico ...........................................................................................
San Juan County, New Mexico ...........................................................................................
San Miguel County, New Mexico ........................................................................................
Santa Fe County, New Mexico ...........................................................................................
Sierra County, New Mexico ................................................................................................
Socorro County, New Mexico .............................................................................................
Taos County, New Mexico ..................................................................................................
Torrance County, New Mexico ............................................................................................
Union County, New Mexico .................................................................................................
Valencia County, New Mexico ............................................................................................
Albany County, New York ...................................................................................................
Allegany County, New York ................................................................................................
Bronx County, New York .....................................................................................................
Broome County, New York .................................................................................................
Cattaraugus County, New York ..........................................................................................
Cayuga County, New York ..................................................................................................
Chautauqua County, New York ..........................................................................................
Chemung County, New York ..............................................................................................
Chenango County, New York .............................................................................................
Clinton County, New York ...................................................................................................
Columbia County, New York ...............................................................................................
Cortland County, New York ................................................................................................
Delaware County, New York ...............................................................................................
Dutchess County, New York ...............................................................................................
Erie County, New York ........................................................................................................
Essex County, New York ....................................................................................................
Franklin County, New York .................................................................................................
Fulton County, New York ....................................................................................................
Genesee County, New York ...............................................................................................
Greene County, New York ..................................................................................................
Hamilton County, New York ................................................................................................
Herkimer County, New York ...............................................................................................
Jefferson County, New York ...............................................................................................
Kings County, New York .....................................................................................................
Lewis County, New York .....................................................................................................
Livingston County, New York ..............................................................................................
Madison County, New York ................................................................................................
Monroe County, New York ..................................................................................................
Montgomery County, New York ..........................................................................................
Nassau County, New York ..................................................................................................
New York County, New York ..............................................................................................
Niagara County, New York .................................................................................................
Oneida County, New York ..................................................................................................
Onondaga County, New York .............................................................................................
Ontario County, New York ..................................................................................................
Orange County, New York ..................................................................................................
Orleans County, New York .................................................................................................
Oswego County, New York .................................................................................................
Otsego County, New York ..................................................................................................
Putnam County, New York ..................................................................................................
Queens County, New York .................................................................................................
Rensselaer County, New York ............................................................................................
Richmond County, New York ..............................................................................................
Rockland County, New York ...............................................................................................
St Lawrence County, New York ..........................................................................................
Saratoga County, New York ...............................................................................................
Schenectady County, New York .........................................................................................
Schoharie County, New York ..............................................................................................
Schuyler County, New York ................................................................................................
Seneca County, New York ..................................................................................................
Steuben County, New York .................................................................................................
Suffolk County, New York ...................................................................................................
Sullivan County, New York .................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00274
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
32
32
32
32
32
32
32
32
32
32
7490
32
32
32
32
32
32
0160
33
5600
0960
33
33
33
2335
33
33
33
33
33
6460
1280
33
33
33
33
0160
33
8680
33
5600
33
6840
8160
6840
0160
5380
5600
5700
8680
8160
6840
5950
6840
8160
33
5600
5600
0160
5600
5600
33
0160
0160
33
33
33
33
5380
33
CBSA No.
32
32
32
32
32
32
32
10740
22140
32
42140
32
32
32
10740
32
10740
10580
33
35644
13780
33
33
33
21300
33
33
33
33
33
39100
15380
33
33
33
33
33
33
46540
33
35644
33
40380
45060
40380
33
35004
35644
15380
46540
45060
40380
39100
40380
45060
33
35644
35644
10580
35644
35644
33
10580
10580
10580
33
33
33
35004
33
46037
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
33720
33730
33740
33750
33760
33770
33800
33900
33910
34000
34010
34020
34030
34040
34050
34060
34070
34080
34090
34100
34110
34120
34130
34140
34150
34160
34170
34180
34190
34200
34210
34220
34230
34240
34250
34251
34270
34280
34290
34300
34310
34320
34330
34340
34350
34360
34370
34380
34390
34400
34410
34420
34430
34440
34450
34460
34470
34480
34490
34500
34510
34520
34530
34540
34550
34560
34570
34580
34590
34600
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Tioga County, New York .....................................................................................................
Tompkins County, New York ..............................................................................................
Ulster County, New York .....................................................................................................
Warren County, New York ..................................................................................................
Washington County, New York ...........................................................................................
Wayne County, New York ...................................................................................................
Westchester County, New York ..........................................................................................
Wyoming County, New York ...............................................................................................
Yates County, New York .....................................................................................................
Alamance County, N Carolina .............................................................................................
Alexander County, N Carolina ............................................................................................
Alleghany County, N Carolina .............................................................................................
Anson County, N Carolina ..................................................................................................
Ashe County, N Carolina ....................................................................................................
Avery County, N Carolina ...................................................................................................
Beaufort County, N Carolina ...............................................................................................
Bertie County, N Carolina ...................................................................................................
Bladen County, N Carolina .................................................................................................
Brunswick County, N Carolina ............................................................................................
Buncombe County, N Carolina ...........................................................................................
Burke County, N Carolina ...................................................................................................
Cabarrus County, N Carolina ..............................................................................................
Caldwell County, N Carolina ...............................................................................................
Camden County, N Carolina ...............................................................................................
Carteret County, N Carolina ................................................................................................
Caswell County, N Carolina ................................................................................................
Catawba County, N Carolina ..............................................................................................
Chatham County, N Carolina ..............................................................................................
Cherokee County, N Carolina .............................................................................................
Chowan County, N Carolina ...............................................................................................
Clay County, N Carolina .....................................................................................................
Cleveland County, N Carolina .............................................................................................
Columbus County, N Carolina ............................................................................................
Craven County, N Carolina .................................................................................................
Cumberland County, N Carolina .........................................................................................
Currituck County, N Carolina ..............................................................................................
Dare County, N Carolina .....................................................................................................
Davidson County, N Carolina ..............................................................................................
Davie County, N Carolina ...................................................................................................
Duplin County, N Carolina ..................................................................................................
Durham County, N Carolina ................................................................................................
Edgecombe County, N Carolina .........................................................................................
Forsyth County, N Carolina .................................................................................................
Franklin County, N Carolina ................................................................................................
Gaston County, N Carolina .................................................................................................
Gates County, N Carolina ...................................................................................................
Graham County, N Carolina ................................................................................................
Granville County, N Carolina ..............................................................................................
Greene County, N Carolina .................................................................................................
Guilford County, N Carolina ................................................................................................
Halifax County, N Carolina ..................................................................................................
Harnett County, N Carolina .................................................................................................
Haywood County, N Carolina ..............................................................................................
Henderson County, N Carolina ...........................................................................................
Hertford County, N Carolina ................................................................................................
Hoke County, N Carolina ....................................................................................................
Hyde County, N Carolina ....................................................................................................
Iredell County, N Carolina ...................................................................................................
Jackson County, N Carolina ...............................................................................................
Johnston County, N Carolina ..............................................................................................
Jones County, N Carolina ...................................................................................................
Lee County, N Carolina .......................................................................................................
Lenoir County, N Carolina ...................................................................................................
Lincoln County, N Carolina .................................................................................................
Mc Dowell County, N Carolina ............................................................................................
Macon County, N Carolina ..................................................................................................
Madison County, N Carolina ...............................................................................................
Martin County, N Carolina ...................................................................................................
Mecklenburg County, N Carolina ........................................................................................
Mitchell County, N Carolina ................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00275
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
0960
33
33
2975
2975
6840
5600
33
33
1300
3290
34
34
34
34
34
34
34
34
0480
3290
1520
34
34
34
34
3290
34
34
34
34
34
34
34
2560
34
34
3120
3120
34
6640
34
3120
6640
1520
34
34
34
34
3120
34
34
34
34
34
34
34
34
34
34
34
34
34
1520
34
34
34
34
1520
34
CBSA No.
13780
27060
28740
24020
24020
40380
35644
33
33
15500
25860
34
16740
34
34
34
34
34
48900
11700
25860
16740
25860
34
34
34
25860
20500
34
34
34
34
34
34
22180
47260
34
34
49180
34
20500
40580
49180
39580
16740
34
34
34
24780
24660
34
34
11700
11700
34
22180
34
34
34
39580
34
34
34
34
34
34
11700
34
16740
34
46038
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
34610
34620
34630
34640
34650
34660
34670
34680
34690
34700
34710
34720
34730
34740
34750
34760
34770
34780
34790
34800
34810
34820
34830
34840
34850
34860
34870
34880
34890
34900
34910
34920
34930
34940
34950
34960
34970
34980
34981
35000
35010
35020
35030
35040
35050
35060
35070
35080
35090
35100
35110
35120
35130
35140
35150
35160
35170
35180
35190
35200
35210
35220
35230
35240
35250
35260
35270
35280
35290
35300
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Montgomery County, N Carolina .........................................................................................
Moore County, N Carolina ..................................................................................................
Nash County, N Carolina ....................................................................................................
New Hanover County, N Carolina .......................................................................................
Northampton County, N Carolina ........................................................................................
Onslow County, N Carolina .................................................................................................
Orange County, N Carolina .................................................................................................
Pamlico County, N Carolina ................................................................................................
Pasquotank County, N Carolina ..........................................................................................
Pender County, N Carolina .................................................................................................
Perquimans County, N Carolina .........................................................................................
Person County, N Carolina .................................................................................................
Pitt County, N Carolina .......................................................................................................
Polk County, N Carolina ......................................................................................................
Randolph County, N Carolina .............................................................................................
Richmond County, N Carolina ............................................................................................
Robeson County, N Carolina ..............................................................................................
Rockingham County, N Carolina .........................................................................................
Rowan County, N Carolina .................................................................................................
Rutherford County, N Carolina ............................................................................................
Sampson County, N Carolina .............................................................................................
Scotland County, N Carolina ...............................................................................................
Stanly County, N Carolina ...................................................................................................
Stokes County, N Carolina ..................................................................................................
Surry County, N Carolina ....................................................................................................
Swain County, N Carolina ...................................................................................................
Transylvania County, N Carolina ........................................................................................
Tyrrell County, N Carolina ...................................................................................................
Union County, N Carolina ...................................................................................................
Vance County, N Carolina ..................................................................................................
Wake County, N Carolina ...................................................................................................
Warren County, N Carolina .................................................................................................
Washington County, N Carolina ..........................................................................................
Watauga County, N Carolina ..............................................................................................
Wayne County, N Carolina .................................................................................................
Wilkes County, N Carolina ..................................................................................................
Wilson County, N Carolina ..................................................................................................
Yadkin County, N Carolina ..................................................................................................
Yancey County, N Carolina .................................................................................................
Adams County, N Dakota ...................................................................................................
Barnes County, N Dakota ...................................................................................................
Benson County, N Dakota ..................................................................................................
Billings County, N Dakota ...................................................................................................
Bottineau County, N Dakota ...............................................................................................
Bowman County, N Dakota .................................................................................................
Burke County, N Dakota .....................................................................................................
Burleigh County, N Dakota .................................................................................................
Cass County, N Dakota ......................................................................................................
Cavalier County, N Dakota .................................................................................................
Dickey County, N Dakota ....................................................................................................
Divide County, N Dakota .....................................................................................................
Dunn County, N Dakota ......................................................................................................
Eddy County, N Dakota ......................................................................................................
Emmons County, N Dakota ................................................................................................
Foster County, N Dakota ....................................................................................................
Golden Valley County, N Dakota ........................................................................................
Grand Forks County, N Dakota ..........................................................................................
Grant County, N Dakota ......................................................................................................
Griggs County, N Dakota ....................................................................................................
Hettinger County, N Dakota ................................................................................................
Kidder County, N Dakota ....................................................................................................
La Moure County, N Dakota ...............................................................................................
Logan County, N Dakota .....................................................................................................
Mc Henry County, N Dakota ...............................................................................................
Mc Intosh County, N Dakota ...............................................................................................
Mc Kenzie County, N Dakota ..............................................................................................
Mc Lean County, N Dakota .................................................................................................
Mercer County, N Dakota ...................................................................................................
Morton County, N Dakota ...................................................................................................
Mountrail County, N Dakota ................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00276
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
34
34
34
9200
34
3605
6640
34
34
34
34
34
34
34
3120
34
34
34
1520
34
34
34
34
3120
34
34
34
34
1520
34
6640
34
34
34
34
34
34
3120
34
35
35
35
35
35
35
35
1010
2520
35
35
35
35
35
35
35
35
2985
35
35
35
35
35
35
35
35
35
35
35
1010
35
CBSA No.
34
34
40580
48900
34
27340
20500
34
34
48900
34
20500
24780
34
24660
34
34
24660
34
34
34
34
16740
49180
34
34
34
34
16740
34
39580
34
34
34
24140
34
34
49180
34
35
35
35
35
35
35
35
13900
22020
35
35
35
35
35
35
35
35
24220
35
35
35
35
35
35
35
35
35
35
35
13900
35
46039
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
35310
35320
35330
35340
35350
35360
35370
35380
35390
35400
35410
35420
35430
35440
35450
35460
35470
35480
35490
35500
35510
35520
36000
36010
36020
36030
36040
36050
36060
36070
36080
36090
36100
36110
36120
36130
36140
36150
36160
36170
36190
36200
36210
36220
36230
36240
36250
36260
36270
36280
36290
36300
36310
36330
36340
36350
36360
36370
36380
36390
36400
36410
36420
36430
36440
36450
36460
36470
36480
36490
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Nelson County, N Dakota ...................................................................................................
Oliver County, N Dakota .....................................................................................................
Pembina County, N Dakota ................................................................................................
Pierce County, N Dakota ....................................................................................................
Ramsey County, N Dakota .................................................................................................
Ransom County, N Dakota .................................................................................................
Renville County, N Dakota ..................................................................................................
Richland County, N Dakota .................................................................................................
Rolette County, N Dakota ...................................................................................................
Sargent County, N Dakota ..................................................................................................
Sheridan County, N Dakota ................................................................................................
Sioux County, N Dakota ......................................................................................................
Slope County, N Dakota .....................................................................................................
Stark County, N Dakota ......................................................................................................
Steele County, N Dakota ....................................................................................................
Stutsman County, N Dakota ...............................................................................................
Towner County, N Dakota ...................................................................................................
Traill County, N Dakota .......................................................................................................
Walsh County, N Dakota .....................................................................................................
Ward County, N Dakota ......................................................................................................
Wells County, N Dakota ......................................................................................................
Williams County, N Dakota .................................................................................................
Adams County, Ohio ...........................................................................................................
Allen County, Ohio ..............................................................................................................
Ashland County, Ohio .........................................................................................................
Ashtabula County, Ohio ......................................................................................................
Athens County, Ohio ...........................................................................................................
Auglaize County, Ohio ........................................................................................................
Belmont County, Ohio .........................................................................................................
Brown County, Ohio ............................................................................................................
Butler County, Ohio .............................................................................................................
Carroll County, Ohio ............................................................................................................
Champaign County, Ohio ....................................................................................................
Clark County, Ohio ..............................................................................................................
Clermont County, Ohio ........................................................................................................
Clinton County, Ohio ...........................................................................................................
Columbiana County, Ohio ...................................................................................................
Coshocton County, Ohio .....................................................................................................
Crawford County, Ohio ........................................................................................................
Cuyahoga County, Ohio ......................................................................................................
Darke County, Ohio .............................................................................................................
Defiance County, Ohio ........................................................................................................
Delaware County, Ohio .......................................................................................................
Erie County, Ohio ................................................................................................................
Fairfield County, Ohio .........................................................................................................
Fayette County, Ohio ..........................................................................................................
Franklin County, Ohio .........................................................................................................
Fulton County, Ohio ............................................................................................................
Gallia County, Ohio .............................................................................................................
Geauga County, Ohio .........................................................................................................
Greene County, Ohio ..........................................................................................................
Guernsey County, Ohio .......................................................................................................
Hamilton County, Ohio ........................................................................................................
Hancock County, Ohio ........................................................................................................
Hardin County, Ohio ............................................................................................................
Harrison County, Ohio .........................................................................................................
Henry County, Ohio .............................................................................................................
Highland County, Ohio ........................................................................................................
Hocking County, Ohio .........................................................................................................
Holmes County, Ohio ..........................................................................................................
Huron County, Ohio ............................................................................................................
Jackson County, Ohio .........................................................................................................
Jefferson County, Ohio .......................................................................................................
Knox County, Ohio ..............................................................................................................
Lake County, Ohio ..............................................................................................................
Lawrence County, Ohio .......................................................................................................
Licking County, Ohio ...........................................................................................................
Logan County, Ohio ............................................................................................................
Lorain County, Ohio ............................................................................................................
Lucas County, Ohio .............................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00277
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
36
4320
36
36
36
4320
9000
36
3200
1320
36
2000
1640
36
36
36
36
1680
36
36
1840
36
1840
36
1840
8400
36
1680
2000
36
1640
36
36
36
36
36
36
36
36
36
8080
36
1680
3400
1840
36
4440
8400
CBSA No.
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
36
30620
36
36
36
36
48540
17140
17140
15940
36
44220
17140
36
36
36
36
17460
36
36
18140
41780
18140
36
18140
45780
36
17460
19380
36
17140
36
36
36
36
36
36
36
36
36
48260
36
17460
26580
18140
36
17460
45780
46040
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
36500
36510
36520
36530
36540
36550
36560
36570
36580
36590
36600
36610
36620
36630
36640
36650
36660
36670
36680
36690
36700
36710
36720
36730
36740
36750
36760
36770
36780
36790
36800
36810
36820
36830
36840
36850
36860
36870
36880
36890
37000
37010
37020
37030
37040
37050
37060
37070
37080
37090
37100
37110
37120
37130
37140
37150
37160
37170
37180
37190
37200
37210
37220
37230
37240
37250
37260
37270
37280
37290
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Madison County, Ohio .........................................................................................................
Mahoning County, Ohio ......................................................................................................
Marion County, Ohio ...........................................................................................................
Medina County, Ohio ..........................................................................................................
Meigs County, Ohio .............................................................................................................
Mercer County, Ohio ...........................................................................................................
Miami County, Ohio .............................................................................................................
Monroe County, Ohio ..........................................................................................................
Montgomery County, Ohio ..................................................................................................
Morgan County, Ohio ..........................................................................................................
Morrow County, Ohio ..........................................................................................................
Muskingum County, Ohio ....................................................................................................
Noble County, Ohio .............................................................................................................
Ottawa County, Ohio ...........................................................................................................
Paulding County, Ohio ........................................................................................................
Perry County, Ohio ..............................................................................................................
Pickaway County, Ohio .......................................................................................................
Pike County, Ohio ...............................................................................................................
Portage County, Ohio ..........................................................................................................
Preble County, Ohio ............................................................................................................
Putnam County, Ohio ..........................................................................................................
Richland County, Ohio ........................................................................................................
Ross County, Ohio ..............................................................................................................
Sandusky County, Ohio ......................................................................................................
Scioto County, Ohio ............................................................................................................
Seneca County, Ohio ..........................................................................................................
Shelby County, Ohio ...........................................................................................................
Stark County, Ohio ..............................................................................................................
Summit County, Ohio ..........................................................................................................
Trumbull County, Ohio ........................................................................................................
Tuscarawas County, Ohio ...................................................................................................
Union County, Ohio .............................................................................................................
Van Wert County, Ohio .......................................................................................................
Vinton County, Ohio ............................................................................................................
Warren County, Ohio ..........................................................................................................
Washington County, Ohio ...................................................................................................
Wayne County, Ohio ...........................................................................................................
Williams County, Ohio .........................................................................................................
Wood County, Ohio .............................................................................................................
Wyandot County, Ohio ........................................................................................................
Adair County, Oklahoma .....................................................................................................
Alfalfa County, Oklahoma ...................................................................................................
Atoka County, Oklahoma ....................................................................................................
Beaver County, Oklahoma ..................................................................................................
Beckham County, Oklahoma ..............................................................................................
Blaine County, Oklahoma ...................................................................................................
Bryan County, Oklahoma ....................................................................................................
Caddo County, Oklahoma ...................................................................................................
Canadian County, Oklahoma ..............................................................................................
Carter County, Oklahoma ...................................................................................................
Cherokee County, Oklahoma ..............................................................................................
Choctaw County, Oklahoma ...............................................................................................
Cimarron County, Oklahoma ...............................................................................................
Cleveland County, Oklahoma .............................................................................................
Coal County, Oklahoma ......................................................................................................
Comanche County, Oklahoma ............................................................................................
Cotton County, Oklahoma ...................................................................................................
Craig County, Oklahoma .....................................................................................................
Creek County, Oklahoma ....................................................................................................
Custer County, Oklahoma ...................................................................................................
Delaware County, Oklahoma ..............................................................................................
Dewey County, Oklahoma ..................................................................................................
Ellis County, Oklahoma .......................................................................................................
Garfield County, Oklahoma .................................................................................................
Garvin County, Oklahoma ...................................................................................................
Grady County, Oklahoma ....................................................................................................
Grant County, Oklahoma ....................................................................................................
Greer County, Oklahoma ....................................................................................................
Harmon County, Oklahoma .................................................................................................
Harper County, Oklahoma ..................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00278
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
1840
9320
36
1680
36
36
2000
36
2000
36
36
36
36
36
36
36
1840
36
0080
36
36
4800
36
36
36
36
36
1320
0080
9320
36
1840
36
36
1640
6020
36
36
8400
36
37
37
37
37
37
37
37
37
5880
37
37
37
37
5880
37
4200
37
37
8560
37
37
37
37
2340
37
37
37
37
37
37
CBSA No.
18140
49660
36
17460
36
36
19380
36
19380
36
18140
36
36
45780
36
36
18140
36
10420
19380
36
31900
36
36
36
36
36
15940
10420
49660
36
18140
36
36
17140
37620
36
36
45780
36
37
37
37
37
37
37
37
37
36420
37
37
37
37
36420
37
30020
37
37
46140
37
37
37
37
37
37
36420
37
37
37
37
46041
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
37300
37310
37320
37330
37340
37350
37360
37370
37380
37390
37400
37410
37420
37430
37440
37450
37460
37470
37480
37490
37500
37510
37520
37530
37540
37550
37560
37570
37580
37590
37600
37610
37620
37630
37640
37650
37660
37670
37680
37690
37700
37710
37720
37730
37740
37750
37760
38000
38010
38020
38030
38040
38050
38060
38070
38080
38090
38100
38110
38120
38130
38140
38150
38160
38170
38180
38190
38200
38210
38220
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Haskell County, Oklahoma ..................................................................................................
Hughes County, Oklahoma .................................................................................................
Jackson County, Oklahoma ................................................................................................
Jefferson County, Oklahoma ...............................................................................................
Johnston County, Oklahoma ...............................................................................................
Kay County, Oklahoma .......................................................................................................
Kingfisher County, Oklahoma .............................................................................................
Kiowa County, Oklahoma ....................................................................................................
Latimer County, Oklahoma .................................................................................................
Le Flore County, Oklahoma ................................................................................................
Lincoln County, Oklahoma ..................................................................................................
Logan County, Oklahoma ...................................................................................................
Love County, Oklahoma ......................................................................................................
Mc Clain County, Oklahoma ...............................................................................................
Mc Curtain County, Oklahoma ............................................................................................
Mc Intosh County, Oklahoma ..............................................................................................
Major County, Oklahoma ....................................................................................................
Marshall County, Oklahoma ................................................................................................
Mayes County, Oklahoma ...................................................................................................
Murray County, Oklahoma ..................................................................................................
Muskogee County, Oklahoma .............................................................................................
Noble County, Oklahoma ....................................................................................................
Nowata County, Oklahoma .................................................................................................
Okfuskee County, Oklahoma ..............................................................................................
Oklahoma County, Oklahoma .............................................................................................
Okmulgee County, Oklahoma .............................................................................................
Osage County, Oklahoma ...................................................................................................
Ottawa County, Oklahoma ..................................................................................................
Pawnee County, Oklahoma ................................................................................................
Payne County, Oklahoma ...................................................................................................
Pittsburg County, Oklahoma ...............................................................................................
Pontotoc County, Oklahoma ...............................................................................................
Pottawatomie County, Oklahoma ........................................................................................
Pushmataha County, Oklahoma .........................................................................................
Roger Mills County, Oklahoma ...........................................................................................
Rogers County, Oklahoma ..................................................................................................
Seminole County, Oklahoma ..............................................................................................
Sequoyah County, Oklahoma .............................................................................................
Stephens County, Oklahoma ..............................................................................................
Texas County, Oklahoma ....................................................................................................
Tillman County, Oklahoma ..................................................................................................
Tulsa County, Oklahoma .....................................................................................................
Wagoner County, Oklahoma ...............................................................................................
Washington County, Oklahoma ..........................................................................................
Washita County, Oklahoma ................................................................................................
Woods County, Oklahoma ..................................................................................................
Woodward County, Oklahoma ............................................................................................
Baker County, Oregon ........................................................................................................
Benton County, Oregon ......................................................................................................
Clackamas County, Oregon ................................................................................................
Clatsop County, Oregon ......................................................................................................
Columbia County, Oregon ...................................................................................................
Coos County, Oregon .........................................................................................................
Crook County, Oregon ........................................................................................................
Curry County, Oregon .........................................................................................................
Deschutes County, Oregon .................................................................................................
Douglas County, Oregon .....................................................................................................
Gilliam County, Oregon .......................................................................................................
Grant County, Oregon .........................................................................................................
Harney County, Oregon ......................................................................................................
Hood River County, Oregon ................................................................................................
Jackson County, Oregon .....................................................................................................
Jefferson County, Oregon ...................................................................................................
Josephine County, Oregon .................................................................................................
Klamath County, Oregon .....................................................................................................
Lake County, Oregon ..........................................................................................................
Lane County, Oregon ..........................................................................................................
Lincoln County, Oregon ......................................................................................................
Linn County, Oregon ...........................................................................................................
Malheur County, Oregon .....................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00279
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
37
37
37
37
37
37
37
37
37
37
37
5880
37
5880
37
37
37
37
37
37
37
37
37
37
5880
37
8560
37
37
37
37
37
5880
37
37
8560
37
2720
37
37
37
8560
8560
37
37
37
37
38
38
6440
38
38
38
38
38
38
38
38
38
38
38
4890
38
38
38
38
2400
38
38
38
CBSA No.
37
37
37
37
37
37
37
37
37
22900
36420
36420
37
36420
37
37
37
37
37
37
37
37
37
37
36420
46140
46140
37
46140
37
37
37
37
37
37
46140
37
22900
37
37
37
46140
46140
37
37
37
37
38
18700
38900
38
38900
38
38
38
13460
38
38
38
38
38
32780
38
38
38
38
21660
38
38
38
46042
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
38230
38240
38250
38260
38270
38280
38290
38300
38310
38320
38330
38340
38350
39000
39010
39070
39080
39100
39110
39120
39130
39140
39150
39160
39180
39190
39200
39210
39220
39230
39240
39250
39260
39270
39280
39290
39310
39320
39330
39340
39350
39360
39370
39380
39390
39400
39410
39420
39440
39450
39460
39470
39480
39510
39520
39530
39540
39550
39560
39580
39590
39600
39610
39620
39630
39640
39650
39670
39680
39690
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Marion County, Oregon .......................................................................................................
Morrow County, Oregon ......................................................................................................
Multnomah County, Oregon ................................................................................................
Polk County, Oregon ...........................................................................................................
Sherman County, Oregon ...................................................................................................
Tillamook County, Oregon ..................................................................................................
Umatilla County, Oregon .....................................................................................................
Union County, Oregon ........................................................................................................
Wallowa County, Oregon ....................................................................................................
Wasco County, Oregon .......................................................................................................
Washington County, Oregon ...............................................................................................
Wheeler County, Oregon ....................................................................................................
Yamhill County, Oregon ......................................................................................................
Adams County, Pennsylvania .............................................................................................
Allegheny County, Pennsylvania .........................................................................................
Armstrong County, Pennsylvania ........................................................................................
Beaver County, Pennsylvania .............................................................................................
Bedford County, Pennsylvania ............................................................................................
Berks County, Pennsylvania ...............................................................................................
Blair County, Pennsylvania .................................................................................................
Bradford County, Pennsylvania ...........................................................................................
Bucks County, Pennsylvania ...............................................................................................
Butler County, Pennsylvania ...............................................................................................
Cambria County, Pennsylvania ...........................................................................................
Cameron County, Pennsylvania ..........................................................................................
Carbon County, Pennsylvania .............................................................................................
Centre County, Pennsylvania ..............................................................................................
Chester County, Pennsylvania ............................................................................................
Clarion County, Pennsylvania .............................................................................................
Clearfield County, Pennsylvania .........................................................................................
Clinton County, Pennsylvania .............................................................................................
Columbia County, Pennsylvania .........................................................................................
Crawford County, Pennsylvania ..........................................................................................
Cumberland County, Pennsylvania .....................................................................................
Dauphin County, Pennsylvania ...........................................................................................
Delaware County, Pennsylvania .........................................................................................
Elk County, Pennsylvania ...................................................................................................
Erie County, Pennsylvania ..................................................................................................
Fayette County, Pennsylvania ............................................................................................
Forest County, Pennsylvania ..............................................................................................
Franklin County, Pennsylvania ............................................................................................
Fulton County, Pennsylvania ..............................................................................................
Greene County, Pennsylvania ............................................................................................
Huntingdon County, Pennsylvania ......................................................................................
Indiana County, Pennsylvania .............................................................................................
Jefferson County, Pennsylvania ..........................................................................................
Juniata County, Pennsylvania .............................................................................................
Lackawanna County, Pennsylvania ....................................................................................
Lancaster County, Pennsylvania .........................................................................................
Lawrence County, Pennsylvania .........................................................................................
Lebanon County, Pennsylvania ..........................................................................................
Lehigh County, Pennsylvania ..............................................................................................
Luzerne County, Pennsylvania ...........................................................................................
Lycoming County, Pennsylvania .........................................................................................
Mc Kean County, Pennsylvania ..........................................................................................
Mercer County, Pennsylvania .............................................................................................
Mifflin County, Pennsylvania ...............................................................................................
Monroe County, Pennsylvania ............................................................................................
Montgomery County, Pennsylvania ....................................................................................
Montour County, Pennsylvania ...........................................................................................
Northampton County, Pennsylvania ....................................................................................
Northumberland County, Pennsylvania ...............................................................................
Perry County, Pennsylvania ................................................................................................
Philadelphia County, Pennsylvania .....................................................................................
Pike County, Pennsylvania .................................................................................................
Potter County, Pennsylvania ...............................................................................................
Schuylkill County, Pennsylvania .........................................................................................
Snyder County, Pennsylvania .............................................................................................
Somerset County, Pennsylvania .........................................................................................
Sullivan County, Pennsylvania ............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00280
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
7080
38
6440
7080
38
38
38
38
38
38
6440
38
6440
9280
6280
39
0845
39
6680
0280
39
6160
39
3680
39
0240
8050
6160
39
39
39
7560
39
3240
3240
6160
39
2360
6280
39
39
39
39
39
39
39
39
7560
4000
39
3240
0240
7560
9140
39
7610
39
7560
6160
39
0240
39
3240
6160
5660
39
39
39
3680
39
CBSA No.
41420
38
38900
41420
38
38
38
38
38
38
38900
38
38900
39
38300
38300
38300
39
39740
11020
39
37964
38300
27780
39
10900
44300
37964
39
39
39
39
39
25420
25420
37964
39
21500
38300
39
39
39
39
39
39
39
39
42540
29540
39
30140
10900
42540
48700
39
49660
39
39
37964
39
10900
39
25420
37964
35084
39
39
39
39
39
46043
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
39700
39710
39720
39730
39740
39750
39760
39770
39790
39800
40010
40020
40030
40040
40050
40060
40070
40080
40090
40100
40110
40120
40130
40140
40145
40150
40160
40170
40180
40190
40200
40210
40220
40230
40240
40250
40260
40265
40270
40280
40290
40300
40310
40320
40330
40340
40350
40360
40370
40380
40390
40400
40410
40420
40430
40440
40450
40460
40470
40480
40490
40500
40510
40520
40530
40540
40550
40560
40570
40580
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Susquehanna County, Pennsylvania ..................................................................................
Tioga County, Pennsylvania ...............................................................................................
Union County, Pennsylvania ...............................................................................................
Venango County, Pennsylvania ..........................................................................................
Warren County, Pennsylvania .............................................................................................
Washington County, Pennsylvania .....................................................................................
Wayne County, Pennsylvania .............................................................................................
Westmoreland County, Pennsylvania .................................................................................
Wyoming County, Pennsylvania .........................................................................................
York County, Pennsylvania .................................................................................................
Adjuntas County, Puerto Rico .............................................................................................
Aguada County, Puerto Rico ..............................................................................................
Aguadilla County, Puerto Rico ............................................................................................
Aguas Buenas County, Puerto Rico ...................................................................................
Aibonito County, Puerto Rico ..............................................................................................
Anasco County, Puerto Rico ...............................................................................................
Arecibo County, Puerto Rico ...............................................................................................
Arroyo County, Puerto Rico ................................................................................................
Barceloneta County, Puerto Rico ........................................................................................
Barranquitas County, Puerto Rico ......................................................................................
Bayamon County, Puerto Rico ............................................................................................
Cabo Rojo County, Puerto Rico ..........................................................................................
Caguas County, Puerto Rico ..............................................................................................
Camuy County, Puerto Rico ...............................................................................................
Canovanas County, Puerto Rico .........................................................................................
Carolina County, Puerto Rico .............................................................................................
Catano County, Puerto Rico ...............................................................................................
Cayey County, Puerto Rico .................................................................................................
Ceiba County, Puerto Rico .................................................................................................
Ciales County, Puerto Rico .................................................................................................
Cidra County, Puerto Rico ..................................................................................................
Coamo County, Puerto Rico ...............................................................................................
Comerio County, Puerto Rico .............................................................................................
Corozal County, Puerto Rico ..............................................................................................
Culebra County, Puerto Rico ..............................................................................................
Dorado County, Puerto Rico ...............................................................................................
Fajardo County, Puerto Rico ...............................................................................................
Florida County, Puerto Rico ................................................................................................
Guanica County, Puerto Rico .............................................................................................
Guayama County, Puerto Rico ...........................................................................................
Guayanilla County, Puerto Rico ..........................................................................................
Guaynabo County, Puerto Rico ..........................................................................................
Gurabo County, Puerto Rico ...............................................................................................
Hatillo County, Puerto Rico .................................................................................................
Hormigueros County, Puerto Rico ......................................................................................
Humacao County, Puerto Rico ...........................................................................................
Isabela County, Puerto Rico ...............................................................................................
Jayuya County, Puerto Rico ...............................................................................................
Juana Diaz County, Puerto Rico .........................................................................................
Juncos County, Puerto Rico ...............................................................................................
Lajas County, Puerto Rico ..................................................................................................
Lares County, Puerto Rico ..................................................................................................
Las Marias County, Puerto Rico .........................................................................................
Las Piedras County, Puerto Rico ........................................................................................
Loiza County, Puerto Rico ..................................................................................................
Luquillo County, Puerto Rico ..............................................................................................
Manati County, Puerto Rico ................................................................................................
Maricao County, Puerto Rico ..............................................................................................
Maunabo County, Puerto Rico ............................................................................................
Mayaguez County, Puerto Rico ..........................................................................................
Moca County, Puerto Rico ..................................................................................................
Morovis County, Puerto Rico ..............................................................................................
Naguabo County, Puerto Rico ............................................................................................
Naranjito County, Puerto Rico ............................................................................................
Orocovis County, Puerto Rico .............................................................................................
Patillas County, Puerto Rico ...............................................................................................
Penuelas County, Puerto Rico ............................................................................................
Ponce County, Puerto Rico .................................................................................................
Quebradillas County, Puerto Rico .......................................................................................
Rincon County, Puerto Rico ................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00281
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
39
39
39
39
39
6280
39
6280
7560
9280
40
0060
0060
7440
40
4840
0470
40
7440
40
7440
4840
1310
0470
7440
7440
7440
1310
40
40
1310
40
40
40
40
40
40
40
40
40
6360
40
1310
0470
4840
40
40
40
6360
40
40
40
40
40
7440
40
40
40
40
4840
0060
40
40
40
40
40
6360
6360
40
40
CBSA No.
39
39
39
39
39
38300
39
38300
42540
49620
40
10380
10380
41980
41980
10380
41980
25020
41980
41980
41980
41900
41980
41980
41980
41980
41980
41980
21940
41980
41980
40
41980
41980
40
41980
21940
41980
49500
25020
49500
41980
41980
41980
32420
41980
10380
40
38660
41980
41900
10380
40
41980
41980
21940
41980
40
41980
32420
10380
41980
41980
41980
41980
25020
49500
38660
41980
10380
46044
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
40590
40610
40620
40630
40640
40650
40660
40670
40680
40690
40700
40710
40720
40730
40740
40750
40760
40770
41000
41010
41020
41030
41050
42000
42010
42020
42030
42040
42050
42060
42070
42080
42090
42100
42110
42120
42130
42140
42150
42160
42170
42180
42190
42200
42210
42220
42230
42240
42250
42260
42270
42280
42290
42300
42310
42320
42330
42340
42350
42360
42370
42380
42390
42400
42410
42420
42430
42440
42450
43010
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Rio Grande County, Puerto Rico ........................................................................................
Sabana Grande County, Puerto Rico .................................................................................
Salinas County, Puerto Rico ...............................................................................................
San German County, Puerto Rico ......................................................................................
San Juan County, Puerto Rico ...........................................................................................
San Lorenzo County, Puerto Rico ......................................................................................
San Sebastian County, Puerto Rico ...................................................................................
Santa Isabel County, Puerto Rico .......................................................................................
Toa Alta County, Puerto Rico .............................................................................................
Toa Baja County, Puerto Rico ............................................................................................
Trujillo Alto County, Puerto Rico .........................................................................................
Utuado County, Puerto Rico ...............................................................................................
Vega Alta County, Puerto Rico ...........................................................................................
Vega Baja County, Puerto Rico ..........................................................................................
Vieques County, Puerto Rico ..............................................................................................
Villalba County, Puerto Rico ...............................................................................................
Yabucoa County, Puerto Rico .............................................................................................
Yauco County, Puerto Rico .................................................................................................
Bristol County, Rhode Island ..............................................................................................
Kent County, Rhode Island .................................................................................................
Newport County, Rhode Island ...........................................................................................
Providence County, Rhode Island ......................................................................................
Washington County, Rhode Island .....................................................................................
Abbeville County, S Carolina ..............................................................................................
Aiken County, S Carolina ....................................................................................................
Allendale County, S Carolina ..............................................................................................
Anderson County, S Carolina .............................................................................................
Bamberg County, S Carolina ..............................................................................................
Barnwell County, S Carolina ...............................................................................................
Beaufort County, S Carolina ...............................................................................................
Berkeley County, S Carolina ...............................................................................................
Calhoun County, S Carolina ...............................................................................................
Charleston County, S Carolina ...........................................................................................
Cherokee County, S Carolina .............................................................................................
Chester County, S Carolina ................................................................................................
Chesterfield County, S Carolina ..........................................................................................
Clarendon County, S Carolina ............................................................................................
Colleton County, S Carolina ................................................................................................
Darlington County, S Carolina ............................................................................................
Dillon County, S Carolina ....................................................................................................
Dorchester County, S Carolina ...........................................................................................
Edgefield County, S Carolina ..............................................................................................
Fairfield County, S Carolina ................................................................................................
Florence County, S Carolina ...............................................................................................
Georgetown County, S Carolina .........................................................................................
Greenville County, S Carolina .............................................................................................
Greenwood County, S Carolina ..........................................................................................
Hampton County, S Carolina ..............................................................................................
Horry County, S Carolina ....................................................................................................
Jasper County, S Carolina ..................................................................................................
Kershaw County, S Carolina ...............................................................................................
Lancaster County, S Carolina .............................................................................................
Laurens County, S Carolina ................................................................................................
Lee County, S Carolina .......................................................................................................
Lexington County, S Carolina .............................................................................................
Mc Cormick County, S Carolina ..........................................................................................
Marion County, S Carolina ..................................................................................................
Marlboro County, S Carolina ...............................................................................................
Newberry County, S Carolina .............................................................................................
Oconee County, S Carolina ................................................................................................
Orangeburg County, S Carolina ..........................................................................................
Pickens County, S Carolina ................................................................................................
Richland County, S Carolina ...............................................................................................
Saluda County, S Carolina ..................................................................................................
Spartanburg County, S Carolina .........................................................................................
Sumter County, S Carolina .................................................................................................
Union County, S Carolina ...................................................................................................
Williamsburg County, S Carolina ........................................................................................
York County, S Carolina .....................................................................................................
Aurora County, S Dakota ....................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00282
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
40
4840
40
4840
40
1310
40
40
40
40
40
40
40
40
40
6360
40
6360
6483
6483
6483
6483
6483
42
0600
42
3160
42
42
42
1440
42
1440
42
42
42
42
42
42
42
1440
42
42
2655
42
3160
42
42
42
42
42
42
42
42
1760
42
42
42
42
42
42
3160
1760
42
3160
42
42
42
1520
43
CBSA No.
41980
41900
40
41900
41980
41980
10380
40
41980
41980
41980
40
41980
41980
40
38660
41980
49500
39300
39300
39300
39300
39300
42
12260
42
11340
42
42
42
16700
17900
16700
42
42
42
42
42
22500
42
16700
12260
17900
22500
42
24860
42
42
34820
42
17900
42
24860
42
17900
42
42
42
42
42
42
24860
17900
17900
43900
44940
42
42
16740
43
46045
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
43020
43030
43040
43050
43060
43070
43080
43090
43100
43110
43120
43130
43140
43150
43160
43170
43180
43190
43200
43210
43220
43230
43240
43250
43260
43270
43280
43290
43300
43310
43320
43330
43340
43350
43360
43370
43380
43390
43400
43410
43420
43430
43440
43450
43460
43470
43480
43490
43500
43510
43520
43530
43540
43550
43560
43570
43580
43590
43600
43610
43620
43630
43640
43650
43670
43680
44000
44010
44020
44030
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Beadle County, S Dakota ....................................................................................................
Bennett County, S Dakota ..................................................................................................
Bon Homme County, S Dakota ...........................................................................................
Brookings County, S Dakota ...............................................................................................
Brown County, S Dakota .....................................................................................................
Brule County, S Dakota ......................................................................................................
Buffalo County, S Dakota ....................................................................................................
Butte County, S Dakota ......................................................................................................
Campbell County, S Dakota ................................................................................................
Charles Mix County, S Dakota ............................................................................................
Clark County, S Dakota ......................................................................................................
Clay County, S Dakota ........................................................................................................
Codington County, S Dakota ..............................................................................................
Corson County, S Dakota ...................................................................................................
Custer County, S Dakota ....................................................................................................
Davison County, S Dakota ..................................................................................................
Day County, S Dakota ........................................................................................................
Deuel County, S Dakota .....................................................................................................
Dewey County, S Dakota ....................................................................................................
Douglas County, S Dakota ..................................................................................................
Edmunds County, S Dakota ................................................................................................
Fall River County, S Dakota ...............................................................................................
Faulk County, S Dakota ......................................................................................................
Grant County, S Dakota ......................................................................................................
Gregory County, S Dakota ..................................................................................................
Haakon County, S Dakota ..................................................................................................
Hamlin County, S Dakota ....................................................................................................
Hand County, S Dakota ......................................................................................................
Hanson County, S Dakota ..................................................................................................
Harding County, S Dakota ..................................................................................................
Hughes County, S Dakota ..................................................................................................
Hutchinson County, S Dakota .............................................................................................
Hyde County, S Dakota ......................................................................................................
Jackson County, S Dakota ..................................................................................................
Jerauld County, S Dakota ...................................................................................................
Jones County, S Dakota .....................................................................................................
Kingsbury County, S Dakota ...............................................................................................
Lake County, S Dakota .......................................................................................................
Lawrence County, S Dakota ...............................................................................................
Lincoln County, S Dakota ...................................................................................................
Lyman County, S Dakota ....................................................................................................
Mc Cook County, S Dakota ................................................................................................
Mc Pherson County, S Dakota ...........................................................................................
Marshall County, S Dakota .................................................................................................
Meade County, S Dakota ....................................................................................................
Mellette County, S Dakota ..................................................................................................
Miner County, S Dakota ......................................................................................................
Minnehaha County, S Dakota .............................................................................................
Moody County, S Dakota ....................................................................................................
Pennington County, S Dakota .............................................................................................
Perkins County, S Dakota ...................................................................................................
Potter County, S Dakota .....................................................................................................
Roberts County, S Dakota ..................................................................................................
Sanborn County, S Dakota .................................................................................................
Shannon County, S Dakota ................................................................................................
Spink County, S Dakota ......................................................................................................
Stanley County, S Dakota ...................................................................................................
Sully County, S Dakota .......................................................................................................
Todd County, S Dakota .......................................................................................................
Tripp County, S Dakota .......................................................................................................
Turner County, S Dakota ....................................................................................................
Union County, S Dakota .....................................................................................................
Walworth County, S Dakota ................................................................................................
Washabaugh County, S Dakota ..........................................................................................
Yankton County, S Dakota ..................................................................................................
Ziebach County, S Dakota ..................................................................................................
Anderson County, Tennessee .............................................................................................
Bedford County, Tennessee ...............................................................................................
Benton County, Tennessee .................................................................................................
Bledsoe County, Tennessee ...............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00283
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
7760
43
6660
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
3840
44
44
44
CBSA No.
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43620
43
43620
43
43
39660
43
43
43620
43
39660
43
43
43
43
43
43
43
43
43
43
43620
43580
43
43
43
43
28940
44
44
44
46046
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
44040
44050
44060
44070
44080
44090
44100
44110
44120
44130
44140
44150
44160
44170
44180
44190
44200
44210
44220
44230
44240
44250
44260
44270
44280
44290
44300
44310
44320
44330
44340
44350
44360
44370
44380
44390
44400
44410
44420
44430
44440
44450
44460
44470
44480
44490
44500
44510
44520
44530
44540
44550
44560
44570
44580
44590
44600
44610
44620
44630
44640
44650
44660
44670
44680
44690
44700
44710
44720
44730
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Blount County, Tennessee ..................................................................................................
Bradley County, Tennessee ................................................................................................
Campbell County, Tennessee .............................................................................................
Cannon County, Tennessee ...............................................................................................
Carroll County, Tennessee .................................................................................................
Carter County, Tennessee ..................................................................................................
Cheatham County, Tennessee ...........................................................................................
Chester County, Tennessee ...............................................................................................
Claiborne County, Tennessee .............................................................................................
Clay County, Tennessee .....................................................................................................
Cocke County, Tennessee ..................................................................................................
Coffee County, Tennessee .................................................................................................
Crockett County, Tennessee ...............................................................................................
Cumberland County, Tennessee ........................................................................................
Davidson County, Tennessee .............................................................................................
Decatur County, Tennessee ...............................................................................................
De Kalb County, Tennessee ...............................................................................................
Dickson County, Tennessee ...............................................................................................
Dyer County, Tennessee ....................................................................................................
Fayette County, Tennessee ................................................................................................
Fentress County, Tennessee ..............................................................................................
Franklin County, Tennessee ...............................................................................................
Gibson County, Tennessee .................................................................................................
Giles County, Tennessee ....................................................................................................
Grainger County, Tennessee ..............................................................................................
Greene County, Tennessee ................................................................................................
Grundy County, Tennessee ................................................................................................
Hamblen County, Tennessee ..............................................................................................
Hamilton County, Tennessee ..............................................................................................
Hancock County, Tennessee ..............................................................................................
Hardeman County, Tennessee ...........................................................................................
Hardin County, Tennessee .................................................................................................
Hawkins County, Tennessee ..............................................................................................
Haywood County, Tennessee .............................................................................................
Henderson County, Tennessee ..........................................................................................
Henry County, Tennessee ..................................................................................................
Hickman County, Tennessee ..............................................................................................
Houston County, Tennessee ...............................................................................................
Humphreys County, Tennessee ..........................................................................................
Jackson County, Tennessee ...............................................................................................
Jefferson County, Tennessee .............................................................................................
Johnson County, Tennessee ..............................................................................................
Knox County, Tennessee ....................................................................................................
Lake County, Tennessee ....................................................................................................
Lauderdale County, Tennessee ..........................................................................................
Lawrence County, Tennessee ............................................................................................
Lewis County, Tennessee ...................................................................................................
Lincoln County, Tennessee .................................................................................................
Loudon County, Tennessee ................................................................................................
Mc Minn County, Tennessee ..............................................................................................
Mc Nairy County, Tennessee ..............................................................................................
Macon County, Tennessee .................................................................................................
Madison County, Tennessee ..............................................................................................
Marion County, Tennessee .................................................................................................
Marshall County, Tennessee ..............................................................................................
Maury County, Tennessee ..................................................................................................
Meigs County, Tennessee ..................................................................................................
Monroe County, Tennessee ................................................................................................
Montgomery County, Tennessee ........................................................................................
Moore County, Tennessee ..................................................................................................
Morgan County, Tennessee ................................................................................................
Obion County, Tennessee ..................................................................................................
Overton County, Tennessee ...............................................................................................
Perry County, Tennessee ...................................................................................................
Pickett County, Tennessee .................................................................................................
Polk County, Tennessee .....................................................................................................
Putnam County, Tennessee ................................................................................................
Rhea County, Tennessee ...................................................................................................
Roane County, Tennessee .................................................................................................
Robertson County, Tennessee ...........................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00284
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
3840
44
44
44
44
3660
5360
44
44
44
44
44
44
44
5360
44
44
5360
44
44
44
44
44
44
3840
44
44
44
1560
44
44
44
3660
44
44
44
44
44
44
44
3840
44
3840
44
44
44
44
44
44
44
44
44
3580
1560
44
44
44
44
1660
44
44
44
44
44
44
44
44
44
44
5360
CBSA No.
28940
17420
44
34980
44
27740
34980
27180
44
44
44
44
44
44
34980
44
44
34980
44
32820
44
44
44
44
34100
44
44
34100
16860
44
44
44
28700
44
44
44
34980
44
44
44
34100
44
28940
44
44
44
44
44
28940
44
44
34980
27180
16860
44
44
44
44
17300
44
44
44
44
44
44
17420
44
44
44
34980
46047
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
44740
44750
44760
44770
44780
44790
44800
44810
44820
44830
44840
44850
44860
44870
44880
44890
44900
44910
44920
44930
44940
45000
45010
45020
45030
45040
45050
45060
45070
45080
45090
45100
45110
45113
45120
45130
45140
45150
45160
45170
45180
45190
45200
45201
45210
45220
45221
45222
45223
45224
45230
45240
45250
45251
45260
45270
45280
45281
45290
45291
45292
45300
45301
45310
45311
45312
45320
45321
45330
45340
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Rutherford County, Tennessee ...........................................................................................
Scott County, Tennessee ....................................................................................................
Sequatchie County, Tennessee ..........................................................................................
Sevier County, Tennessee ..................................................................................................
Shelby County, Tennessee .................................................................................................
Smith County, Tennessee ...................................................................................................
Stewart County, Tennessee ................................................................................................
Sullivan County, Tennessee ...............................................................................................
Sumner County, Tennessee ...............................................................................................
Tipton County, Tennessee ..................................................................................................
Trousdale County, Tennessee ............................................................................................
Unicoi County, Tennessee ..................................................................................................
Union County, Tennessee ...................................................................................................
Van Buren County, Tennessee ...........................................................................................
Warren County, Tennessee ................................................................................................
Washington County, Tennessee .........................................................................................
Wayne County, Tennessee .................................................................................................
Weakley County, Tennessee ..............................................................................................
White County, Tennessee ...................................................................................................
Williamson County, Tennessee ...........................................................................................
Wilson County, Tennessee .................................................................................................
Anderson County, Texas .....................................................................................................
Andrews County, Texas ......................................................................................................
Angelina County, Texas ......................................................................................................
Aransas County, Texas .......................................................................................................
Archer County, Texas .........................................................................................................
Armstrong County, Texas ...................................................................................................
Atascosa County, Texas .....................................................................................................
Austin County, Texas ..........................................................................................................
Bailey County, Texas ..........................................................................................................
Bandera County, Texas ......................................................................................................
Bastrop County, Texas ........................................................................................................
Baylor County, Texas ..........................................................................................................
Bee County, Texas ..............................................................................................................
Bell County, Texas ..............................................................................................................
Bexar County, Texas ...........................................................................................................
Blanco County, Texas .........................................................................................................
Borden County, Texas ........................................................................................................
Bosque County, Texas ........................................................................................................
Bowie County, Texas ..........................................................................................................
Brazoria County, Texas .......................................................................................................
Brazos County, Texas .........................................................................................................
Brewster County, Texas ......................................................................................................
Briscoe County, Texas ........................................................................................................
Brooks County, Texas .........................................................................................................
Brown County, Texas ..........................................................................................................
Burleson County, Texas ......................................................................................................
Burnet County, Texas .........................................................................................................
Caldwell County, Texas ......................................................................................................
Calhoun County, Texas .......................................................................................................
Callahan County, Texas ......................................................................................................
Cameron County, Texas .....................................................................................................
Camp County, Texas ..........................................................................................................
Carson County, Texas ........................................................................................................
Cass County, Texas ............................................................................................................
Castro County, Texas .........................................................................................................
Chambers County, Texas ...................................................................................................
Cherokee County, Texas ....................................................................................................
Childress County, Texas .....................................................................................................
Clay County, Texas .............................................................................................................
Cochran County, Texas ......................................................................................................
Coke County, Texas ............................................................................................................
Coleman County, Texas ......................................................................................................
Collin County, Texas ...........................................................................................................
Collingsworth County, Texas ..............................................................................................
Colorado County, Texas .....................................................................................................
Comal County, Texas ..........................................................................................................
Comanche County, Texas ...................................................................................................
Concho County, Texas ........................................................................................................
Cooke County, Texas ..........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00285
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
5360
44
1560
3840
4920
44
44
3660
5360
4920
44
3660
3840
44
44
3660
44
44
44
5360
5360
45
45
45
45
9080
45
45
45
45
45
0640
45
45
3810
7240
45
45
45
8360
1145
1260
45
45
45
45
45
45
45
45
45
1240
45
45
45
45
45
45
45
45
45
45
45
1920
45
45
7240
45
45
45
CBSA No.
34980
44
16860
44
32820
34980
17300
28700
34980
32820
34980
27740
28940
44
44
27740
44
44
44
34980
34980
45
45
45
18580
48660
11100
41700
26420
45
41700
12420
45
45
28660
41700
45
45
45
45500
26420
17780
45
45
45
45
17780
45
12420
47020
10180
15180
45
11100
45
45
26420
45
45
48660
45
45
45
19124
45
45
41700
45
45
45
46048
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
45341
45350
45360
45361
45362
45370
45380
45390
45391
45392
45400
45410
45420
45421
45430
45431
45440
45450
45451
45460
45470
45480
45490
45500
45510
45511
45520
45521
45522
45530
45531
45540
45541
45542
45550
45551
45552
45560
45561
45562
45563
45564
45570
45580
45581
45582
45583
45590
45591
45592
45600
45610
45620
45621
45630
45631
45632
45640
45650
45651
45652
45653
45654
45660
45661
45662
45670
45671
45672
45680
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Coryell County, Texas .........................................................................................................
Cottle County, Texas ...........................................................................................................
Crane County, Texas ..........................................................................................................
Crockett County, Texas .......................................................................................................
Crosby County, Texas .........................................................................................................
Culberson County, Texas ....................................................................................................
Dallam County, Texas .........................................................................................................
Dallas County, Texas ..........................................................................................................
Dawson County, Texas .......................................................................................................
Deaf Smith County, Texas ..................................................................................................
Delta County, Texas ............................................................................................................
Denton County, Texas ........................................................................................................
De Witt County, Texas ........................................................................................................
Dickens County, Texas .......................................................................................................
Dimmit County, Texas .........................................................................................................
Donley County, Texas .........................................................................................................
Duval County, Texas ...........................................................................................................
Eastland County, Texas ......................................................................................................
Ector County, Texas ............................................................................................................
Edwards County, Texas ......................................................................................................
Ellis County, Texas .............................................................................................................
El Paso County, Texas .......................................................................................................
Erath County, Texas ...........................................................................................................
Falls County, Texas ............................................................................................................
Fannin County, Texas .........................................................................................................
Fayette County, Texas ........................................................................................................
Fisher County, Texas ..........................................................................................................
Floyd County, Texas ...........................................................................................................
Foard County, Texas ...........................................................................................................
Fort Bend County, Texas ....................................................................................................
Franklin County, Texas .......................................................................................................
Freestone County, Texas ....................................................................................................
Frio County, Texas ..............................................................................................................
Gaines County, Texas .........................................................................................................
Galveston County, Texas ....................................................................................................
Garza County, Texas ..........................................................................................................
Gillespie County, Texas ......................................................................................................
Glasscock County, Texas ...................................................................................................
Goliad County, Texas ..........................................................................................................
Gonzales County, Texas .....................................................................................................
Gray County, Texas ............................................................................................................
Grayson County, Texas ......................................................................................................
Gregg County, Texas ..........................................................................................................
Grimes County, Texas ........................................................................................................
Guadaloupe County, Texas ................................................................................................
Hale County, Texas .............................................................................................................
Hall County, Texas ..............................................................................................................
Hamilton County, Texas ......................................................................................................
Hansford County, Texas .....................................................................................................
Hardeman County, Texas ...................................................................................................
Hardin County, Texas .........................................................................................................
Harris County, Texas ..........................................................................................................
Harrison County, Texas ......................................................................................................
Hartley County, Texas .........................................................................................................
Haskell County, Texas ........................................................................................................
Hays County, Texas ............................................................................................................
Hemphill County, Texas ......................................................................................................
Henderson County, Texas ..................................................................................................
Hidalgo County, Texas ........................................................................................................
Hill County, Texas ...............................................................................................................
Hockley County, Texas .......................................................................................................
Hood County, Texas ...........................................................................................................
Hopkins County, Texas .......................................................................................................
Houston County, Texas .......................................................................................................
Howard County, Texas ........................................................................................................
Hudspeth County, Texas .....................................................................................................
Hunt County, Texas ............................................................................................................
Hutchinson County, Texas ..................................................................................................
Irion County, Texas .............................................................................................................
Jack County, Texas .............................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00286
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
3810
45
45
45
45
45
45
1920
45
45
45
1920
45
45
45
45
45
45
5800
45
1920
2320
45
45
45
45
45
45
45
3360
45
45
45
45
2920
45
45
45
45
45
45
7640
4420
45
7240
45
45
45
45
45
0840
3360
4420
45
45
0640
45
45
4880
45
45
45
45
45
45
45
45
45
45
45
CBSA No.
28660
45
45
45
31180
45
45
19124
45
45
19124
19124
45
45
45
45
45
45
36220
45
19124
21340
45
45
45
45
45
45
45
26420
45
45
45
45
26420
45
45
45
47020
45
45
43300
30980
45
41700
45
45
45
45
45
13140
26420
45
45
45
12420
45
45
32580
45
45
45
45
45
45
45
19124
45
41660
45
46049
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
45681
45690
45691
45700
45710
45711
45720
45721
45722
45730
45731
45732
45733
45734
45740
45741
45742
45743
45744
45750
45751
45752
45753
45754
45755
45756
45757
45758
45759
45760
45761
45762
45770
45771
45772
45780
45781
45782
45783
45784
45785
45790
45791
45792
45793
45794
45795
45796
45797
45800
45801
45802
45803
45804
45810
45820
45821
45822
45830
45831
45832
45840
45841
45842
45843
45844
45845
45850
45860
45861
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Jackson County, Texas .......................................................................................................
Jasper County, Texas .........................................................................................................
Jeff Davis County, Texas ....................................................................................................
Jefferson County, Texas .....................................................................................................
Jim Hogg County, Texas .....................................................................................................
Jim Wells County, Texas ....................................................................................................
Johnson County, Texas ......................................................................................................
Jones County, Texas ..........................................................................................................
Karnes County, Texas .........................................................................................................
Kaufman County, Texas ......................................................................................................
Kendall County, Texas ........................................................................................................
Kenedy County, Texas ........................................................................................................
Kent County, Texas .............................................................................................................
Kerr County, Texas .............................................................................................................
Kimble County, Texas .........................................................................................................
King County, Texas .............................................................................................................
Kinney County, Texas .........................................................................................................
Kleberg County, Texas ........................................................................................................
Knox County, Texas ............................................................................................................
Lamar County, Texas ..........................................................................................................
Lamb County, Texas ...........................................................................................................
Lampasas County, Texas ...................................................................................................
La Salle County, Texas .......................................................................................................
Lavaca County, Texas ........................................................................................................
Lee County, Texas ..............................................................................................................
Leon County, Texas ............................................................................................................
Liberty County, Texas .........................................................................................................
Limestone County, Texas ...................................................................................................
Lipscomb County, Texas .....................................................................................................
Live Oak County, Texas ......................................................................................................
Llano County, Texas ...........................................................................................................
Loving County, Texas .........................................................................................................
Lubbock County, Texas ......................................................................................................
Lynn County, Texas ............................................................................................................
Mc Culloch County, Texas ..................................................................................................
Mc Lennan County, Texas ..................................................................................................
Mc Mullen County, Texas ...................................................................................................
Madison County, Texas ......................................................................................................
Marion County, Texas .........................................................................................................
Martin County, Texas ..........................................................................................................
Mason County, Texas .........................................................................................................
Matagorda County, Texas ...................................................................................................
Maverick County, Texas ......................................................................................................
Medina County, Texas ........................................................................................................
Menard County, Texas ........................................................................................................
Midland County, Texas .......................................................................................................
Milam County, Texas ..........................................................................................................
Mills County, Texas .............................................................................................................
Mitchell County, Texas ........................................................................................................
Montague County, Texas ....................................................................................................
Montgomery County, Texas ................................................................................................
Moore County, Texas ..........................................................................................................
Morris County, Texas ..........................................................................................................
Motley County, Texas .........................................................................................................
Nacogdoches County, Texas ..............................................................................................
Navarro County, Texas .......................................................................................................
Newton County, Texas ........................................................................................................
Nolan County, Texas ...........................................................................................................
Nueces County, Texas ........................................................................................................
Ochiltree County, Texas ......................................................................................................
Oldham County, Texas .......................................................................................................
Orange County, Texas ........................................................................................................
Palo Pinto County, Texas ...................................................................................................
Panola County, Texas .........................................................................................................
Parker County, Texas .........................................................................................................
Parmer County, Texas ........................................................................................................
Pecos County, Texas ..........................................................................................................
Polk County, Texas .............................................................................................................
Potter County, Texas ..........................................................................................................
Presidio County, Texas .......................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00287
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
45
45
45
0840
45
45
2800
45
45
1920
45
45
45
45
45
45
45
45
45
45
45
45
45
45
45
45
3360
45
45
45
45
45
4600
45
45
8800
45
45
45
45
45
45
45
45
45
5040
45
45
45
45
3360
45
45
45
45
45
45
45
1880
45
45
0840
45
45
2800
45
45
45
0320
45
CBSA No.
45
45
45
13140
45
45
23104
10180
45
19124
41700
45
45
45
45
45
45
45
45
45
45
28660
45
45
45
45
26420
45
45
45
45
45
31180
45
45
47380
45
45
45
45
45
45
45
41700
45
33260
45
45
45
45
26420
45
45
45
45
45
45
45
18580
45
45
13140
45
45
23104
45
45
45
11100
45
46050
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
45870
45871
45872
45873
45874
45875
45876
45877
45878
45879
45880
45881
45882
45883
45884
45885
45886
45887
45888
45889
45890
45891
45892
45893
45900
45901
45902
45903
45904
45905
45910
45911
45912
45913
45920
45921
45930
45940
45941
45942
45943
45944
45945
45946
45947
45948
45949
45950
45951
45952
45953
45954
45955
45960
45961
45962
45970
45971
45972
45973
45974
45980
45981
45982
45983
46000
46010
46020
46030
46040
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Rains County, Texas ...........................................................................................................
Randall County, Texas ........................................................................................................
Reagan County, Texas .......................................................................................................
Real County, Texas .............................................................................................................
Red River County, Texas ....................................................................................................
Reeves County, Texas ........................................................................................................
Refugio County, Texas ........................................................................................................
Roberts County, Texas .......................................................................................................
Robertson County, Texas ...................................................................................................
Rockwall County, Texas ......................................................................................................
Runnels County, Texas .......................................................................................................
Rusk County, Texas ............................................................................................................
Sabine County, Texas .........................................................................................................
San Augustine County, Texas ............................................................................................
San Jacinto County, Texas .................................................................................................
San Patricio County, Texas ................................................................................................
San Saba County, Texas ....................................................................................................
Schleicher County, Texas ...................................................................................................
Scurry County, Texas ..........................................................................................................
Shackelford County, Texas .................................................................................................
Shelby County, Texas .........................................................................................................
Sherman County, Texas .....................................................................................................
Smith County, Texas ...........................................................................................................
Somervell County, Texas ....................................................................................................
Starr County, Texas ............................................................................................................
Stephens County, Texas .....................................................................................................
Sterling County, Texas ........................................................................................................
Stonewall County, Texas ....................................................................................................
Sutton County, Texas ..........................................................................................................
Swisher County, Texas .......................................................................................................
Tarrant County, Texas ........................................................................................................
Taylor County, Texas ..........................................................................................................
Terrell County, Texas ..........................................................................................................
Terry County, Texas ............................................................................................................
Throckmorton County, Texas ..............................................................................................
Titus County, Texas ............................................................................................................
Tom Green County, Texas ..................................................................................................
Travis County, Texas ..........................................................................................................
Trinity County, Texas ..........................................................................................................
Tyler County, Texas ............................................................................................................
Upshur County, Texas ........................................................................................................
Upton County, Texas ..........................................................................................................
Uvalde County, Texas .........................................................................................................
Val Verde County, Texas ....................................................................................................
Van Zandt County, Texas ...................................................................................................
Victoria County, Texas ........................................................................................................
Walker County, Texas .........................................................................................................
Waller County, Texas ..........................................................................................................
Ward County, Texas ...........................................................................................................
Washington County, Texas .................................................................................................
Webb County, Texas ...........................................................................................................
Wharton County, Texas ......................................................................................................
Wheeler County, Texas .......................................................................................................
Wichita County, Texas ........................................................................................................
Wilbarger County, Texas .....................................................................................................
Willacy County, Texas .........................................................................................................
Williamson County, Texas ...................................................................................................
Wilson County, Texas .........................................................................................................
Winkler County, Texas ........................................................................................................
Wise County, Texas ............................................................................................................
Wood County, Texas ...........................................................................................................
Yoakum County, Texas .......................................................................................................
Young County, Texas ..........................................................................................................
Zapata County, Texas .........................................................................................................
Zavala County, Texas .........................................................................................................
Beaver County, Utah ...........................................................................................................
Box Elder County, Utah ......................................................................................................
Cache County, Utah ............................................................................................................
Carbon County, Utah ..........................................................................................................
Daggett County, Utah ..........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00288
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
45
0320
45
45
45
45
45
45
45
1920
45
45
45
45
45
1880
45
45
45
45
45
45
8640
45
45
45
45
45
45
45
2800
0040
45
45
45
45
7200
0640
45
45
45
45
45
45
45
8750
45
3360
45
45
4080
45
45
9080
45
45
0640
45
45
45
45
45
45
45
45
46
46
46
46
46
CBSA No.
45
11100
45
45
45
45
45
45
17780
19124
45
30980
45
45
26420
18580
45
45
45
45
45
45
46340
45
45
45
45
45
45
45
23104
10180
45
45
45
45
41660
12420
45
45
30980
45
45
45
45
47020
45
26420
45
45
29700
45
45
48660
45
45
12420
41700
45
23104
45
45
45
45
45
46
46
30860
46
46
46051
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
46050
46060
46070
46080
46090
46100
46110
46120
46130
46140
46150
46160
46170
46180
46190
46200
46210
46220
46230
46240
46250
46260
46270
46280
47000
47010
47020
47030
47040
47050
47060
47070
47080
47090
47100
47110
47120
47130
49000
49010
49011
49020
49030
49040
49050
49060
49070
49080
49088
49090
49100
49110
49111
49120
49130
49140
49141
49150
49160
49170
49180
49190
49191
49194
49200
49210
49211
49212
49213
49220
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Davis County, Utah .............................................................................................................
Duchesne County, Utah ......................................................................................................
Emery County, Utah ............................................................................................................
Garfield County, Utah ..........................................................................................................
Grand County, Utah ............................................................................................................
Iron County, Utah ................................................................................................................
Juab County, Utah ..............................................................................................................
Kane County, Utah ..............................................................................................................
Millard County, Utah ............................................................................................................
Morgan County, Utah ..........................................................................................................
Piute County, Utah ..............................................................................................................
Rich County, Utah ...............................................................................................................
Salt Lake County, Utah .......................................................................................................
San Juan County, Utah .......................................................................................................
Sanpete County, Utah .........................................................................................................
Sevier County, Utah ............................................................................................................
Summit County, Utah ..........................................................................................................
Tooele County, Utah ...........................................................................................................
Uintah County, Utah ............................................................................................................
Utah County, Utah ...............................................................................................................
Wasatch County, Utah ........................................................................................................
Washington County, Utah ...................................................................................................
Wayne County, Utah ...........................................................................................................
Weber County, Utah ............................................................................................................
Addison County, Vermont ...................................................................................................
Bennington County, Vermont ..............................................................................................
Caledonia County, Vermont ................................................................................................
Chittenden County, Vermont ...............................................................................................
Essex County, Vermont ......................................................................................................
Franklin County, Vermont ...................................................................................................
Grand Isle County, Vermont ...............................................................................................
Lamoille County, Vermont ...................................................................................................
Orange County, Vermont ....................................................................................................
Orleans County, Vermont ....................................................................................................
Rutland County, Vermont ....................................................................................................
Washington County, Vermont .............................................................................................
Windham County, Vermont .................................................................................................
Windsor County, Vermont ...................................................................................................
Accomack County, Virginia .................................................................................................
Albemarle County, Virginia ..................................................................................................
Alexandria City County, Virginia .........................................................................................
Alleghany County, Virginia ..................................................................................................
Amelia County, Virginia .......................................................................................................
Amherst County, Virginia ....................................................................................................
Appomattox County, Virginia ...............................................................................................
Arlington County, Virginia ....................................................................................................
Augusta County, Virginia .....................................................................................................
Bath County, Virginia ..........................................................................................................
Bedford City County, Virginia ..............................................................................................
Bedford County, Virginia .....................................................................................................
Bland County, Virginia .........................................................................................................
Botetourt County, Virginia ...................................................................................................
Bristol City County, Virginia ................................................................................................
Brunswick County, Virginia .................................................................................................
Buchanan County, Virginia ..................................................................................................
Buckingham County, Virginia ..............................................................................................
Buena Vista City County, Virginia .......................................................................................
Campbell County, Virginia ...................................................................................................
Caroline County, Virginia ....................................................................................................
Carroll County, Virginia .......................................................................................................
Charles City County, Virginia ..............................................................................................
Charlotte County, Virginia ...................................................................................................
Charlottesville City County, Virginia ....................................................................................
Chesapeake County, Virginia ..............................................................................................
Chesterfield County, Virginia ...............................................................................................
Clarke County, Virginia .......................................................................................................
Clifton Forge City County, Virginia ......................................................................................
Colonial Heights County, Virginia .......................................................................................
Covington City County, Virginia ..........................................................................................
Craig County, Virginia .........................................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00289
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
7160
46
46
46
46
46
46
45
46
46
46
46
7160
46
46
46
46
46
46
6520
46
46
46
7160
47
47
47
1303
47
47
1303
47
47
47
47
47
47
47
49
1540
8840
49
49
4640
49
8840
49
49
49
49
49
6800
3660
49
49
49
49
4640
49
49
6760
49
1540
5720
6760
49
49
6760
49
49
CBSA No.
36260
46
46
46
46
46
39340
46
46
36260
46
46
41620
46
46
46
41620
41620
46
39340
46
41100
46
36260
47
47
47
15540
47
15540
15540
47
47
47
47
47
47
47
49
16820
47894
49
40060
31340
31340
47894
49
49
31340
31340
49
40220
28700
49
49
49
49
31340
40060
49
40060
49
16820
47260
40060
47894
49
40060
49
40220
46052
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
49230
49240
49241
49250
49260
49270
49280
49288
49290
49291
49300
49310
49320
49328
49330
49340
49342
49343
49350
49360
49370
49380
49390
49400
49410
49411
49420
49421
49430
49440
49450
49451
49460
49470
49480
49490
49500
49510
49520
49522
49530
49540
49550
49551
49560
49561
49563
49565
49570
49580
49590
49600
49610
49620
49621
49622
49641
49650
49660
49661
49670
49680
49690
49700
49701
49710
49711
49712
49720
49730
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Culpeper County, Virginia ...................................................................................................
Cumberland County, Virginia ..............................................................................................
Danville City County, Virginia ..............................................................................................
Dickenson County, Virginia .................................................................................................
Dinniddie County, Virginia ...................................................................................................
Emporia County, Virginia ....................................................................................................
Essex County, Virginia ........................................................................................................
Fairfax City County, Virginia ...............................................................................................
Fairfax County, Virginia .......................................................................................................
Falls Church City County, Virginia ......................................................................................
Fauquier County, Virginia ....................................................................................................
Floyd County, Virginia .........................................................................................................
Fluvanna County, Virginia ...................................................................................................
Franklin City County, Virginia ..............................................................................................
Franklin County, Virginia .....................................................................................................
Frederick County, Virginia ...................................................................................................
Fredericksburg City County, Virginia ..................................................................................
Galax City County, Virginia .................................................................................................
Giles County, Virginia ..........................................................................................................
Gloucester County, Virginia ................................................................................................
Goochland County, Virginia ................................................................................................
Grayson County, Virginia ....................................................................................................
Greene County, Virginia ......................................................................................................
Greensville County, Virginia ................................................................................................
Halifax County, Virginia .......................................................................................................
Hampton City County, Virginia ............................................................................................
Hanover County, Virginia ....................................................................................................
Harrisonburg City County, Virginia ......................................................................................
Henrico County, Virginia .....................................................................................................
Henry County, Virginia ........................................................................................................
Highland County, Virginia ....................................................................................................
Hopewell City County, Virginia ............................................................................................
Isle Of Wight County, Virginia .............................................................................................
James City Co County, Virginia ..........................................................................................
King And Queen County, Virginia .......................................................................................
King George County, Virginia .............................................................................................
King William County, Virginia ..............................................................................................
Lancaster County, Virginia ..................................................................................................
Lee County, Virginia ............................................................................................................
Lexington County, Virginia ..................................................................................................
Loudoun County, Virginia ....................................................................................................
Louisa County, Virginia .......................................................................................................
Lunenburg County, Virginia .................................................................................................
Lynchburg City County, Virginia ..........................................................................................
Madison County, Virginia ....................................................................................................
Martinsville City County, Virginia ........................................................................................
Manassas City County, Virginia ..........................................................................................
Manassas Park City County, Virginia .................................................................................
Mathews County, Virginia ...................................................................................................
Mecklenburg County, Virginia .............................................................................................
Middlesex County, Virginia ..................................................................................................
Montgomery County, Virginia ..............................................................................................
Nansemond County, Virginia ..............................................................................................
Nelson County, Virginia .......................................................................................................
New Kent County, Virginia ..................................................................................................
Newport News City County, Virginia ...................................................................................
Norfolk City County, Virginia ...............................................................................................
Northampton County, Virginia .............................................................................................
Northumberland County, Virginia ........................................................................................
Norton City County, Virginia ................................................................................................
Nottoway County, Virginia ...................................................................................................
Orange County, Virginia ......................................................................................................
Page County, Virginia .........................................................................................................
Patrick County, Virginia .......................................................................................................
Petersburg City County, Virginia .........................................................................................
Pittsylvania County, Virginia ................................................................................................
Portsmouth City County, Virginia ........................................................................................
Poquoson City County, Virginia ..........................................................................................
Powhatan County, Virginia ..................................................................................................
Prince Edward County, Virginia ..........................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00290
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
49
49
1950
49
6760
49
49
8840
8840
8840
49
49
1540
49
49
49
49
49
49
5720
6760
49
1540
49
49
5720
6760
49
6760
49
49
6760
49
5720
49
49
49
49
49
49
8840
49
49
4640
49
49
8840
8840
49
49
49
49
49
49
6760
5720
5720
49
49
49
49
49
49
49
6760
1950
5720
5720
6760
49
CBSA No.
49
40060
19260
49
40060
49
49
47894
47894
47894
47894
49
16820
49
40220
49020
47894
49
13980
47260
40060
49
16820
49
49
47260
40060
25500
40060
49
49
40060
47260
47260
40060
49
40060
49
49
49
47894
40060
49
31340
49
49
47894
47894
47260
49
49
13980
49
16820
40060
47260
47260
49
49
49
49
49
49
49
40060
19260
47260
47260
40060
49
46053
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
49740
49750
49770
49771
49780
49790
49791
49800
49801
49810
49820
49830
49838
49840
49850
49860
49867
49870
49880
49890
49891
49892
49900
49910
49920
49921
49930
49950
49951
49960
49961
49962
49970
49980
49981
50000
50010
50020
50030
50040
50050
50060
50070
50080
50090
50100
50110
50120
50130
50140
50150
50160
50170
50180
50190
50200
50210
50220
50230
50240
50250
50260
50270
50280
50290
50300
50310
50320
50330
50340
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Prince George County, Virginia ..........................................................................................
Prince William County, Virginia ...........................................................................................
Pulaski County, Virginia ......................................................................................................
Radford City County, Virginia ..............................................................................................
Rappahannock County, Virginia ..........................................................................................
Richmond County, Virginia ..................................................................................................
Richmond City County, Virginia ..........................................................................................
Roanoke County, Virginia ...................................................................................................
Roanoke City County, Virginia ............................................................................................
Rockbridge County, Virginia ................................................................................................
Rockingham County, Virginia ..............................................................................................
Russell County, Virginia ......................................................................................................
Salem County, Virginia ........................................................................................................
Scott County, Virginia ..........................................................................................................
Shenandoah County, Virginia .............................................................................................
Smyth County, Virginia ........................................................................................................
South Boston City County, Virginia .....................................................................................
Southampton County, Virginia ............................................................................................
Spotsylvania County, Virginia .............................................................................................
Stafford County, Virginia .....................................................................................................
Staunton City County, Virginia ............................................................................................
Suffolk City County, Virginia ...............................................................................................
Surry County, Virginia .........................................................................................................
Sussex County, Virginia ......................................................................................................
Tazewell County, Virginia ....................................................................................................
Virginia Beach City County, Virginia ...................................................................................
Warren County, Virginia ......................................................................................................
Washington County, Virginia ...............................................................................................
Waynesboro City County, Virginia ......................................................................................
Westmoreland County, Virginia ...........................................................................................
Williamsburg City County, Virginia ......................................................................................
Winchester City County, Virginia ........................................................................................
Wise County, Virginia ..........................................................................................................
Wythe County, Virginia ........................................................................................................
York County, Virginia ..........................................................................................................
Adams County, Washington ................................................................................................
Asotin County, Washington .................................................................................................
Benton County, Washington ...............................................................................................
Chelan County, Washington ...............................................................................................
Clallam County, Washington ...............................................................................................
Clark County, Washington ..................................................................................................
Columbia County, Washington ............................................................................................
Cowlitz County, Washington ...............................................................................................
Douglas County, Washington ..............................................................................................
Ferry County, Washington ..................................................................................................
Franklin County, Washington ..............................................................................................
Garfield County, Washington ..............................................................................................
Grant County, Washington ..................................................................................................
Grays Harbor County, Washington .....................................................................................
Island County, Washington .................................................................................................
Jefferson County, Washington ............................................................................................
King County, Washington ....................................................................................................
Kitsap County, Washington .................................................................................................
Kittitas County, Washington ................................................................................................
Klickitat County, Washington ..............................................................................................
Lewis County, Washington ..................................................................................................
Lincoln County, Washington ...............................................................................................
Mason County, Washington ................................................................................................
Okanogan County, Washington ..........................................................................................
Pacific County, Washington ................................................................................................
Pend Oreille County, Washington .......................................................................................
Pierce County, Washington .................................................................................................
San Juan County, Washington ...........................................................................................
Skagit County, Washington .................................................................................................
Skamania County, Washington ...........................................................................................
Snohomish County, Washington .........................................................................................
Spokane County, Washington .............................................................................................
Stevens County, Washington ..............................................................................................
Thurston County, Washington .............................................................................................
Wahkiakum County, Washington ........................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00291
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
6760
8840
49
49
49
49
6760
6800
6800
49
49
49
6800
3660
49
49
49
49
49
8840
49
5720
49
49
49
5720
49
3660
49
49
5720
49
49
49
5720
50
50
6740
50
50
8725
50
50
50
50
6740
50
50
50
50
50
7600
1150
50
50
50
50
50
50
50
50
8200
50
50
50
7600
7840
50
5910
50
CBSA No.
40060
47894
13980
13980
49
49
40060
40220
40220
49
25500
49
40220
28700
49
49
49
49
47894
47894
49
47260
47260
40060
49
47260
47894
28700
49
49
47260
49020
49
49
47260
50
30300
28420
48300
50
38900
50
31020
48300
50
28420
50
50
50
50
50
42644
14740
50
50
50
50
50
50
50
50
45104
50
34580
38900
42644
44060
50
36500
50
46054
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
50350
50360
50370
50380
51000
51010
51020
51030
51040
51050
51060
51070
51080
51090
51100
51110
51120
51130
51140
51150
51160
51170
51180
51190
51200
51210
51220
51230
51240
51250
51260
51270
51280
51290
51300
51310
51320
51330
51340
51350
51360
51370
51380
51390
51400
51410
51420
51430
51440
51450
51460
51470
51480
51490
51500
51510
51520
51530
51540
52000
52010
52020
52030
52040
52050
52060
52070
52080
52090
52100
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Walla Walla County, Washington ........................................................................................
Whatcom County, Washington ............................................................................................
Whitman County, Washington .............................................................................................
Yakima County, Washington ...............................................................................................
Barbour County, W Virginia ................................................................................................
Berkeley County, W Virginia ...............................................................................................
Boone County, W Virginia ...................................................................................................
Braxton County, W Virginia .................................................................................................
Brooke County, W Virginia ..................................................................................................
Cabell County, W Virginia ...................................................................................................
Calhoun County, W Virginia ................................................................................................
Clay County, W Virginia ......................................................................................................
Doddridge County, W Virginia .............................................................................................
Fayette County, W Virginia .................................................................................................
Gilmer County, W Virginia ...................................................................................................
Grant County, W Virginia ....................................................................................................
Greenbrier County, W Virginia ............................................................................................
Hampshire County, W Virginia ............................................................................................
Hancock County, W Virginia ...............................................................................................
Hardy County, W Virginia ....................................................................................................
Harrison County, W Virginia ................................................................................................
Jackson County, W Virginia ................................................................................................
Jefferson County, W Virginia ..............................................................................................
Kanawha County, W Virginia ..............................................................................................
Lewis County, W Virginia ....................................................................................................
Lincoln County, W Virginia ..................................................................................................
Logan County, W Virginia ...................................................................................................
Mc Dowell County, W Virginia ............................................................................................
Marion County, W Virginia ..................................................................................................
Marshall County, W Virginia ................................................................................................
Mason County, W Virginia ..................................................................................................
Mercer County, W Virginia ..................................................................................................
Mineral County, W Virginia .................................................................................................
Mingo County, W Virginia ...................................................................................................
Monongalia County, W Virginia ...........................................................................................
Monroe County, W Virginia .................................................................................................
Morgan County, W Virginia .................................................................................................
Nicholas County, W Virginia ...............................................................................................
Ohio County, W Virginia ......................................................................................................
Pendleton County, W Virginia .............................................................................................
Pleasants County, W Virginia .............................................................................................
Pocahontas County, W Virginia ..........................................................................................
Preston County, W Virginia .................................................................................................
Putnam County, W Virginia .................................................................................................
Raleigh County, W Virginia .................................................................................................
Randolph County, W Virginia ..............................................................................................
Ritchie County, W Virginia ..................................................................................................
Roane County, W Virginia ...................................................................................................
Summers County, W Virginia ..............................................................................................
Taylor County, W Virginia ...................................................................................................
Tucker County, W Virginia ..................................................................................................
Tyler County, W Virginia .....................................................................................................
Upshur County, W Virginia ..................................................................................................
Wayne County, W Virginia ..................................................................................................
Webster County, W Virginia ................................................................................................
Wetzel County, W Virginia ..................................................................................................
Wirt County, W Virginia .......................................................................................................
Wood County, W Virginia ....................................................................................................
Wyoming County, W Virginia ..............................................................................................
Adams County, Wisconsin ..................................................................................................
Ashland County, Wisconsin ................................................................................................
Barron County, Wisconsin ...................................................................................................
Bayfield County, Wisconsin .................................................................................................
Brown County, Wisconsin ...................................................................................................
Buffalo County, Wisconsin ..................................................................................................
Burnett County, Wisconsin ..................................................................................................
Calumet County, Wisconsin ................................................................................................
Chippewa County, Wisconsin .............................................................................................
Clark County, Wisconsin .....................................................................................................
Columbia County, Wisconsin ..............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00292
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
50
0860
50
9260
51
51
51
51
8080
3400
51
51
51
51
51
51
51
51
8080
51
51
51
51
1480
51
51
51
51
51
9000
51
51
1900
51
51
51
51
51
9000
51
51
51
51
1480
51
51
51
51
51
51
51
51
51
3400
51
51
51
6020
51
52
52
52
52
3080
52
52
0460
2290
52
52
CBSA No.
50
13380
50
49420
51
25180
16620
51
48260
26580
51
16620
51
51
51
51
51
49020
48260
51
51
51
47894
16620
51
16620
51
51
51
48540
51
51
19060
51
34060
51
25180
51
48540
51
37620
51
34060
16620
51
51
51
51
51
51
51
51
51
26580
51
51
37620
37620
51
52
52
52
52
24580
52
52
11540
20740
52
31540
46055
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
52110
52120
52130
52140
52150
52160
52170
52180
52190
52200
52210
52220
52230
52240
52250
52260
52270
52280
52290
52300
52310
52320
52330
52340
52350
52360
52370
52380
52381
52390
52400
52410
52420
52430
52440
52450
52460
52470
52480
52490
52500
52510
52520
52530
52540
52550
52560
52570
52580
52590
52600
52610
52620
52630
52640
52650
52660
52670
52680
52690
52700
53000
53010
53020
53030
53040
53050
53060
53070
53080
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
VerDate jul<14>2003
ESRD MSA
No.
County and state name
Crawford County, Wisconsin ...............................................................................................
Dane County, Wisconsin .....................................................................................................
Dodge County, Wisconsin ...................................................................................................
Door County, Wisconsin ......................................................................................................
Douglas County, Wisconsin ................................................................................................
Dunn County, Wisconsin .....................................................................................................
Eau Claire County, Wisconsin ............................................................................................
Florence County, Wisconsin ...............................................................................................
Fond Du Lac County, Wisconsin ........................................................................................
Forest County, Wisconsin ...................................................................................................
Grant County, Wisconsin ....................................................................................................
Green County, Wisconsin ...................................................................................................
Green Lake County, Wisconsin ..........................................................................................
Iowa County, Wisconsin ......................................................................................................
Iron County, Wisconsin .......................................................................................................
Jackson County, Wisconsin ................................................................................................
Jefferson County, Wisconsin ...............................................................................................
Juneau County, Wisconsin ..................................................................................................
Kenosha County, Wisconsin ...............................................................................................
Kewaunee County, Wisconsin ............................................................................................
La Crosse County, Wisconsin .............................................................................................
Lafayette County, Wisconsin ...............................................................................................
Langlade County, Wisconsin ...............................................................................................
Lincoln County, Wisconsin ..................................................................................................
Manitowoc County, Wisconsin ............................................................................................
Marathon County, Wisconsin ..............................................................................................
Marinette County, Wisconsin ..............................................................................................
Marquette County, Wisconsin .............................................................................................
Menominee County, Wisconsin ...........................................................................................
Milwaukee County, Wisconsin ............................................................................................
Monroe County, Wisconsin .................................................................................................
Oconto County, Wisconsin ..................................................................................................
Oneida County, Wisconsin ..................................................................................................
Outagamie County, Wisconsin ............................................................................................
Ozaukee County, Wisconsin ...............................................................................................
Pepin County, Wisconsin ....................................................................................................
Pierce County, Wisconsin ...................................................................................................
Polk County, Wisconsin ......................................................................................................
Portage County, Wisconsin .................................................................................................
Price County, Wisconsin .....................................................................................................
Racine County, Wisconsin ..................................................................................................
Richland County, Wisconsin ...............................................................................................
Rock County, Wisconsin .....................................................................................................
Rusk County, Wisconsin .....................................................................................................
St Croix County, Wisconsin ................................................................................................
Sauk County, Wisconsin .....................................................................................................
Sawyer County, Wisconsin .................................................................................................
Shawano County, Wisconsin ..............................................................................................
Sheboygan County, Wisconsin ...........................................................................................
Taylor County, Wisconsin ...................................................................................................
Trempealeau County, Wisconsin ........................................................................................
Vernon County, Wisconsin ..................................................................................................
Vilas County, Wisconsin ......................................................................................................
Walworth County, Wisconsin ..............................................................................................
Washburn County, Wisconsin .............................................................................................
Washington County, Wisconsin ..........................................................................................
Waukesha County, Wisconsin ............................................................................................
Waupaca County, Wisconsin ..............................................................................................
Waushara County, Wisconsin .............................................................................................
Winnebago County, Wisconsin ...........................................................................................
Wood County, Wisconsin ....................................................................................................
Albany County, Wyoming ....................................................................................................
Big Horn County, Wyoming .................................................................................................
Campbell County, Wyoming ................................................................................................
Carbon County, Wyoming ...................................................................................................
Converse County, Wyoming ...............................................................................................
Crook County, Wyoming .....................................................................................................
Fremont County, Wyoming .................................................................................................
Goshen County, Wyoming ..................................................................................................
Hot Springs County, Wyoming ............................................................................................
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00293
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
52
4720
52
52
2240
52
2290
52
52
52
52
52
52
52
52
52
52
52
3800
52
3870
3880
52
52
52
8940
52
52
52
5080
52
52
52
0460
5080
52
52
52
52
52
6600
52
3620
52
5120
52
52
52
7620
52
52
52
52
52
52
5080
5080
52
52
0460
52
53
53
53
53
53
53
53
53
53
CBSA No.
52
31540
52
52
20260
52
20740
52
22540
52
52
52
52
31540
52
52
52
52
29404
24580
29100
52
52
52
52
48140
52
52
52
33340
52
24580
52
11540
33340
52
33460
52
52
52
39540
52
27500
52
33460
52
52
52
43100
52
52
52
52
52
52
33340
33340
52
52
36780
52
53
53
53
53
53
53
53
53
53
46056
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA)
CROSSWALK—Continued
SSA state/county
code
53090
53100
53110
53120
53130
53140
53150
53160
53170
53180
53190
53200
53210
53220
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
ESRD MSA
No.
County and state name
Johnson County, Wyoming .................................................................................................
Laramie County, Wyoming ..................................................................................................
Lincoln County, Wyoming ...................................................................................................
Natrona County, Wyoming ..................................................................................................
Niobrara County, Wyoming .................................................................................................
Park County, Wyoming .......................................................................................................
Platte County, Wyoming ......................................................................................................
Sheridan County, Wyoming ................................................................................................
Sublette County, Wyoming ..................................................................................................
Sweetwater County, Wyoming ............................................................................................
Teton County, Wyoming ......................................................................................................
Uinta County, Wyoming ......................................................................................................
Washakie County, Wyoming ...............................................................................................
Weston County, Wyoming ...................................................................................................
CBSA No.
53
1580
53
1350
53
53
53
53
53
53
53
53
53
53
53
16940
53
16220
53
53
53
53
53
53
53
53
53
53
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT
[Effective January 1, 2006]
CPT/HCPCS
Codes
78000
78000
78000
78001
78001
78001
78003
78003
78003
78006
78006
78006
78007
78007
78007
78010
78010
78010
78011
78011
78011
78015
78015
78015
78016
78016
78016
78018
78018
78018
78020
78020
78020
78070
78070
78070
78075
78075
78075
78099
78099
78099
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
Thyroid, single uptake ....................................................................................................................
Thyroid, single uptake ....................................................................................................................
Thyroid, single uptake ....................................................................................................................
Thyroid, multiple uptakes ...............................................................................................................
Thyroid, multiple uptakes ...............................................................................................................
Thyroid, multiple uptakes ...............................................................................................................
Thyroid suppress/stimul .................................................................................................................
Thyroid suppress/stimul .................................................................................................................
Thyroid suppress/stimul .................................................................................................................
Thyroid imaging with uptake ..........................................................................................................
Thyroid imaging with uptake ..........................................................................................................
Thyroid imaging with uptake ..........................................................................................................
Thyroid image, mult uptakes ..........................................................................................................
Thyroid image, mult uptakes ..........................................................................................................
Thyroid image, mult uptakes ..........................................................................................................
Thyroid imaging ..............................................................................................................................
Thyroid imaging ..............................................................................................................................
Thyroid imaging ..............................................................................................................................
Thyroid imaging with flow ..............................................................................................................
Thyroid imaging with flow ..............................................................................................................
Thyroid imaging with flow ..............................................................................................................
Thyroid met imaging ......................................................................................................................
Thyroid met imaging ......................................................................................................................
Thyroid met imaging ......................................................................................................................
Thyroid met imaging/studies ..........................................................................................................
Thyroid met imaging/studies ..........................................................................................................
Thyroid met imaging/studies ..........................................................................................................
Thyroid met imaging, body ............................................................................................................
Thyroid met imaging, body ............................................................................................................
Thyroid met imaging, body ............................................................................................................
Thyroid met uptake ........................................................................................................................
Thyroid met uptake ........................................................................................................................
Thyroid met uptake ........................................................................................................................
Parathyroid nuclear imaging ..........................................................................................................
Parathyroid nuclear imaging ..........................................................................................................
Parathyroid nuclear imaging ..........................................................................................................
Adrenal nuclear imaging ................................................................................................................
Adrenal nuclear imaging ................................................................................................................
Adrenal nuclear imaging ................................................................................................................
Endocrine nuclear procedure .........................................................................................................
Endocrine nuclear procedure .........................................................................................................
Endocrine nuclear procedure .........................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00294
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
46057
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
78102
78102
78102
78103
78103
78103
78104
78104
78104
78110
78110
78110
78111
78111
78111
78120
78120
78120
78121
78121
78121
78122
78122
78122
78130
78130
78130
78135
78135
78135
78140
78140
78140
78160
78160
78160
78162
78162
78162
78170
78170
78170
78172
78172
78172
78185
78185
78185
78190
78190
78190
78191
78191
78191
78195
78195
78195
78199
78199
78199
78201
78201
78201
78202
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
Bone marrow imaging, ltd ..............................................................................................................
Bone marrow imaging, ltd ..............................................................................................................
Bone marrow imaging, ltd ..............................................................................................................
Bone marrow imaging, mult ...........................................................................................................
Bone marrow imaging, mult ...........................................................................................................
Bone marrow imaging, mult ...........................................................................................................
Bone marrow imaging, body ..........................................................................................................
Bone marrow imaging, body ..........................................................................................................
Bone marrow imaging, body ..........................................................................................................
Plasma volume, single ...................................................................................................................
Plasma volume, single ...................................................................................................................
Plasma volume, single ...................................................................................................................
Plasma volume, multiple ................................................................................................................
Plasma volume, multiple ................................................................................................................
Plasma volume, multiple ................................................................................................................
Red cell mass, single .....................................................................................................................
Red cell mass, single .....................................................................................................................
Red cell mass, single .....................................................................................................................
Red cell mass, multiple ..................................................................................................................
Red cell mass, multiple ..................................................................................................................
Red cell mass, multiple ..................................................................................................................
Blood volume .................................................................................................................................
Blood volume .................................................................................................................................
Blood volume .................................................................................................................................
Red cell survival study ...................................................................................................................
Red cell survival study ...................................................................................................................
Red cell survival study ...................................................................................................................
Red cell survival kinetics ................................................................................................................
Red cell survival kinetics ................................................................................................................
Red cell survival kinetics ................................................................................................................
Red cell sequestration ...................................................................................................................
Red cell sequestration ...................................................................................................................
Red cell sequestration ...................................................................................................................
Plasma iron turnover ......................................................................................................................
Plasma iron turnover ......................................................................................................................
Plasma iron turnover ......................................................................................................................
Radioiron absorption exam ............................................................................................................
Radioiron absorption exam ............................................................................................................
Radioiron absorption exam ............................................................................................................
Red cell iron utilization ...................................................................................................................
Red cell iron utilization ...................................................................................................................
Red cell iron utilization ...................................................................................................................
Total body iron estimation ..............................................................................................................
Total body iron estimation ..............................................................................................................
Total body iron estimation ..............................................................................................................
Spleen imaging ..............................................................................................................................
Spleen imaging ..............................................................................................................................
Spleen imaging ..............................................................................................................................
Platelet survival, kinetics ................................................................................................................
Platelet survival, kinetics ................................................................................................................
Platelet survival, kinetics ................................................................................................................
Platelet survival ..............................................................................................................................
Platelet survival ..............................................................................................................................
Platelet survival ..............................................................................................................................
Lymph system imaging ..................................................................................................................
Lymph system imaging ..................................................................................................................
Lymph system imaging ..................................................................................................................
Blood/lymph nuclear exam .............................................................................................................
Blood/lymph nuclear exam .............................................................................................................
Blood/lymph nuclear exam .............................................................................................................
Liver imaging ..................................................................................................................................
Liver imaging ..................................................................................................................................
Liver imaging ..................................................................................................................................
Liver imaging with flow ...................................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00295
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
46058
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
78202
78202
78205
78205
78205
78206
78206
78206
78215
78215
78215
78216
78216
78216
78220
78220
78220
78223
78223
78223
78230
78230
78230
78231
78231
78231
78232
78232
78232
78258
78258
78258
78261
78261
78261
78262
78262
78262
78264
78264
78264
78270
78270
78270
78271
78271
78271
78272
78272
78272
78278
78278
78278
78282
78282
78282
78290
78290
78290
78291
78291
78291
78299
78299
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
Liver imaging with flow ...................................................................................................................
Liver imaging with flow ...................................................................................................................
Liver imaging (3D) ..........................................................................................................................
Liver imaging (3D) ..........................................................................................................................
Liver imaging (3D) ..........................................................................................................................
Liver image (3d) with flow ..............................................................................................................
Liver image (3d) with flow ..............................................................................................................
Liver image (3d) with flow ..............................................................................................................
Liver and spleen imaging ...............................................................................................................
Liver and spleen imaging ...............................................................................................................
Liver and spleen imaging ...............................................................................................................
Liver & spleen image/flow ..............................................................................................................
Liver & spleen image/flow ..............................................................................................................
Liver & spleen image/flow ..............................................................................................................
Liver function study ........................................................................................................................
Liver function study ........................................................................................................................
Liver function study ........................................................................................................................
Hepatobiliary imaging .....................................................................................................................
Hepatobiliary imaging .....................................................................................................................
Hepatobiliary imaging .....................................................................................................................
Salivary gland imaging ...................................................................................................................
Salivary gland imaging ...................................................................................................................
Salivary gland imaging ...................................................................................................................
Serial salivary imaging ...................................................................................................................
Serial salivary imaging ...................................................................................................................
Serial salivary imaging ...................................................................................................................
Salivary gland function exam .........................................................................................................
Salivary gland function exam .........................................................................................................
Salivary gland function exam .........................................................................................................
Esophageal motility study ..............................................................................................................
Esophageal motility study ..............................................................................................................
Esophageal motility study ..............................................................................................................
Gastric mucosa imaging ................................................................................................................
Gastric mucosa imaging ................................................................................................................
Gastric mucosa imaging ................................................................................................................
Gastroesophageal reflux exam ......................................................................................................
Gastroesophageal reflux exam ......................................................................................................
Gastroesophageal reflux exam ......................................................................................................
Gastric emptying study ..................................................................................................................
Gastric emptying study ..................................................................................................................
Gastric emptying study ..................................................................................................................
Vit B-12 absorption exam ..............................................................................................................
Vit B-12 absorption exam ..............................................................................................................
Vit B-12 absorption exam ..............................................................................................................
Vit b-12 absrp exam, int fac ...........................................................................................................
Vit b-12 absrp exam, int fac ...........................................................................................................
Vit b-12 absrp exam, int fac ...........................................................................................................
Vit B-12 absorp, combined ............................................................................................................
Vit B-12 absorp, combined ............................................................................................................
Vit B-12 absorp, combined ............................................................................................................
Acute GI blood loss imaging ..........................................................................................................
Acute GI blood loss imaging ..........................................................................................................
Acute GI blood loss imaging ..........................................................................................................
GI protein loss exam ......................................................................................................................
GI protein loss exam ......................................................................................................................
GI protein loss exam ......................................................................................................................
Meckel’s divert exam .....................................................................................................................
Meckel’s divert exam .....................................................................................................................
Meckel’s divert exam .....................................................................................................................
Leveen/shunt patency exam ..........................................................................................................
Leveen/shunt patency exam ..........................................................................................................
Leveen/shunt patency exam ..........................................................................................................
GI nuclear procedure .....................................................................................................................
GI nuclear procedure .....................................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00296
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
C
C
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
46059
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
78299
78300
78300
78300
78305
78305
78305
78306
78306
78306
78315
78315
78315
78320
78320
78320
78350
78350
78350
78351
78399
78399
78399
78414
78414
78414
78428
78428
78428
78445
78445
78445
78455
78455
78455
78456
78456
78456
78457
78457
78457
78458
78458
78458
78459
78459
78459
78460
78460
78460
78461
78461
78461
78464
78464
78464
78465
78465
78465
78466
78466
78466
78468
78468
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
GI nuclear procedure .....................................................................................................................
Bone imaging, limited area ............................................................................................................
Bone imaging, limited area ............................................................................................................
Bone imaging, limited area ............................................................................................................
Bone imaging, multiple areas ........................................................................................................
Bone imaging, multiple areas ........................................................................................................
Bone imaging, multiple areas ........................................................................................................
Bone imaging, whole body .............................................................................................................
Bone imaging, whole body .............................................................................................................
Bone imaging, whole body .............................................................................................................
Bone imaging, 3 phase ..................................................................................................................
Bone imaging, 3 phase ..................................................................................................................
Bone imaging, 3 phase ..................................................................................................................
Bone imaging (3D) .........................................................................................................................
Bone imaging (3D) .........................................................................................................................
Bone imaging (3D) .........................................................................................................................
Bone mineral, single photon ..........................................................................................................
Bone mineral, single photon ..........................................................................................................
Bone mineral, single photon ..........................................................................................................
Bone mineral, dual photon .............................................................................................................
Musculoskeletal nuclear exam .......................................................................................................
Musculoskeletal nuclear exam .......................................................................................................
Musculoskeletal nuclear exam .......................................................................................................
Non-imaging heart function ............................................................................................................
Non-imaging heart function ............................................................................................................
Non-imaging heart function ............................................................................................................
Cardiac shunt imaging ...................................................................................................................
Cardiac shunt imaging ...................................................................................................................
Cardiac shunt imaging ...................................................................................................................
Vascular flow imaging ....................................................................................................................
Vascular flow imaging ....................................................................................................................
Vascular flow imaging ....................................................................................................................
Venous thrombosis study ...............................................................................................................
Venous thrombosis study ...............................................................................................................
Venous thrombosis study ...............................................................................................................
Acute venous thrombus image ......................................................................................................
Acute venous thrombus image ......................................................................................................
Acute venous thrombus image ......................................................................................................
Venous thrombosis imaging ...........................................................................................................
Venous thrombosis imaging ...........................................................................................................
Venous thrombosis imaging ...........................................................................................................
Ven thrombosis images, bilat .........................................................................................................
Ven thrombosis images, bilat .........................................................................................................
Ven thrombosis images, bilat .........................................................................................................
Heart muscle imaging (PET) ..........................................................................................................
Heart muscle imaging (PET) ..........................................................................................................
Heart muscle imaging (PET) ..........................................................................................................
Heart muscle blood, single ............................................................................................................
Heart muscle blood, single ............................................................................................................
Heart muscle blood, single ............................................................................................................
Heart muscle blood, multiple .........................................................................................................
Heart muscle blood, multiple .........................................................................................................
Heart muscle blood, multiple .........................................................................................................
Heart image (3d), single ................................................................................................................
Heart image (3d), single ................................................................................................................
Heart image (3d), single ................................................................................................................
Heart image (3d), multiple .............................................................................................................
Heart image (3d), multiple .............................................................................................................
Heart image (3d), multiple .............................................................................................................
Heart infarct image .........................................................................................................................
Heart infarct image .........................................................................................................................
Heart infarct image .........................................................................................................................
Heart infarct image (ef) ..................................................................................................................
Heart infarct image (ef) ..................................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00297
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
C
C
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
46060
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
78468
78469
78469
78469
78472
78472
78472
78473
78473
78473
78478
78478
78478
78480
78480
78480
78481
78481
78481
78483
78483
78483
78491
78491
78491
78492
78492
78492
78494
78494
78494
78496
78496
78496
78499
78499
78499
78580
78580
78580
78584
78584
78584
78585
78585
78585
78586
78586
78586
78587
78587
78587
78588
78588
78588
78591
78591
78591
78593
78593
78593
78594
78594
78594
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
Heart infarct image (ef) ..................................................................................................................
Heart infarct image (3D) ................................................................................................................
Heart infarct image (3D) ................................................................................................................
Heart infarct image (3D) ................................................................................................................
Gated heart, planar, single ............................................................................................................
Gated heart, planar, single ............................................................................................................
Gated heart, planar, single ............................................................................................................
Gated heart, multiple ......................................................................................................................
Gated heart, multiple ......................................................................................................................
Gated heart, multiple ......................................................................................................................
Heart wall motion add-on ...............................................................................................................
Heart wall motion add-on ...............................................................................................................
Heart wall motion add-on ...............................................................................................................
Heart function add-on ....................................................................................................................
Heart function add-on ....................................................................................................................
Heart function add-on ....................................................................................................................
Heart first pass, single ...................................................................................................................
Heart first pass, single ...................................................................................................................
Heart first pass, single ...................................................................................................................
Heart first pass, multiple ................................................................................................................
Heart first pass, multiple ................................................................................................................
Heart first pass, multiple ................................................................................................................
Heart image (pet), single ...............................................................................................................
Heart image (pet), single ...............................................................................................................
Heart image (pet), single ...............................................................................................................
Heart image (pet), multiple ............................................................................................................
Heart image (pet), multiple ............................................................................................................
Heart image (pet), multiple ............................................................................................................
Heart image, spect .........................................................................................................................
Heart image, spect .........................................................................................................................
Heart image, spect .........................................................................................................................
Heart first pass add-on ..................................................................................................................
Heart first pass add-on ..................................................................................................................
Heart first pass add-on ..................................................................................................................
Cardiovascular nuclear exam ........................................................................................................
Cardiovascular nuclear exam ........................................................................................................
Cardiovascular nuclear exam ........................................................................................................
Lung perfusion imaging ..................................................................................................................
Lung perfusion imaging ..................................................................................................................
Lung perfusion imaging ..................................................................................................................
Lung V/Q image single breath .......................................................................................................
Lung V/Q image single breath .......................................................................................................
Lung V/Q image single breath .......................................................................................................
Lung V/Q imaging ..........................................................................................................................
Lung V/Q imaging ..........................................................................................................................
Lung V/Q imaging ..........................................................................................................................
Aerosol lung image, single .............................................................................................................
Aerosol lung image, single .............................................................................................................
Aerosol lung image, single .............................................................................................................
Aerosol lung image, multiple ..........................................................................................................
Aerosol lung image, multiple ..........................................................................................................
Aerosol lung image, multiple ..........................................................................................................
Perfusion lung image .....................................................................................................................
Perfusion lung image .....................................................................................................................
Perfusion lung image .....................................................................................................................
Vent image, 1 breath, 1 proj ..........................................................................................................
Vent image, 1 breath, 1 proj ..........................................................................................................
Vent image, 1 breath, 1 proj ..........................................................................................................
Vent image, 1 proj, gas ..................................................................................................................
Vent image, 1 proj, gas ..................................................................................................................
Vent image, 1 proj, gas ..................................................................................................................
Vent image, mult proj, gas .............................................................................................................
Vent image, mult proj, gas .............................................................................................................
Vent image, mult proj, gas .............................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00298
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
C
C
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
46061
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
78596
78596
78596
78599
78599
78599
78600
78600
78600
78601
78601
78601
78605
78605
78605
78606
78606
78606
78607
78607
78607
78608
78608
78608
78609
78609
78609
78610
78610
78610
78615
78615
78615
78630
78630
78630
78635
78635
78635
78645
78645
78645
78647
78647
78647
78650
78650
78650
78660
78660
78660
78699
78699
78699
78700
78700
78700
78701
78701
78701
78704
78704
78704
78707
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
Lung differential function ................................................................................................................
Lung differential function ................................................................................................................
Lung differential function ................................................................................................................
Respiratory nuclear exam ..............................................................................................................
Respiratory nuclear exam ..............................................................................................................
Respiratory nuclear exam ..............................................................................................................
Brain imaging, ltd static ..................................................................................................................
Brain imaging, ltd static ..................................................................................................................
Brain imaging, ltd static ..................................................................................................................
Brain imaging, ltd w/flow ................................................................................................................
Brain imaging, ltd w/flow ................................................................................................................
Brain imaging, ltd w/flow ................................................................................................................
Brain imaging, complete ................................................................................................................
Brain imaging, complete ................................................................................................................
Brain imaging, complete ................................................................................................................
Brain imaging, compl w/flow ..........................................................................................................
Brain imaging, compl w/flow ..........................................................................................................
Brain imaging, compl w/flow ..........................................................................................................
Brain imaging (3D) .........................................................................................................................
Brain imaging (3D) .........................................................................................................................
Brain imaging (3D) .........................................................................................................................
Brain imaging (PET) .......................................................................................................................
Brain imaging (PET) .......................................................................................................................
Brain imaging (PET) .......................................................................................................................
Brain imaging (PET) .......................................................................................................................
Brain imaging (PET) .......................................................................................................................
Brain imaging (PET) .......................................................................................................................
Brain flow imaging only ..................................................................................................................
Brain flow imaging only ..................................................................................................................
Brain flow imaging only ..................................................................................................................
Cerebral vascular flow image ........................................................................................................
Cerebral vascular flow image ........................................................................................................
Cerebral vascular flow image ........................................................................................................
Cerebrospinal fluid scan ................................................................................................................
Cerebrospinal fluid scan ................................................................................................................
Cerebrospinal fluid scan ................................................................................................................
CSF ventriculography .....................................................................................................................
CSF ventriculography .....................................................................................................................
CSF ventriculography .....................................................................................................................
CSF shunt evaluation .....................................................................................................................
CSF shunt evaluation .....................................................................................................................
CSF shunt evaluation .....................................................................................................................
Cerebrospinal fluid scan ................................................................................................................
Cerebrospinal fluid scan ................................................................................................................
Cerebrospinal fluid scan ................................................................................................................
CSF leakage imaging .....................................................................................................................
CSF leakage imaging .....................................................................................................................
CSF leakage imaging .....................................................................................................................
Nuclear exam of tear flow ..............................................................................................................
Nuclear exam of tear flow ..............................................................................................................
Nuclear exam of tear flow ..............................................................................................................
Nervous system nuclear exam ......................................................................................................
Nervous system nuclear exam ......................................................................................................
Nervous system nuclear exam ......................................................................................................
Kidney imaging, static ....................................................................................................................
Kidney imaging, static ....................................................................................................................
Kidney imaging, static ....................................................................................................................
Kidney imaging with flow ...............................................................................................................
Kidney imaging with flow ...............................................................................................................
Kidney imaging with flow ...............................................................................................................
Imaging renogram ..........................................................................................................................
Imaging renogram ..........................................................................................................................
Imaging renogram ..........................................................................................................................
Kidney flow/function image ............................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00299
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
46062
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
78707
78707
78708
78708
78708
78709
78709
78709
78710
78710
78710
78715
78715
78715
78725
78725
78725
78730
78730
78730
78740
78740
78740
78760
78760
78760
78761
78761
78761
78799
78799
78799
78800
78800
78800
78801
78801
78801
78802
78802
78802
78803
78803
78803
78804
78804
78804
78805
78805
78805
78806
78806
78806
78807
78807
78807
78811
78811
78811
78812
78812
78812
78813
78813
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
............................
Status
code
MOD
Description
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney flow/function image ............................................................................................................
Kidney imaging (3D) ......................................................................................................................
Kidney imaging (3D) ......................................................................................................................
Kidney imaging (3D) ......................................................................................................................
Renal vascular flow exam ..............................................................................................................
Renal vascular flow exam ..............................................................................................................
Renal vascular flow exam ..............................................................................................................
Kidney function study .....................................................................................................................
Kidney function study .....................................................................................................................
Kidney function study .....................................................................................................................
Urinary bladder retention ...............................................................................................................
Urinary bladder retention ...............................................................................................................
Urinary bladder retention ...............................................................................................................
Ureteral reflux study .......................................................................................................................
Ureteral reflux study .......................................................................................................................
Ureteral reflux study .......................................................................................................................
Testicular imaging ..........................................................................................................................
Testicular imaging ..........................................................................................................................
Testicular imaging ..........................................................................................................................
Testicular imaging/flow ...................................................................................................................
Testicular imaging/flow ...................................................................................................................
Testicular imaging/flow ...................................................................................................................
Genitourinary nuclear exam ...........................................................................................................
Genitourinary nuclear exam ...........................................................................................................
Genitourinary nuclear exam ...........................................................................................................
Tumor imaging, limited area ..........................................................................................................
Tumor imaging, limited area ..........................................................................................................
Tumor imaging, limited area ..........................................................................................................
Tumor imaging, mult areas ............................................................................................................
Tumor imaging, mult areas ............................................................................................................
Tumor imaging, mult areas ............................................................................................................
Tumor imaging, whole body ...........................................................................................................
Tumor imaging, whole body ...........................................................................................................
Tumor imaging, whole body ...........................................................................................................
Tumor imaging (3D) .......................................................................................................................
Tumor imaging (3D) .......................................................................................................................
Tumor imaging (3D) .......................................................................................................................
Tumor imaging, whole body ...........................................................................................................
Tumor imaging, whole body ...........................................................................................................
Tumor imaging, whole body ...........................................................................................................
Abscess imaging, ltd area ..............................................................................................................
Abscess imaging, ltd area ..............................................................................................................
Abscess imaging, ltd area ..............................................................................................................
Abscess imaging, whole body .......................................................................................................
Abscess imaging, whole body .......................................................................................................
Abscess imaging, whole body .......................................................................................................
Nuclear localization/abscess ..........................................................................................................
Nuclear localization/abscess ..........................................................................................................
Nuclear localization/abscess ..........................................................................................................
Tumor imaging (pet), limited ..........................................................................................................
Tumor imaging (pet), limited ..........................................................................................................
Tumor imaging (pet), limited ..........................................................................................................
Tumor image (pet)/skul-thigh .........................................................................................................
Tumor image (pet)/skul-thigh .........................................................................................................
Tumor image (pet)/skul-thigh .........................................................................................................
Tumor image (pet) full body ...........................................................................................................
Tumor image (pet) full body ...........................................................................................................
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00300
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
C
C
A
C
C
A
C
C
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
46063
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
MOD
Description
Status
code
78813 ............................
78814 ............................
78814 ............................
78814 ............................
78815 ............................
78815 ............................
78815 ............................
78816 ............................
78816 ............................
78816 ............................
78890 ............................
78890 ............................
78890 ............................
78891 ............................
78891 ............................
78891 ............................
78999 ............................
78999 ............................
78999 ............................
79005 ............................
79005 ............................
79005 ............................
79101 ............................
79101 ............................
79101 ............................
79200 ............................
79200 ............................
79200 ............................
79300 ............................
79300 ............................
79300 ............................
79403 ............................
79403 ............................
79403 ............................
79440 ............................
79440 ............................
79440 ............................
79445 ............................
79445 ............................
79445 ............................
79999 ............................
79999 ............................
79999 ............................
A4641 ...........................
A4642 ...........................
A9500 ...........................
A9502 ...........................
A9503 ...........................
A9504 ...........................
A9505 ...........................
A9507 ...........................
A9508 ...........................
A9510 ...........................
A9511 ...........................
A9512 ...........................
A9513 ...........................
A9514 ...........................
A9515 ...........................
A9516 ...........................
A9517 ...........................
A9519 ...........................
A9520 ...........................
A9521 ...........................
A9522 ...........................
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
TC ............
26 .............
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
Tumor image (pet) full body ...........................................................................................................
Tumor image pet/ct, limited ...........................................................................................................
Tumor image pet/ct, limited ...........................................................................................................
Tumor image pet/ct, limited ...........................................................................................................
Tumorimage pet/ct skul-thigh .........................................................................................................
Tumorimage pet/ct skul-thigh .........................................................................................................
Tumorimage pet/ct skul-thigh .........................................................................................................
Tumor image pet/ct full body .........................................................................................................
Tumor image pet/ct full body .........................................................................................................
Tumor image pet/ct full body .........................................................................................................
Nuclear medicine data proc ...........................................................................................................
Nuclear medicine data proc ...........................................................................................................
Nuclear medicine data proc ...........................................................................................................
Nuclear med data proc ..................................................................................................................
Nuclear med data proc ..................................................................................................................
Nuclear med data proc ..................................................................................................................
Nuclear diagnostic exam ................................................................................................................
Nuclear diagnostic exam ................................................................................................................
Nuclear diagnostic exam ................................................................................................................
Nuclear rx, oral admin ....................................................................................................................
Nuclear rx, oral admin ....................................................................................................................
Nuclear rx, oral admin ....................................................................................................................
Nuclear rx, iv admin .......................................................................................................................
Nuclear rx, iv admin .......................................................................................................................
Nuclear rx, iv admin .......................................................................................................................
Nuclear rx, intracav admin .............................................................................................................
Nuclear rx, intracav admin .............................................................................................................
Nuclear rx, intracav admin .............................................................................................................
Nuclr rx, interstit colloid ..................................................................................................................
Nuclr rx, interstit colloid ..................................................................................................................
Nuclr rx, interstit colloid ..................................................................................................................
Hematopoietic nuclear tx ...............................................................................................................
Hematopoietic nuclear tx ...............................................................................................................
Hematopoietic nuclear tx ...............................................................................................................
Nuclear rx, intra-articular ................................................................................................................
Nuclear rx, intra-articular ................................................................................................................
Nuclear rx, intra-articular ................................................................................................................
Nuclear rx, intra-arterial .................................................................................................................
Nuclear rx, intra-arterial .................................................................................................................
Nuclear rx, intra-arterial .................................................................................................................
Nuclear medicine therapy ..............................................................................................................
Nuclear medicine therapy ..............................................................................................................
Nuclear medicine therapy ..............................................................................................................
Diagnostic imaging agent.
Satumomab pendetide per dose.
Technetium TC 99m sestamibi.
Technetium TC99M tetrofosmin.
Technetium TC 99m medronate.
Technetium tc 99m apcitide.
Thallous chloride TL 201/mci.
Indium/111 capromab pendetid.
Iobenguane sulfate I-131.
Technetium TC99m Disofenin.
Technetium TC 99m depreotide.
Technetiumtc99mpertechnetate.
Technetium tc-99m mebrofenin.
Technetiumtc99mpyrophosphate.
Technetium tc-99m pentetate.
I-123 sodium iodide capsule.
Th I131 so iodide cap millic.
Technetiumtc-99mmacroag albu.
Technetiumtc-99m sulfur clld.
Technetiumtc-99m exametazine.
Indium111ibritumomabtiuxetan.
——————————
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00301
Fmt 4742
Sfmt 4742
E:\FR\FM\08AUP2.SGM
08AUP2
A
C
C
A
C
C
A
C
C
A
B
B
B
B
B
B
C
C
C
A
A
A
A
A
A
A
A
A
C
C
A
A
A
A
A
A
A
A
A
A
C
C
C
46064
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules
ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES
UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued
[Effective January 1, 2006]
CPT/HCPCS
Codes
A9523
A9524
A9526
A9527
A9528
A9529
A9530
A9531
A9532
A9533
A9534
A9600
A9603
A9605
A9699
C1079
C1080
C1081
C1082
C1083
C1091
C1092
C1093
C1122
C1200
C1201
C1775
C9102
C9103
C9400
C9401
C9402
C9403
C9404
C9405
Q3000
Q3002
Q3003
Q3004
Q3005
Q3006
Q3007
Q3008
Q3009
Q3010
Q3011
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
...........................
MOD
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
..................
Status
code
Description
Yttrium90ibritumomabtiuxetan.
Iodinated I-131 serumalbumin.
Ammonia N-13, per dose.
I-131 tositumomab therapeut.
Dx I131 so iodide cap millic.
Dx I131 so iodide sol millic.
Th I131 so iodide sol millic.
Dx I131 so iodide microcurie.
I-125 serum albumin micro.
I-131 tositumomab diagnostic.
I-131 tositumomab therapeut.
Strontium-89 chloride.
I-131sodiumiodidecap per mci.
Samarium sm153 lexidronamm.
Noc therapeutic radiopharm.
CO 57/58 per 0.5 uCi.
I-131 tositumomab, dx.
I-131 tositumomab, tx.
In-111 ibritumomab tiuxetan.
Yttrium 90 ibritumomab tiuxe.
IN111 oxyquinoline,per0.5mCi.
IN 111 pentetate per 0.5 mCi.
TC99M fanolesomab.
Tc 99M ARCITUMOMAB PER VIAL.
TC 99M Sodium Glucoheptonat.
TC 99M SUCCIMER, PER Vial.
FDG, per dose (4-40 mCi/ml).
51 Na Chromate, 50mCi.
Na Iothalamate I-125, 10 uCi.
Thallous chloride, brand.
Strontium-89 chloride,brand.
Th I131 so iodide cap, brand.
Dx I131 so iodide cap, brand.
Dx I131 so iodide sol, brand.
Th I131 so iodide sol, brand.
Rubidium RB-82.
Gallium ga 67.
Technetium tc99m bicisate.
Xenon xe 133.
Technetium tc99m mertiatide.
Technetium tc99m glucepatate.
Sodium phosphate p32.
Indium 111-in pentetreotide.
Technetium tc99m oxidronate.
Technetium tc99mlabeledrbcs.
Chromic phosphate p32.
CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
[FR Doc. 05–15370 Filed 8–1–05; 4:16 pm]
BILLING CODE 4120–01–P
VerDate jul<14>2003
20:18 Aug 05, 2005
Jkt 205001
PO 00000
Frm 00302
Fmt 4701
Sfmt 4701
E:\FR\FM\08AUP2.SGM
08AUP2
]]>Agencies
[Federal Register Volume 70, Number 151 (Monday, August 8, 2005)]
[Proposed Rules]
[Pages 45764-46064]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-15370]
[[Page 45763]]
-----------------------------------------------------------------------
Part II
Department of Health and Human Services
-----------------------------------------------------------------------
Centers for Medicare & Medicaid Services
-----------------------------------------------------------------------
42 CFR Part 405, et al.
Medicare Program; Revisions to Payment Policies Under the Physician Fee
Schedule for Calendar Year 2006; Proposed Rule
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 /
Proposed Rules
[[Page 45764]]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 405, 410, 411, 413, 414, and 426
[CMS-1502-P]
RIN 0938-AN84
Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2006
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: This proposed rule would refine the resource-based practice
expense relative value units (PE RVUs) and propose changes to payment
based on supplemental survey data for practice expense and revisions to
our methodology for calculating practice expense RVUs, as well as make
other proposed changes to Medicare Part B payment policy. We are also
proposing policy changes related to revisions to malpractice RVUs, in
addition to revising the list of telehealth services. In this proposed
rule, we also discuss multiple procedure payment reduction for
diagnostic imaging, and several coding issues.
We are proposing these changes to ensure that our payment systems
are updated to reflect changes in medical practice and the relative
value of services. This proposed rule also discusses geographic
locality changes; payment for covered outpatient drugs and biologicals;
supplemental payments to federally qualified health centers (FQHCs);
payment for renal dialysis services; the national coverage decision
(NCD) process; coverage of screening for glaucoma; private contracts;
and physician referrals for nuclear medicine services and supplies to
health care entities with which they have financial relationships.
In addition, we include discussions on payment for teaching
anesthesiologists, the therapy cap, the chiropractic demonstration and
the Sustainable Growth Rate (SGR).
DATES: Comment Date: Comments will be considered if we receive them at
one of the addresses provided below, no later than 5 p.m. on September
30, 2005.
ADDRESSES: In commenting, please refer to file code CMS-1502-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to https://www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By mail. You may mail written comments (one original and two
copies) to the following address ONLY: Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Attention: CMS-1502-
P, P.O. Box 8017, Baltimore, MD 21244-8017.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address ONLY: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-1502-P, Mail Stop C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7197 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may submit
comments on this document's paperwork requirements by mailing your
comments to the addresses provided at the end of the ``Collection of
Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Pam West (410) 786-2302 (for issues related to practice expense).
Rick Ensor (410) 786-5617 (for issues related to the non-physician
workpool and supplemental survey data).
Stephanie Monroe (410) 786-6864 (for issues related to the
geographic practice cost index).
Craig Dobyski (410) 786-4584 (for issues related to list of
telehealth services).
Ken Marsalek (410) 786-4502 (for issues related to multiple
procedure reduction for diagnostic imaging services and payment for
teaching anesthesiologists).
Henry Richter (410) 786-4562 (for issues related to payments for
end stage renal disease facilities).
Angela Mason (410) 786-7452 or Catherine Jansto (410) 786-7762 (for
issues related to payment for covered outpatient drugs and
biologicals).
Fred Grabau (410) 786-0206 (for issues related to private contracts
and opt out provision).
David Worgo (410) 786-5919 (for issues related to Federally
Qualified Health Centers).
Vadim Lubarsky (410) 786-0840 (for issues related National Coverage
Decision timeframes).
Bill Larson (410) 786-7176 (for issues related to coverage of
screening for glaucoma).
Diane Milstead (410) 786-3355 or Gaysha Brooks (410) 786-9649 (for
all other issues).
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-1502-P and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. CMS posts all electronic
comments received before the close of the comment period on its public
website as soon as possible after they have been received. Hard copy
comments received timely will be available for public inspection as
they are received, generally beginning approximately 3 weeks after
publication of a document, at the headquarters of the Centers for
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore,
Maryland 21244, Monday
[[Page 45765]]
through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an
appointment to view public comments, phone 1-800-743-3951.
This Federal Register document is also available from the Federal
Register online database through GPO Access a service of the U.S.
Government Printing Office. The Web site address is: https://
www.access.gpo.gov/nara/.
Information on the physician fee schedule can be found on the CMS
homepage. You can access this data by using the following directions:
1. Go to the CMS homepage (https://www.cms.hhs.gov).
2. Place your cursor over the word ``Professionals'' in the blue
areas near the top of the page. Select ``physicians'' from the drop-
down menu.
3. Under ``Billing/Payment'' select ``Physician Fee Schedule''.
To assist readers in referencing sections contained in this
preamble, we are providing the following table of contents. Some of the
issues discussed in this preamble affect the payment policies, but do
not require changes to the regulations in the Code of Federal
Regulations. Information on the regulation's impact appears throughout
the preamble and is not exclusively in section VI.
Table of Contents
I. Background
A. Introduction
B. Development of the Relative Value System
C. Components of the Fee Schedule Payment Amounts
D. Most Recent Changes to the Fee Schedule
II. Provisions of the Proposed Rule
A. Resource-Based Practice Expense RVUs
1. Current Methodology
2. Practice Expense Proposals for Calendar Year 2006
B. Geographic Practice Cost Indices
C. Malpractice Relative Value Units (RVUs)
D. Medicare Telehealth Services
E. Contractor Pricing of Unlisted Therapy Modalities and
Procedures
F. Payment for Teaching Anesthesiologists
G. End Stage Renal Disease (ESRD) Related Provisions
1. Revised Pricing Methodology for Separately Billable Drugs and
Biologicals Furnished by ESRD Facilities.
2. Adjustment to Account for Changes in the Pricing of
Separately Billable Drugs and Biologicals and the Estimated Increase
in Expenditures for Drugs and Biologicals
3. Proposed Revisions to Geographic Designations and Wage
Indexes Applied to the End Stage Renal Disease Composite Payment
Rate Wage Index
4. Proposed Revisions to Sec. 413.170 (Scope) and Sec. 413.174
(Prospective rates for hospital-based and independent ESRD
facilities)
5. Proposed Revisions to the Composite Payment Rate Exceptions
Process
H. Payment for Covered Outpatient Drugs and Biologicals
I. Private Contracts and Opt-out Provision
J. Multiple Procedure Reduction for Diagnostic Imaging
K. Therapy Cap
L. Chiropractic Services Demonstration
M. Supplemental Payments to Federally Qualified Health Centers
(FQHCs) Subcontracting with Medicare Advantage Plans
N. National Coverage Decisions Timeframes
O. Coverage of Screening for Glaucoma
P. Physician Referrals for Nuclear Medicine Services and
Suppliers to Health Care Entities with Which They Have Financial
Relationships
Q. Sustainable Growth Rate
III. Collection of Information Requirements
IV. Response to Comments
V. Regulatory Impact Analysis
Regulation Text
Addendum A--Explanation and Use of Addendum B
Addendum B--2006 Relative Value Units and Related Information Used
in Determining Medicare Payments for 2006
Addendum C--Codes for Which we Received Practice Expense Review
Committee (PERC) Recommendations on Practice Expense Direct Cost
Inputs.
Addendum D--2006 Geographic Practice Cost Indices By Medicare
Carrier and Locality
Addendum E--Proposed 2006 Geographic Adjustment Factors (GAFs)
Addendum F--ESRD Facilities Metropolitan Statistical Areas (MSA)/
Core-Based Statistical Areas (CBSA) Crosswalk
Addendum G--List of CPT/HCPCS Codes Used to Describe Nuclear
Medicine Designated Health Services Under Section 1877 of the Social
Security Act
In addition, because of the many organizations and terms to
which we refer by acronym in this proposed final rule, we are
listing these acronyms and their corresponding terms in alphabetical
order below:
AADA American Academy of Dermatology Association
AAH American Association of Homecare
ACC American College of Cardiology
ACG American College of Gastroenterology
ACR American College of Radiology
AFROC Association of Freestanding Radiation Oncology Centers
AGA American Gastroenterological Association
AMA American Medical Association
AMP Average manufacturer price
ASA American Society of Anesthesiologists
ASGE American Society of Gastrointestinal Endoscopy
ASP Average sales price
ASTRO American Society for Therapeutic Radiation Oncology
ATA American Telemedicine Association
AUA American Urological Association
AWP Average wholesale price
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act of 1999
BES (Bureau of the Census') Business Expenditure Survey
BIPA Benefits Improvement and Protection Act of 2000
BLS Bureau of Labor Statistics
BMI Body mass index
BNF Budget neutrality factor
BSA Body surface area
CAP College of American Pathologists
CBSA Core-Based Statistical Area
CF Conversion factor
CFR Code of Federal Regulations
CMA California Medical Association
CMS Centers for Medicare & Medicaid Services
CNS Clinical nurse specialist
CPEP Clinical Practice Expert Panel
CPI Consumer Price Index
CPO Care Plan Oversight
CPT (Physicians') Current Procedural Terminology (4th Edition, 2002,
copyrighted by the American Medical Association)
CRNA Certified Registered Nurse Anesthetist
CT Computed tomography
CTA Computed tomographic angiography
CY Calendar year
DHS Designated health services
DME Durable medical equipment
DMERC Durable Medical Equipment Regional Carrier
DSMT Diabetes outpatient self-management training services
E&M Evaluation and management
EPO Erythopoeitin
ESRD End stage renal disease
FAX Facsimile
FI Fiscal intermediary
FQHC Federally qualified healthcare center
FR Federal Register
GAF Geographic adjustment factor
GAO General Accounting Office
GPCI Geographic practice cost index
HCPAC Health Care Professional Advisory Committee
HCPCS Healthcare Common Procedure Coding System
HHA Home health agency
HHS (Department of) Health and Human Services
HOCM High Osmolar Contrast Media
HPSA Health professional shortage area
HRSA Health Resources Services Administration (HHS)
IDTFs Independent diagnostic testing facilities
IPF Inpatient psychiatric facility
IPPS Inpatient prospective payment system
IRF Inpatient rehabilitation facility
ISO Insurance Services Office
IVIG Intravenous immune globulin
JCAAI Joint Council of Allergy, Asthma, and Immunology
JUA Joint underwriting association
LCD Local coverage determination
LTCH Long-term care hospital
LOCM Low Osmolar Contrast Media
MA Medicare Advantage
MCAC Medicare Coverage Advisory Committee
MCG Medical College of Georgia
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
[[Page 45766]]
MMA Medicare Prescription Drug, Improvement, and Modernization Act
of 2003
MNT Medical nutrition therapy
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
NCD National coverage determination
NCQDIS National Coalition of Quality Diagnostic Imaging Services
NDC National drug code
NECMA New England County Metropolitan Area
NECTA New England City and Town Area
NP Nurse practitioner
NPP Nonphysician practitioners
OBRA Omnibus Budget Reconciliation Act
OIG Office of Inspector General
OMB Office of Management and Budget
OPPS Outpatient prospective payment system
PA Physician assistant
PC Professional component
PE Practice Expense
PEAC Practice Expense Advisory Committee
PERC Practice Expense Review Committee
PET Positron emission tomography
PFS Physician Fee Schedule
PLI Professional liability insurance
PPI Producer price index
PPO Preferred provider organization
PPS Prospective payment system
PRA Paperwork Reduction Act
PT Physical therapy
RFA Regulatory Flexibility Act
RIA Regulatory impact analysis
RN Registered nurse
RUC (AMA's Specialty Society) Relative (Value) Update Committee
RVU Relative value unit
SGR Sustainable growth rate
SMS (AMA's) Socioeconomic Monitoring System
SNF Skilled nursing facility
SNM Society for Nuclear Medicine
TA Technology assessment
TC Technical component
tPA Tissue-type plasminogen activator
UAF Update adjustment factor
WAC Wholesale acquisition cost
WAMP Widely available market price
I. Background
[If you choose to comment on issues in this section, please include the
caption ``BACKGROUND'' at the beginning of your comments.]
A. Introduction
Since January 1, 1992, Medicare has paid for physicians' services
under section 1848 of the Social Security Act (the Act), ``Payment for
Physicians' Services.'' The Act requires that payments under the
physician fee schedule (PFS) be based on national uniform relative
value units (RVUs) based on the resources used in furnishing a service.
Section 1848(c) of the Act requires that national RVUs be established
for physician work, practice expense (PE), and malpractice expense.
Prior to the establishment of the resource-based relative value system,
Medicare payment for physicians' services was based on reasonable
charges.
B. Development of the Relative Value System
1. Work RVUs
The concepts and methodology underlying the PFS were enacted as
part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Pub. L.
101-239, and OBRA 1990, (Pub. L. 101-508). The final rule, published
November 25, 1991 (56 FR 59502), set forth the fee schedule for payment
for physicians' services beginning January 1, 1992. Initially, only the
physician work RVUs were resource-based, and the PE and malpractice
RVUs were based on average allowable charges.
The physician work RVUs established for the implementation of the
fee schedule in January 1992 were developed with extensive input from
the physician community. A research team at the Harvard School of
Public Health developed the original physician work RVUs for most codes
in a cooperative agreement with the Department of Health and Human
Services. In constructing the code-specific vignettes for the original
physician work RVUs, Harvard worked with panels of experts, both inside
and outside the government and obtained input from numerous physician
specialty groups.
Section 1848(b)(2)(A) of the Act specifies that the RVUs for
radiology services are based on relative value scale we adopted under
section 1834(b)(1)(A) of the Act, (the American College of Radiology
(ACR) relative value scale), which we integrated into the overall PFS.
Section 1848(b)(2)(B) of the Act specifies that the RVUs for anesthesia
services are based on RVUs from a uniform relative value guide. We
established a separate conversion factor (CF) for anesthesia services,
and we continue to utilize time units as a factor in determining
payment for these services. As a result, there is a separate payment
methodology for anesthesia services.
We establish physician work RVUs for new and revised codes based on
recommendations received from the American Medical Association's (AMA)
Specialty Society Relative Value Update Committee (RUC).
2. Practice Expense Relative Value Units (PE RVUs)
Section 121 of the Social Security Act Amendments of 1994 (Pub. L.
103-432), enacted on October 31, 1994, amended section
1848(c)(2)(C)(ii) of the Act and required us to develop resource-based
PE RVUs for each physician's service beginning in 1998. We were to
consider general categories of expenses (such as office rent and wages
of personnel, but excluding malpractice expenses) comprising practice
expenses.
Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L.
105-33), amended section 1848(c)(2)(C)(ii) of the Act to delay
implementation of the resource-based PE RVU system until January 1,
1999. In addition, section 4505(b) of the BBA provided for a 4-year
transition period from charge-based PE RVUs to resource-based RVUs.
We established the resource-based PE RVUs for each physician's
service in a final rule, published November 2, 1998 (63 FR 58814),
effective for services furnished in 1999. Based on the requirement to
transition to a resource-based system for PE over a 4-year period,
resource-based PE RVUs did not become fully effective until 2002.
This resource-based system was based on two significant sources of
actual PE data: The Clinical Practice Expert Panel (CPEP) data and the
AMA's Socioeconomic Monitoring System (SMS) data. The CPEP data were
collected from panels of physicians, practice administrators, and
nonphysicians (for example, registered nurses) nominated by physician
specialty societies and other groups. The CPEP panels identified the
direct inputs required for each physician's service in both the office
setting and out-of-office setting. The AMA's SMS data provided
aggregate specialty-specific information on hours worked and practice
expenses.
Separate PE RVUs are established for procedures that can be
performed in both a nonfacility setting, such as a physician's office,
and a facility setting, such as a hospital outpatient department. The
difference between the facility and nonfacility RVUs reflects the fact
that a facility receives separate payment from Medicare for its costs
of providing the service, apart from payment under the PFS. The
nonfacility RVUs reflect all of the direct and indirect practice
expenses of providing a particular service.
Section 212 of the Balanced Budget Refinement Act of 1999 (BBRA)
(Pub. L. 106-113) directed the Secretary to establish a process under
which we accept and use, to the maximum extent practicable and
consistent with sound data practices, data collected or developed by
entities and organizations to supplement the data we normally collect
in determining the PE component. On May 3, 2000, we
[[Page 45767]]
published the interim final rule (65 FR 25664) that set forth the
criteria for the submission of these supplemental PE survey data. The
criteria were modified in response to comments received, and published
in the Federal Register (65 FR 65376) as part of a November 1, 2000
final rule. The PFS final rules published in 2001 and 2003,
respectively, (66 FR 55246 and 68 FR 63196) extended the period during
which we would accept these supplemental data.
3. Resource-Based Malpractice RVUs
Section 4505(f) of the BBA amended section 1848(c) of the Act to
require us to implement resource-based malpractice RVUs for services
furnished on or after 2000. The resource-based malpractice RVUs were
implemented in the PFS final rule published November 2, 1999 (64 FR
59380). The malpractice RVUs were based on malpractice insurance
premium data collected from commercial and physician-owned insurers
from all the States, the District of Columbia, and Puerto Rico.
4. Refinements to the RVUs
Section 1848(c)(2)(B)(i) of the Act requires that we review all
RVUs no less often than every five years. The first 5-year review of
the physician work RVUs went into effect in 1997, published on November
22, 1996 (61 FR 59489). The second 5-year review went into effect in
2002, published on November 1, 2001 (66 FR 55246). The next scheduled
5-year review is scheduled to go into effect in 2007.
In 1999, the AMA's RUC established the Practice Expense Advisory
Committee (PEAC) for the purpose of refining the direct PE inputs.
Through March of 2004, the PEAC provided recommendations to CMS for
over 7,600 codes (all but a few hundred of the codes currently listed
in the AMA's Current Procedural Terminology (CPT) codes).
In the November 15, 2004, PFS final rule (69 FR 66236), we
implemented the first 5-year review of the malpractice RVUs (69 FR
66263).
5. Adjustments to RVUs are Budget Neutral
Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments
in RVUs for a year may not cause total PFS payments to differ by more
than $20 million from what they would have been if the adjustments were
not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act,
if adjustments to RVUs cause expenditures to change by more than $20
million, we make adjustments to ensure that expenditures do not
increase or decrease by more than $20 million.
C. Components of the Fee Schedule Payment Amounts
To calculate the payment for every physician service, the
components of the fee schedule (physician work, PE, and malpractice
RVUs) are adjusted by a geographic practice cost index (GPCI). The
GPCIs reflect the relative costs of physician work, practice expenses,
and malpractice insurance in an area compared to the national average
costs for each component.
Payments are converted to dollar amounts through the application of
a CF, which is calculated by the Office of the Actuary and is updated
annually for inflation.
The general formula for calculating the Medicare fee schedule
amount for a given service and fee schedule area can be expressed as:
Payment = [(RVU work x GPCI work) + (RVU PE x GPCI PE) + (RVU
malpractice x GPCI malpractice)] x CF.
D. Most Recent Changes to the Fee Schedule
In the November 15, 2004 PFS final rule (69 FR 66236), we refined
the resource-based PE RVUs and made other changes to Medicare Part B
payment policy. These policy changes included--
Supplemental survey data for PE;
Updated GPCIs for physician work and PE;
Updated malpractice RVUs;
Revised requirements for supervision of therapy
assistants;
Revised payment rules for low osmolar contrast media;
Payment policies for physicians and practitioners managing
dialysis patients;
Clarification of care plan oversight CPO) requirements;
Requirements for supervision of diagnostic psychological
testing services;
Clarifications to the policies affecting therapy services
provided incident to a physician's service;
Requirements for assignment of Medicare claims;
Additions to the list of telehealth services;
Changes to payments for drug administration services; and
Several coding issues.
The November 15, 2004, final rule also addressed the following
provisions of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173):
Coverage of an initial preventive physical examination.
Coverage of cardiovascular screening blood tests.
Coverage of diabetes screening tests.
Incentive payment improvements for physicians in physician
shortage areas.
Changes to payment for covered outpatient drugs and
biologicals and drug administration services.
Changes to payment for renal dialysis services.
Coverage of routine costs associated with certain clinical
trials of category A devices as defined by the Food and Drug
Administration.
Coverage of hospice consultation service.
Indexing the Part B deductible to inflation.
Extension of coverage of intravenous immune globulin
(IVIG) for the treatment in the home of primary immune deficiency
diseases.
Revisions to reassignment provisions.
Payment for diagnostic mammograms.
Coverage of religious nonmedical health care institution
items and services to the beneficiary's home.
In addition, the November 15, 2004 PFS final rule finalized the
calendar year (CY) 2004 interim RVUs for new and revised codes in
effect during CY 2004 and issued interim RVUs for new and revised
procedure codes for CY 2005; updated the codes subject to the physician
self-referral prohibition; discussed payment for set-up of portable x-
ray equipment; discussed the third 5-year refinement of work RVUs; and
solicited comments on potentially misvalued work RVUs.
In accordance with section 1848(d)(1)(E) of the Act, we also
announced that the PFS update for CY 2005 would be 1.5 percent; the
initial estimate for the sustainable growth rate for CY 2005 is 4.3;
and the CF for CY 2005 is $37.8975.
II. Provisions of the Proposed Rule
This proposed rule would affect the regulations set forth at Part
405, Federal Health Insurance for the Aged and Disabled; Part 410,
Supplementary Medical Insurance (SMI) Benefits; Part 411, Exclusions
from Medicare and Limitations on Medicare Payment; Part 413, Principles
of Reasonable Cost Reimbursement, Payment for End-Stage Renal Disease
Services, Prospectively Determined Payment Rates for Skilled Nursing
Facilities; 414, Payment for Part B Medical and Other Health Services;
Part 426, Review of National Coverage Determinations and Local Coverage
Determinations.
[[Page 45768]]
A. Resource-Based Practice Expense (PE) RVUs
Based on section 1848(c)(1)(B) of the Act practice expenses are the
portion of the resources used in furnishing the service that reflects
the general categories of physician and practitioner expenses (such as
office rent and wages of personnel, but excluding malpractice
expenses).
Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-
432), enacted on October 31, 1994, required us to develop a methodology
for a resource-based system for determining PE RVUs for each
physician's service. Up until this point, physicians' practice expenses
were based on historical allowed charges. This legislation stated that
the revised PE methodology must consider the staff, equipment, and
supplies used in the provision of various medical and surgical services
in various settings beginning in 1998. The Secretary has interpreted
this to mean that Medicare payments for each service would be based on
the relative PE resources typically involved with performing the
service.
The initial implementation of resource-based PE RVUs was delayed
until January 1, 1999, by section 4505(a) of the BBA 1997. In addition,
section 4505(b) of the BBA 1997 required the new payment methodology be
phased-in over 4 years, effective for services furnished in CY 1999,
and fully effective in CY 2002. The first step toward implementation
called for by the statute was to adjust the PE values for certain
services for CY 1998. Section 4505(d) of BBA 1997 required that, in
developing the resource-based PE RVUs, the Secretary must:
Use, to the maximum extent possible, generally accepted
cost accounting principles that recognize all staff, equipment,
supplies, and expenses, not solely those that can be linked to specific
procedures.
Develop a refinement method to be used during the
transition.
Consider, in the course of notice and comment rulemaking,
impact projections that compare new proposed payment amounts to data on
actual physician PEs.
Beginning in CY 1999, Medicare began the four year transition to
resource-based PE RVUs. In CY 2002, the resource-based PE RVUs were
fully transitioned.
1. Current Methodology
The following sections discuss the current PE methodology.
a. Data Sources
There are two primary data sources used to calculate PEs. The
American Medical Association's (AMA) Socioeconomic Monitoring System
(SMS) survey data are used to develop the PEs per hour for each
specialty. The second source of data used to calculate PEs was
originally developed by the Clinical Practice Expert Panels (CPEP). The
CPEP data include the supplies, equipment and staff times specific to
each procedure.
The AMA developed the SMS survey in 1981 and discontinued it in
1999. Beginning in 2002, we incorporated the 1999 SMS survey data into
our calculation of the PE RVUs, using a 5-year average of SMS survey
data. (See Revisions to Payment Policies and Five-Year Review of and
Adjustments to the Relative Value Units Under the Physician Fee
Schedule for Calendar Year 2002 final rule, published November 1, 2001
(66 FR 55246).) The SMS PE survey data are adjusted to a common year,
1995. The SMS data provide the following six categories of PE costs:
Clinical payroll expenses, which are payroll expenses
(including fringe benefits) for nonphysician personnel.
Administrative payroll expenses, which are payroll
expenses (including fringe benefits) for nonphysician personnel
involved in administrative, secretarial or clerical activities.
Office expenses, which include expenses for rent, mortgage
interest, depreciation on medical buildings, utilities and telephones.
Medical material and supply expenses, which include
expenses for drugs, x-ray films, and disposable medical products.
Medical equipment expenses, which include expenses
depreciation, leases, and rent of medical equipment used in the
diagnosis or treatment of patients.
All other expenses, which include expenses for legal
services, accounting, office management, professional association
memberships, and any professional expenses not mentioned above.
In accordance with section 212 of the BBRA, we established a
process to supplement the SMS data for a specialty with data collected
by entities and organizations other than the AMA (that is, the
specialty itself). (See the Criteria for Submitting Supplemental
Practice Expense Survey Data interim final rule with comment period,
published on May 3, 2000 (65 FR 25664).) Originally, the deadline to
submit supplementary survey data was through August 1, 2001. This
deadline was extended in the November 1, 2001 final rule through August
1, 2003. (See the Revisions to Payment Policies and Five-Year Review of
and Adjustments to the Relative Value Units Under the Physician Fee
Schedule for Calendar Year 2002 final rule, published on November 1,
2001 (66 FR 55246).) Then, to ensure maximum opportunity for
specialties to submit supplementary survey data, we extended the
deadline to submit surveys until March 1, 2005. (See the Revisions to
Payment Policies Under the Physician Fee Schedule for Calendar Year
2002 final rule, published on November 7, 2003 (68 FR 63196).)
The CPEPs consisted of panels of physicians, practice
administrators, and nonphysicians (registered nurses (RNs), for
example) who were nominated by physician specialty societies and other
groups. There were 15 CPEPs consisting of 180 members from more than 61
specialties and subspecialties. Approximately 50 percent of the
panelists were physicians.
The CPEPs identified specific inputs involved in each physician
service provided in an office or facility setting. The inputs
identified were the quantity and type of nonphysician labor, medical
supplies, and medical equipment.
In 1999, the AMA's RUC established the Practice Expense Advisory
Committee (PEAC). Since 1999, and until March 2004, the PEAC, a multi-
specialty committee, reviewed the original CPEP inputs and provided us
with recommendations for refining these direct PE inputs for existing
CPT codes. Through its last meeting in March 2004, the PEAC provided
recommendations which we have reviewed and accepted for over 7,600
codes. As a result of this scrutiny, the current CPEP inputs differ
markedly from those originally recommended by the CPEPs. The PEAC has
now been replaced by the Practice Expense Review Committee (PERC),
which acts to assist the RUC in recommending PE inputs.
b. Allocation of Practice Expenses to Services
In order to establish PE RVUs for specific services, it is
necessary to establish the direct and indirect PE associated with each
service. Our current approach allocates aggregate specialty practice
costs to specific procedures and, thus, is often referred to as a
``top-down'' approach. The specialty PEs are derived from the AMA's SMS
survey and supplementary survey data. The PEs for a given specialty are
allocated to the services performed by that specialty on the basis
[[Page 45769]]
of the CPEP data and work RVUs assigned to each CPT code. The specific
process is detailed as follows:
Step 1--Calculation of the SMS Cost Pool for Each Specialty
The six SMS cost categories can be described as either direct or
indirect expenses. The three direct expense categories include clinical
labor, medical supplies and medical equipment. Indirect expenses
include administrative labor, office expense, and all other expenses.
We combine these indirect expenses into a single category. The SMS cost
pool for each specialty is calculated as follows:
The specialty PE per hour (PE/HR) for each of the three
direct and one indirect cost categories from the SMS is calculated by
dividing the aggregate PE per specialty by the specialty's total hours
spent in patient care activities (also determined by the SMS survey).
The PE/HR is divided by 60 seconds to obtain the PE per minute (PE/
MIN).
Each specialty's PE pools (for each of the three direct
and one indirect cost categories) are created by multiplying the PE/MIN
for the specialty by the total time the specialty spent treating
Medicare patients for all procedures (determined using Medicare
utilization data). Physician time on a procedure-specific level is
available through RUC surveys of new or revised codes and through
surveys conducted as part of the 5 year review process. For codes that
the RUC has not yet reviewed, the original data from the Harvard
resource-based RVU system survey is used. Physician time includes time
spent on the case prior to, during, and after the procedure. The
physician procedure time is multiplied by the frequency that each
procedure is performed on Medicare patients by the specialty.
The total specialty-specific SMS PE for each cost category
is the sum, for each direct and indirect cost category, of all of the
procedure-specific total PEs.
Table 1 illustrates an example of the calculation of the total SMS
cost pools for the three direct and one indirect cost categories
discussed in step 1. For this specialty, PE/HR for clinical payroll
expenses is $9.30 per hour. The hourly rate is divided by 60 minutes to
obtain the clinical payroll per minute for the specialty.
The total clinical payroll for providing hypothetical procedure
00001 for this specialty of $3,633,465 is the result of taking the
clinical payroll per minute of $0.16; multiplying this by the physician
time for procedure 00001 (56 minutes); and multiplying the result by
the number of times this procedure was provided to Medicare patients by
this specialty (418,602). The total amount spent on clinical payroll in
this specialty is $667,457,018. This amount is calculated by summing
the clinical payroll expenses of procedure 00001 and all of the other
services provided by this specialty.
TABLE 1.--Calculation of SMS Cost Pool
--------------------------------------------------------------------------------------------------------------------------------------------------------
Clinical Medical Medical Indirect
Standard methodology payroll (A) supplies (B) equipment (C) expenses (D) Total * (E)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(a) PE/HR.......................................................... $9.30 $4.80 $7.40 $46.50 $68.00
(b) PE/Minute...................................................... $0.16 $0.08 $0.12 $0.78 $1.13
(c) Physician Time--00001.......................................... 56 56 56 56 56
(d) Number of Services............................................. 418,602 418,602 418,602 418,602 418,602
(e) Subtotal....................................................... $3,633,465 $1,875,337 $2,891,144 $18,167,327 $26,567,274
(f) All Other Services............................................. $663,823,552 $342,618,608 $528,203,687 $3,319,117,762 $4,853,763,609
(g) Total--SMS Pool................................................ $667,457,018 $344,493,945 $531,094,831 $3,337,285,089 $4,880,330,883
--------------------------------------------------------------------------------------------------------------------------------------------------------
(b) = (a)/60
(e) = (b)*(c)*(d)
(g) = (e)+(f)
* Components may not add to totals due to rounding.
Step 2--Calculation of CPEP Cost Pool
CPEP data provide expenditure amounts for the direct expense
categories (clinical labor, supplies and equipment cost) at the
procedure level. Multiplying the CPEP procedure-level PEs for each of
these three categories by the number of times the specialty provided
the procedure, produces a total category cost, per procedure, for that
specialty. The sum of the total expenses from each procedure results in
the total CPEP category cost for the specialty.
For example, in Table 2, using CPEP data, the clinical labor cost
of procedure 00001 is $65.23. Under the methodology described above in
this step, this is multiplied by the number of services for the
specialty (418,602), to yield the total CPEP data clinical labor cost
of the procedure: $27,305,408. In this example, the clinical labor cost
for all other services performed by this specialty is $831,618,600.
Therefore, the entire clinical labor CPEP expense pool for the
specialty is $858,924,008. Step 2 is repeated to calculate the CPEP
supply and equipment costs.
TABLE 2.--Calculation of CPEP Cost Pool
----------------------------------------------------------------------------------------------------------------
Clinical labor
Standard methodology (A) Supplies (B) Equipment (C)
----------------------------------------------------------------------------------------------------------------
(a) CPT 00001................................................ $65.23 $52.49 $1,556.86
(b) Allowed Services......................................... 418,602 418,602 418,602
(c) Subtotal................................................. $27,305,408 $21,972,838 $651,704,875
(d) All Other Services....................................... $831,618,600 $389,921,779 $5,277,570,148
(e) Total CPEP Pool.......................................... $858,924,008 $411,894,617 $5,929,275,023
----------------------------------------------------------------------------------------------------------------
(c) = (a)*(b)
(e) = (c)+(d)
[[Page 45770]]
Step 3--Calculation and Application of Scaling Factors
This step ensures that the total of the CPEP costs across all
procedures performed by the specialty equates with the total direct
costs for the specialty as reflected by the SMS data. To accomplish
this, the CPEP data are scaled to SMS data by means of a scaling factor
so that the total CPEP costs for each specialty equals the total SMS
cost for the specialty. (The scaling factor is calculated by dividing
the specialty's SMS pool by the specialty's CPEP pool.)
The unscaled CPEP cost per procedure value, at the direct cost
level, is then multiplied by the respective specialty scalar to yield
the scaled CPEP procedure value. The sum of the scaled CPEP direct cost
pool expenditures equals the total scaled direct expense for the
specific procedure at the specialty level.
In the Step 3 example shown in Table 3, the SMS total clinical
labor costs for the specialty is $667,457,018. This amount divided by
the CPEP total clinical labor amount of $858,924,008 yields a scaling
factor of 0.78. The CPEP clinical labor cost for hypothetical procedure
00001 is $65.23. Multiplying the 0.78 scaling factor for clinical labor
costs by $65.23 yields the scaled clinical labor cost amount of $50.69.
Individual scaling factors must also be calculated for supply and
equipment expenses. The sum of the scaled direct cost values, $50.69,
$43.90 and $139.45, respectively, equals the total scaled direct
expense of $234.04.
[GRAPHIC] [TIFF OMITTED] TP08AU05.000
Step 4--Calculation of Indirect Expenses
Indirect PEs cannot be directly attributed to a specific service
because they are incurred by the practice as a whole. Indirect costs
include rent, utilities, office equipment and supplies, and accounting
and legal fees. There is not a single, universally accepted approach
for allocating indirect practice costs to individual procedure codes.
Rather allocation involves judgment in identifying the base or bases
that are the best measures of a practice's indirect costs.
To allocate the indirect PEs to a specific service, we use the
following methodology:
The scaled direct expenses and the converted work RVU (the
work RVU for the service is multiplied by $34.5030, the 1995 CF) are
added together, and then multiplied by the number of services provided
by the specialty to Medicare patients;
The total indirect PEs per specialty are calculated by
summing the indirect expenses for all other procedures provided by that
specialty.
In the Table 4, the physician work RVU for procedure 00001 is 2.36.
Multiplying the work RVU by the 1995 CF of $34.5030 equals $81.43. The
physician work value is added to the scaled total direct expense from
Step 3 ($234.04). The total of $314.47 is a proxy for the indirect PE
for the specialty attributed to this procedure. The total indirect
expenses are then multiplied by the number of services provided by the
specialty (418,602), to calculate total indirect expenses for this
procedure of $132,055,728. The process is repeated across all
procedures performed by the specialty, and the indirect expenses for
each service are summed to arrive at the total specialty indirect PE
pool of $6,745,545,434.
Table 4.--Calculation of Indirect Expense
----------------------------------------------------------------------------------------------------------------
Physician Total direct
Standard methodology work* expense Total
(A) (B) (C)
--------------------------------------------------------------
(a) CPT 00001................................................ $81.43 $234.04 $315.47
(b) Allowed Services......................................... .............. .............. 418,602
(c) Subtotal................................................. .............. .............. $132,055,728
(d) All Other Services....................................... .............. .............. $6,613,489,706
(e) Total Indirect Expense................................... .............. .............. $6,745,545,434
----------------------------------------------------------------------------------------------------------------
*Calculated by multiplying work RVU of 2.36 by 1995 conversion factor of $34.5030.
[[Page 45771]]
Step 5--Calculation and Application of Indirect Scaling Factors
Similar to the direct costs, the indirect costs are scaled to
ensure that the total across all procedures performed by the specialty
equates with the total indirect costs for the specialty as reflected by
the SMS data. To accomplish this, the indirect costs calculated in Step
4 (Table 4) are scaled to SMS data. The calculation of the indirect
scaling factors is as follows:
The specialty's total SMS indirect expense pool is divided
by the specialty's total indirect expense pool calculated in Step 4
(Table 4), to yield the indirect expense scaling factor.
The unscaled indirect expense amount, at the procedure
level, is multiplied by the specialty's scaling factor to calculate the
procedure's scaled indirect expenses.
The sum of the scaled indirect expense amount and the
procedure's direct expenses yields the total PEs for the specialty for
this procedure.
In table 5, to calculate the indirect scaling factor for
hypothetical procedure 00001, divide the total SMS indirect pool,
$3,337,285,089 (calculated in Step 1--Table 1), by the total indirect
expense for the specialty across all procedures of $6,745,545,434. This
results in a scaling factor of 0.49. Next, the unscaled indirect cost
of $315.47 is multiplied by the 0.49 scaling factor, resulting in
scaled indirect cost of $156.07. To calculate the total PEs for the
specialty for procedure 00001, the scaled direct and indirect expenses
are added, totaling $390.12.
[GRAPHIC] [TIFF OMITTED] TP08AU05.001
Step 6--Weighted Average of RVUs for Procedures Performed by More Than
One Specialty
For codes that are performed by more than one specialty, a weighted
average PE is calculated based on Medicare frequency data of all
specialties performing the procedure as shown in Table 6.
Table 6.--Weight Averaging for All Specialties
------------------------------------------------------------------------
Percent of
Standard Methodology Practice total allowed
expense value services
(A) (B)
-----------------------------------------
(a) Specialty Total Practice Expense.... $390.12 83
(b) Weighted Avg.--All Other Specialties $929.87 17
(c) Weighted Avg.--All Specialties...... $481.70 100
------------------------------------------------------------------------
Step 7--Budget Neutrality and Final RVU Calculation
The total scaled direct and indirect inputs are then adjusted by a
budget neutrality factor to calculate RVUs. Section
1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may
not cause total PFS payments to differ by more than $20 million from
what they would have been if the adjustments were not made. Budget
neutrality for the upcoming year is determined relative to the sum of
PE RVUs for the current year. Although the PE RVUs for any particular
code may vary from year-to-year, the sum of PE RVUs across all codes is
set equal to the current year. The budget neutrality factor (BNF) is
equal to the sum of the current year's PE RVUs, divided by the sum of
the direct and indirect inputs across all codes for the upcoming year.
The BNF is applied to (multiplied by) the scaled direct and indirect
expenses for each code to set the PE RVU for the upcoming year.
In Table 7, the sum of the scaled direct and indirect expenses for
hypothetical code 00001 ($481.70) is multiplied by the BNF (0.02 in
this example) to yield a PE RVU of 10.60.
[[Page 45772]]
Table 7.--Calculate PE RVU
----------------------------------------------------------------------------------------------------------------
Total scaled
direct and Budget
indirect neutrality Final PE RVU
inputs factor
(A) (B) (C)
-----------------------------------------------------------------
(a) Code 00001.................................................. $481.70 0.02 10.60
----------------------------------------------------------------------------------------------------------------
c. Other Methodological Issues: Nonphysician Work Pool (NPWP)
As an interim measure, until we could further analyze the effect of
the top-down methodology on the Medicare payment for services with no
physician work (including the technical components (TCs) of radiation
oncology, radiology and other diagnostic tests), we created a separate
PE pool for these services. However, any specialty society could
request that its services be removed from the nonphysician work pool.
We have removed some services from the nonphysician work pool if we
find that the requesting specialty provides the service the majority of
the time.
NPWP Step 1--Calculation of the SMS Cost Pool for Each Specialty
This step parallels the calculations described above for the
standard ``top-down'' PE allocation methodology. For codes in the
nonphysician work pool, the direct and indirect SMS costs are set equal
to the weighted average of the PE/HR for the specialties that provide
the services in the pool. Clinical staff time is substituted for
physician time in the calculation. The clinical staff time for the code
is from CPEP data. Otherwise, the calculation is similar to the method
described previously for codes with physician time.
The following example in Table 8 illustrates this calculation for
hypothetical code 00002. In this example, the average clinical payroll
PE/HR for all specialties in the nonphysician work pool is $12.30 and
the clinical staff time for code 00002 is 116 minutes.
Table 8.--Calculate SMS Cost Pools for Nonphysician Work Pool
----------------------------------------------------------------------------------------------------------------
Non-Physician work pool Clinical Medical Medical Indirect
methodology (NPWP) payroll supplies equipment expenses Total*
(A) (B) (C) (D) (E)
---------------------------------
(a) NPWP--PE/HR................. $12.30 $7.40 $3.20 $46.30 $69.00
(b) NPWP--PE/Minute............. 0.21 0.12 0.05 0.77 1.15
(c) Clinical Staff Time--00002.. 116 116 116 116 116
(d) Number of Services.......... 105,095 105,095 105,095 105,095 105,095
(e) Total--NPWP ``SMS'' Pool.... $2,499,159 $1,503,559 $650,188 $9,407,404 $14,019,673
----------------------------------------------------------------------------------------------------------------
(b) = (a)/60
(e) = (b)*(c)*(d)
* Components may not add to totals due to rounding.
NPWP Step 2--Calculation of Charge-based PE RVU Cost Pool
The nonphysician work pool calculation uses the 1998 (charge-based)
PE RVU value for the code, multiplied by the 1995 CF (25.74 x $34.503 =
$888.11). The percentage of clinical labor, supplies and equipment are
the percentage that each PE category represents for all physicians
relative to the total PE for all physicians (calculated from the SMS
data) as shown in Table 9.
Table 9.--Calculate Charge-Based Cost Pools for Nonphysician Work Pool
----------------------------------------------------------------------------------------------------------------
NPWP methodology Clinical Supplies Equipment
(A) (B) (C)
-----------------------------------------------------------------
(a) CPT 00002--Charge Based Value............................... $888.11 $888.11 $888.11
(b) Percent Clinical, Supplies, Equipment....................... 0.18 0.11 0.05
(c) CPT 00002................................................... 158.08 95.03 41.74
(d) Number of--NPWP............................................. 105,095 105,095 105,095
(e) Total NPWP ``CPEP'' Pool.................................... $16,613,742 $4,386,775 $9,986,912
----------------------------------------------------------------------------------------------------------------
(c) = (a)*(b)
(e) = (c)*(d)
NPWP Step 3--Calculation and Application of Scaling Factors
After the total cost pools for each specialty and code performed by
the specialty are calculated, the steps to ensure the total costs for
all of the procedures performed by a specialty do not exceed the total
costs for the specialty (scaling) are the same as those described
previously for codes with physician work.
In Table 10 below, the SMS total clinical labor costs is
$2,499,159. This amount divided by the charge-based total clinical
labor amount of $16,613,742 yields a scaling factor of 0.15. The
charge-based clinical labor cost for hypothetical procedure 00002 is
$158.08 (from step 2--Table 2). Multiplying the 0.15 scaling factor for
clinical labor costs by $158.08 yields the
[[Page 45773]]
scaled clinical labor cost amount of $23.78. Individual scaling factors
must be calculated for both supply and equipment expenses. The sum of
the scaled direct cost values, $23.78, $32.57 and $2.72, respectively,
equals the total scaled direct expense of $59.07.
[GRAPHIC] [TIFF OMITTED] TP08AU05.002
NPWP Step 4--Calculation of Indirect Expenses
Because codes in the nonphysician work pool do not have work RVUs,
indirect expenses are set equal to direct expenses (for codes with
physician work, indirect expenses equal the sum of the scaled direct
expenses and the converted work RVU). This amount is then multiplied by
the number of times the procedure is performed.
In Table 11, the scaled total direct expense from Step 3 (Table 3)
($408.79) is also the proxy for the total indirect expense attributed
to the procedure. The total indirect expense is multiplied by the
number of services (105,095), to calculate total indirect cost for this
procedure of $6,207,961.
Table 11.--Calculation of Indirect Expenses
----------------------------------------------------------------------------------------------------------------
Physician Total direct
NPWP methodology work* expense Total
(A) (B) (C)
-----------------------------------------------------------------
(a) CPT 00002................................................... $ $59.07 $59.07
(b) Allowed Services--NPWP...................................... .............. .............. 105,095
(c) Total NPWP Indirect Expense................................. .............. .............. $6,207,961
----------------------------------------------------------------------------------------------------------------
NPWP Step 5--Calculation and Application of Indirect Scaling Factors
Similar to the direct costs, the indirect costs are scaled to
ensure that the total of the charge-based PE RVU costs across all
procedures equates with the total indirect costs as reflected by the
SMS data for the NPWP. To accomplish this, the charge-based data are
scaled to SMS data so the total charge-based costs equal the total SMS
costs.
In Table 12, to calculate the indirect scaling factor for
hypothetical procedure 00002, divide the total SMS indirect expense,
$9,407,404 (from Step 1--Table 1), by the total charge-based indirect
expense of $6,207,961. This results in a scaling factor of 1.51. Next,
the unscaled indirect charge-based cost for procedure 00002 of $59.07
(from step 4--Table 4) is multiplied by the 1.51 scaling factor,
resulting in scaled indirect costs for this procedure of $89.19.
[[Page 45774]]
[GRAPHIC] [TIFF OMITTED] TP08AU05.092
NPWP Step 6--Budget Neutrality and Final RVU Calculation
Similar to the calculation for codes with physician work, the BNF
is applied to (multiplied by) the scaled direct and indirect expenses
for each code to set the PE RVU for the upcoming year.
In Table 13, the sum of the scaled direct and indirect expenses for
hypothetical code 00002 ($148.26) is multiplied by the BNF (0.022 in
this example) to yield a PE RVU of 3.26.
Table 13.--Budget Neutrality and Final RVU Calculation
------------------------------------------------------------------------
Total
scaled
direct Budget Final PE
and neutrality RVU
indirect factor
inputs
------------------------------------------------------------------------
Code 00002............................ $148.26 0.022 3.26
------------------------------------------------------------------------
d. Facility/Non-facility Costs
Procedures that can be performed in a physician's office as well as
in a hospital have two PE RVUs; facility and non-facility. The non-
facility setting includes physicians' offices, patients' homes,
freestanding imaging centers, and independent pathology labs. Facility
settings include hospitals, ambulatory surgery centers, and skilled
nursing facilities (SNFs). The methodology for calculating the PE RVU
is the same for both facility and non-facility RVUs, but is calculated
independently to yield two separate PE RVUs. Because the PEs for
services provided in a facility setting are generally included in the
payment to the facility (rather than the payment to the physician under
the fee schedule), the PE RVUs are generally lower for services
provided in the facility setting.
2. PE Proposals for CY 2006
The following discussions outline the specific PE related proposals
for CY 2006.
a. Supplemental PE Surveys
The following discussions outline the criteria for supplemental
survey submission as well as information we have received for approval.
(1) Survey Criteria and Submission Dates
In accordance with section 212 of the BBRA, we established criteria
to evaluate survey data collected by organizations to supplement the
SMS survey data normally used in the calculation of the PE component of
the PFS. In the Payment Policies Under the Physician Fee Schedule for
Calendar Year 2002 final rule, published November 7, 2003 (68 FR
63196), we provided that, beginning in 2004, supplemental survey data
had to be submitted by March 1 to be considered for use in computing PE
RVUs for the following year. This allows us to publish our decisions
regarding survey data in the proposed rule and provides the opportunity
for public comment on these results before implementation.
To continue to ensure the maximum opportunity for specialties to
submit supplemental PE data, we extended until 2005 the period that we
would accept survey data that meet the criteria set forth in the
November 2000 PFS final rule. The deadline for submission of
supplemental data to be considered in CY 2006 was March 1, 2005.
(2) Submission of Supplemental Survey Data
The following discussion outlines the survey data submitted for CY
2004 and CY 2005.
Surveys Submitted in 2004
As explained in the November 15, 2004 Physician Fee Schedule final
rule (69 FR 66242), we received surveys by March 1, 2004 from the
American College of Cardiology (ACC), the American College of Radiology
(ACR), and the American Society for Therapeutic Radiation Oncology
(ASTRO). The data submitted by the ACC and the ACR met our criteria.
However, as requested by the ACC and the ACR, we deferred using their
data until issues related to the nonphysician work pool could be
addressed. We are proposing to use the ACC and ACR survey data in the
calculation of PE RVUs for 2006, but only as specified in the proposals
relating to a revised methodology for establishing direct PE RVUs, and
a transition period for the revised methodology, as described below.
The survey data from ASTRO did not meet the precision criteria
established for supplemental surveys, therefore, we did not use it in
the calculation of PE RVUs for 2005.
Surveys Submitted in 2005
This year we received s
