Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction, 50680-50886 [05-16699]

Download as PDF 50680 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 419 and 485 [CMS–1501–CN] RIN 0938–AN46 Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule; correction. AGENCY: This document corrects technical errors that appeared in the proposed rule published in the Federal Register on July 25, 2005 entitled ‘‘Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Proposed Rule.’’ FOR FURTHER INFORMATION CONTACT: Rebecca Kane, (410) 786–0378. SUPPLEMENTARY INFORMATION: SUMMARY: I. Background FR Doc. 05–14448 contains our proposed rule to update the Medicare Outpatient Prospective Payment System for calendar year (CY) 2006. We have identified a number of technical errors in the ‘‘Summary of Errors’’ section and are correcting them in the ‘‘Correction of Errors’’ section below. II. Summary of Errors A. Corrections Related to the Rural Adjustment Calculation The calendar year (CY) 2006 Outpatient Prospective Payment System (OPPS) proposed rule that we published in the Federal Register on July 25, 2005 included a proposed 6.6 percent adjustment for rural sole community hospitals. The calculations used to develop the conversion factor and budget neutrality scalar inadvertently incorporated this adjustment as 6.4 percent. The rural adjustment is used in calculations that determine the scalar and conversion factor, and therefore affects the payment rates and copayment amounts published in the proposed rule. The corrected scalar is 1.003753831, and the corrected conversion factor is $59.343. The various changes to the preamble are specified under section III. of this correction notice. In addition to preamble text changes, we are correcting specific tables and addenda which also reflected the inadvertent use of a 6.4 VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 percent rural adjustment factor, which we have described below. On page 42709, we published Table 11. We are correcting the last column of this table to present the corrected proposed CY 2006 payment amounts. In section III. of this notice, we republish Table 11 as corrected. On pages 42761–42762, we published Table 33. In section III. of this notice, we republish Table 33 as corrected. On pages 42764–42775, we published Addendum A, which provides the payment rates and copayment amounts for Ambulatory Payment Classification (APC) groups used for payment purposes under the OPPS. A corrected Addendum A is posted on the OPPS Web site at https://www.cms.hhs.gov/ providers/hopps/2006p/1501p.asp. On pages 42776–42965, we published Addendum B, which provides the payment rates and copayment amounts for services payable under OPPS. A corrected Addendum B, including additional technical errors affecting HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS Web site at https://www.cms.hhs.gov/ providers/hopps/2006p/1501p.asp. We are posting the corrected Addendum A and Addendum B on our Web site rather than publishing them in this notice because of the large volume of data included in these addenda. Hard copies of these tables are available by contacting the CMS staff member identified above. We note that as soon as we discovered these inadvertent errors that affected the payment rates noted in the proposed rule, we posted the corrections on the CMS Web site at: https:// www.cms.hhs.gov/providers/hopps/ 2006p/1501p.asp. B. Other Corrections We also noted other typographical, formatting, and other technical errors in the proposed rule. On page 42714, we published Table 15. The proposed ‘‘unadjusted’’ and ‘‘adjusted’’ CY 2006 APC median cost for APC 0085 Level II Electrophysiologic Evaluation contained a typographical error and should read $2,123.38. We are correcting this under section III. of this notice. On page 42761, column 2 includes a comparison that discusses the differences in copayments from CY 2005 to CY 2006. While the analysis of this example is correct, the example incorrectly identifies the comparison as being the ‘‘minimum unadjusted copayment’’ rather than the ‘‘national unadjusted copayment’’. We are making this correction under section III. of this PO 00000 Frm 00002 Fmt 4701 Sfmt 4702 notice to refer to the ‘‘national unadjusted copayment’’. On page 42737, we published Table 26, which inadvertently excluded C2636 (Brachytherapy linear source, Palladium –103, per 1 mm) which was accurately described in the text of page 42736 as a proposed separately payable brachytherapy source. In section III. of the notice we append the excluded row to correct table 26 as published. The other technical, typographical, formatting, and other errors that appeared on various other pages of the Federal Register are corrected as noted in section III. of this notice. III. Correction of Errors In FR Doc. 05–14448 of July 25, 2005 (70 FR 42674), make the following corrections: 1. On page 42690, in column 3, in the last paragraph, in line 20, the figure ‘‘0.999207669’’ is corrected to read ‘‘1.003753831’’. 2. On page 42691, in column 1, in the second full paragraph, line 8, the year ‘‘2006’’ is corrected to read ‘‘2007’’. 3. On page 42694, a. In column 1, in the second full paragraph, in line 8, the figure ‘‘$240.51’’ is corrected to read ‘‘$241.57’’. b. In column 1, in the second full paragraph, in line 8, the figure ‘‘$48.10’’ is corrected to read ‘‘$48.31’’. c. In column 3, in the third full paragraph, in line 8, the figure ‘‘1.002015212’’ is corrected to read ‘‘1.002023412’’. d. In column 3, in the third full paragraph, in line 18, the figure ‘‘0.99652023’’ is corrected to read ‘‘0.99639633’’. e. In column 3, in the last partial paragraph, in line 5, the figure ‘‘1.002015212’’ is corrected to read ‘‘1.002023412’’. 4. On page 42695, a. In column 1, in the first partial paragraph, in line 5, the figure ‘‘0.99652023’’ is corrected to read ‘‘0.99639633’’. b. In column 1, in the first partial paragraph, in line 7, the figure ‘‘$59.350’’ is corrected to read ‘‘$59.343’’. 5. On page 42703, a. In column 1, in the second full paragraph, in line 5, the figure ‘‘$9.95’’ is corrected to read ‘‘$7.00’’. b. In column 1, in the second full paragraph, in line 5, the figure ‘‘40’’ is corrected to read ‘‘28’’. c. In column 1, in the second full paragraph, in line 6, the figure ‘‘$24.89’’ is corrected to read ‘‘$25.00’’. 6. On page 42709, E:\FR\FM\26AUP3.SGM 26AUP3 50681 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules a. In column 1, in the first full paragraph, in line 22, the figure ‘‘$1,297’’ is corrected to read ‘‘$1,274’’. b. In column 1, in the first full paragraph, in line 23, the figure ‘‘$1,366’’ is corrected to read ‘‘$1,244’’. c. In column 1, in the first full paragraph, in line 25, the figure ‘‘$1,100’’ is corrected to read ‘‘$1,025’’. d. Table 11 is corrected to read as follows: TABLE 11.—PROPOSED APC REASSIGNMENT OF NEW TECHNOLOGY PROCEDURES INTO CLINICAL APCS FOR CY 2006 HCPCS 0027T 33225 61623 92974 93580 93581 95965 95966 95967 C9713 .... .... .... .... .... .... .... .... .... .... CY 2005 APC Descriptor Endoscopic epidural lysis ....................................................... L ventric pacing lead add-on ................................................. Endovasc tempory vessel occl .............................................. Cath place, cardio brachytx ................................................... Transcath closure of asd ....................................................... Transcath closure of vsd ........................................................ Meg, spontaneous .................................................................. Meg, evoked, single ............................................................... Meg, evoked, each add’l ........................................................ Non-contact laser vap prosta ................................................. 7. On page 42710, in column 2, in the first full paragraph, in line 19, the figure ‘‘$93.71’’ is corrected to read ‘‘$93.37’’. CY 2005 status indicator 1547 1525 1555 1559 1559 1559 1528 1516 1511 1525 T S T T T T S S S S Proposed CY 2006 APC 0220 0418 0081 0103 0434 0434 0430 0430 0430 0429 8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7, both occurrences of the figure ‘‘$2,123.46’’ are corrected to read ‘‘$2,123.38’’. Proposed CY 2006 status indicator T T T T T T T T T T CY 2005 payment amount $850 3,750 1,650 2,250 2,250 2,250 5,250 1,450 950 3,750 Long descriptor APC APC title C2636 .... Brachytherapy linear source, Palladium–103, per 1mm .................. 2636 Brachytx linear source, P–103 ................. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 i. In column 2, in the first partial paragraph, in line 2, the figure ‘‘1.8’’ is corrected to read ‘‘1.6’’. j. In column 2, in the first full paragraph, in line 4, the figure ‘‘0.4’’ is corrected to read ‘‘0.3’’. k. In column 2, in the first full paragraph, in line 5, the figure ‘‘0.5’’ is corrected to read ‘‘0.3’’. l. In column 2, in the first full paragraph, in line 9, the figure ‘‘0.9’’ is corrected to read ‘‘1.6’’. m. In column 2, in the first full paragraph, in line 10, the figure ‘‘1.4’’ is corrected to read ‘‘2.2’’. n. In column 2, in the first full paragraph, in line 21, the sentence portion ‘‘1.3 percent and voluntary and government hospitals will gain at least 0.1 percent.’’ is corrected to read ‘‘1.1 percent, voluntary hospitals would gain 0.2 percent, and government hospitals will see no changes as a result of changes to APC structure.’’ o. In column 3, in the second full paragraph, in line 7, the figure ‘‘0.997’’ is corrected to read ‘‘0.996’’. p. In column 3, in the second full paragraph, in line 10, the figure ‘‘0.3’’ is corrected to read ‘‘0.4’’. q. In column 3, in the second full paragraph, in line 13, the figure ‘‘5.2’’ is corrected to read ‘‘5.4’’. 13. On page 42760, PO 00000 Frm 00003 Fmt 4701 Sfmt 4702 $1,030.11 6,486.45 2,044.21 873.18 5,387.61 5,387.61 676.75 676.75 676.75 2,511.08 9. On page 42737, Table 26, ‘‘Proposed Separately payable Brachytherapy Sources for CY 2006’’ is appended with the following row: HCPCS 10. On page 42756, in column 1, in the first partial paragraph, in line 5, the figure ‘‘1.8’’ is corrected to read ‘‘1.7’’. 11. On page 42758, in column 2, in the third full paragraph, in line 13, the figure ‘‘$59.35’’ is corrected to read ‘‘$59.34’’. 12. On page 42759, a. In column 1, in the first partial paragraph, in line 21, the figure ‘‘5.8’’ is corrected to read ‘‘5.6’’. b. In column 1, in the first partial paragraph, in line 31, the figure ‘‘1.2’’ is corrected to read ‘‘1.3’’. c. In column 1, in the first partial paragraph, in line 31, the figure ‘‘1.8’’ is corrected to read ‘‘1.7’’. d. In column 1, in the first partial paragraph, in line 36, the figure ‘‘2.6’’ is corrected to read ‘‘2.5’’. e. In column 1, in the second partial paragraph, in line 22, the figure ‘‘2.9’’ is corrected to read ‘‘2.7’’. f. In column 1, in the second partial paragraph, in line 25, the figure ‘‘0.7’’ is corrected to read ‘‘0.6’’. g. In column 1, in the second partial paragraph, in line 30, the text ‘‘West South Central’’ is corrected to read ‘‘New England’’. h. In column 2, in the first partial paragraph, in line 2, the figure ‘‘1.9’’ is corrected to read ‘‘1.7’’. Proposed CY 2006 payment amount New status indicator H a. In column 1, in the first partial paragraph, in line 6, the figure ‘‘0.3’’ is corrected to read ‘‘0.4’’. b. In column 1, in the first full paragraph, in line 19, the figure ‘‘5.8’’ is corrected to read ‘‘5.6’’. c. In column 1, in the first full paragraph, in line 24, the figure ‘‘–2.8’’ is corrected to read ‘‘–2.4’’. d. In column 1, in the first full paragraph, in line 32, the figure ‘‘1.2’’ is corrected to read ‘‘1.3’’. e. In column 1, in the first full paragraph, in line 35, the figure ‘‘0.3’’ is corrected to read ‘‘0.4’’. f. In column 1, in the first full paragraph, in line 37, the figure ‘‘1.5’’ is corrected to read ‘‘1.4’’. g. In column 1, in the last paragraph, in line 7, the figure ‘‘8.6’’ is corrected to read ‘‘8.7’’. h. In column 1, in the third partial paragraph, in line 12, the figure ‘‘5.0’’ is corrected to read ‘‘4.7’’. i. In column 3, in the first partial paragraph, in line 6, the figure ‘‘2.6’’ is corrected to read ‘‘2.5’’. j. In column 3, in the first partial paragraph, in line 12, the figure ‘‘2.1’’ is corrected to read ‘‘1.8’’. k. In column 3, in the first partial paragraph, in line 32, the figure ‘‘3.7’’ is corrected to read ‘‘3.6’’. E:\FR\FM\26AUP3.SGM 26AUP3 50682 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules l. In column 3, in the first full paragraph, in line 11, the figure ‘‘3.4’’ is corrected to read ‘‘3.5’’. m. In column 3, in the first full paragraph, in line 13, the figure ‘‘6.4’’ is corrected to read ‘‘6.5’’. n. In column 3, in the first full paragraph, in line 30, the text ‘‘greater than’’ is corrected to read ‘‘of at least’’. o. In column 3, in the first full paragraph, in lines 33 and 34, the figure ‘‘only 1.0’’ is corrected to read ‘‘1.4’’ and the text ‘‘and 0.8 percent, respectively.’’ is appended to the end of the sentence. 14. On page 42761 a. In column 1, in the first partial paragraph, in line 3, the figure ‘‘1.9’’ is corrected to read ‘‘2.6’’. b. In column 1, in the first partial paragraph, in line 6, the figure ‘‘2.6’’ is corrected to read ‘‘3.4’’. c. In column 1, in the first partial paragraph, in line 11, the figure ‘‘0.8’’ is corrected to read ‘‘0.6’’. d. In column 1, in line 12, the designation for the heading ‘‘Estimated Impacts of This Proposed Rule on Beneficiaries’’ is corrected from ‘‘G’’ to read ‘‘F’’. e. In column 1, in the second partial paragraph, in line 12, the figure ‘‘$11.86’’ is corrected to read ‘‘$11.91’’. f. In column 2, in the first partial paragraph, in lines 4 and 6, the term ‘‘minimum’’ is corrected to read ‘‘national’’. g. In column 2, in the first partial paragraph, in line 8, the figure ‘‘$223.91’’ is corrected to read ‘‘$224.91’’. h. Table 33 is corrected to read as follows: TABLE 33.—IMPACT OF PROPOSED CHANGES FOR CY 2006 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (1) Hospital category ALL HOSPITALS ............................................................................................ URBAN HOSPITALS ...................................................................................... LARGE URBAN ....................................................................................... OTHER URBAN ...................................................................................... RURAL HOSPITALS ...................................................................................... SOLE COMMUNITY ................................................................................ OTHER RURAL ....................................................................................... BEDS (URBAN): 0–99 BEDS .............................................................................................. 100–199 BEDS ........................................................................................ 200–299 BEDS ........................................................................................ 300–499 BEDS ........................................................................................ 500 + BEDS ............................................................................................ BEDS (RURAL): 0–49 BEDS .............................................................................................. 50–100 BEDS .......................................................................................... 101–149 BEDS ........................................................................................ 150–199 BEDS ........................................................................................ 200 + BEDS ............................................................................................ VOLUME (URBAN): LT 5,000 claim lines ................................................................................ 5,000–10,999 ........................................................................................... 11,000–20,999 ......................................................................................... 21,000–42,999 ......................................................................................... GT 42,999 ................................................................................................ VOLUME (RURAL): LT 5,000 claim lines ................................................................................ 5,000–10,999 ........................................................................................... 11,000–20,999 ......................................................................................... 21,000–42,999 ......................................................................................... GT 42,999 ................................................................................................ REGION (URBAN): NEW ENGLAND ...................................................................................... MIDDLE ATLANTIC ................................................................................. SOUTH ATLANTIC .................................................................................. EAST NORTH CENT .............................................................................. EAST SOUTH CENT ............................................................................... WEST NORTH CENT ............................................................................. WEST SOUTH CENT .............................................................................. MOUNTAIN .............................................................................................. PACIFIC ................................................................................................... PUERTO RICO ........................................................................................ REGION (RURAL): NEW ENGLAND ...................................................................................... MIDDLE ATLANTIC ................................................................................. SOUTH ATLANTIC .................................................................................. EAST NORTH CENT .............................................................................. EAST SOUTH CENT ............................................................................... WEST NORTH CENT ............................................................................. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00004 Fmt 4701 Sfmt 4702 APC changes New wage index New adj for rural sole community hospitals Cumulative (Cols 2,3,4) with market basket update All changes (2) Number of hospitals (3) (4) (5) (6) 4212 2949 1624 1325 1263 478 785 0.0 0.0 ¥0.8 1.0 ¥0.1 ¥0.1 ¥0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 ¥0.4 ¥0.4 ¥0.4 1.8 5.4 ¥0.4 3.2 2.8 2.0 3.8 5.0 8.7 2.8 1.9 1.6 0.8 2.5 3.5 6.5 1.6 917 964 503 402 163 0.0 ¥0.4 0.2 ¥0.1 0.3 0.2 0.0 0.1 ¥0.1 0.0 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 3.0 2.5 3.2 2.6 3.1 2.1 1.5 2.4 1.5 1.0 551 419 180 62 51 ¥0.9 ¥0.8 1.4 ¥0.2 0.1 0.2 0.2 0.0 ¥0.2 0.0 2.1 2.3 1.1 1.8 1.7 4.6 4.8 5.8 4.7 5.1 3.1 3.0 4.7 3.7 3.1 600 180 299 575 1295 ¥5.6 ¥2.4 ¥0.6 ¥0.6 0.2 0.5 0.2 0.2 0.1 0.0 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥2.4 0.5 2.4 2.3 3.0 ¥1.8 0.6 2.5 1.9 1.6 119 195 325 364 260 ¥2.7 ¥1.9 ¥0.9 ¥0.9 0.6 0.0 0.0 ¥0.1 0.2 0.0 1.4 2.1 2.0 1.9 1.7 1.7 3.4 4.3 4.5 5.7 1.4 2.4 3.4 3.0 3.8 166 393 453 466 197 184 445 163 431 51 ¥1.3 0.6 ¥0.4 0.4 1.5 2.5 ¥0.3 ¥0.1 ¥1.7 0.4 ¥0.1 ¥0.1 ¥0.4 ¥0.1 0.0 ¥0.3 ¥0.1 ¥0.2 1.1 ¥0.3 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 ¥0.4 1.4 3.4 2.0 3.2 4.4 5.1 2.5 2.5 2.2 2.9 ¥0.2 2.1 1.0 1.7 3.4 3.6 1.3 1.3 1.4 2.2 37 78 189 171 202 188 ¥1.1 1.7 ¥0.4 ¥0.6 ¥0.7 1.6 0.9 ¥0.4 ¥0.2 0.1 0.5 ¥0.3 1.2 1.4 1.7 1.4 0.5 2.6 4.2 6.0 4.4 4.1 3.5 7.2 0.8 4.1 3.3 2.2 3.0 4.7 E:\FR\FM\26AUP3.SGM 26AUP3 50683 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules TABLE 33.—IMPACT OF PROPOSED CHANGES FOR CY 2006 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM— Continued APC changes New wage index New adj for rural sole community hospitals Cumulative (Cols 2,3,4) with market basket update All changes (2) (3) (4) (5) (6) 242 95 61 ¥0.9 ¥1.0 ¥0.7 ¥0.2 0.1 1.8 2.2 4.6 2.7 4.4 7.0 7.2 3.7 5.2 5.3 3115 769 328 ¥0.3 0.3 0.3 0.1 0.0 ¥0.2 0.3 ¥0.2 ¥0.3 3.2 3.3 3.0 2.3 2.3 0.6 16 386 555 802 977 792 684 0.3 0.1 0.0 0.1 0.1 ¥0.3 ¥1.6 0.0 ¥0.2 0.1 0.0 ¥0.1 0.1 0.0 ¥0.4 ¥0.3 0.2 0.1 0.0 ¥0.1 ¥0.4 3.1 2.8 3.5 3.5 3.2 3.0 1.2 3.1 1.7 2.4 2.3 1.9 1.8 ¥2.6 944 1401 16 588 0.4 ¥0.3 0.3 ¥2.2 ¥0.1 0.1 0.0 0.1 ¥0.4 ¥0.4 ¥0.4 ¥0.4 3.1 2.5 3.1 0.7 1.7 1.8 3.1 ¥3.4 2397 1091 724 0.2 ¥1.1 0.0 0.0 0.0 0.1 0.0 0.0 0.2 3.3 2.1 3.6 2.0 1.6 1.7 Number of hospitals (1) Hospital category WEST SOUTH CENT .............................................................................. MOUNTAIN .............................................................................................. PACIFIC ................................................................................................... TEACHING STATUS: NON-TEACHING ..................................................................................... MINOR ..................................................................................................... MAJOR .................................................................................................... DSH PATIENT PERCENT: 0 ............................................................................................................... GT 0–0.10 ................................................................................................ 0.10–0.16 ................................................................................................. 0.16–0.23 ................................................................................................. 0.23–0.35 ................................................................................................. GE 0.35 ................................................................................................... TEFRA: DSH NOT AVAIL 1 ..................................................................... URBAN TEACHING/DSH: TEACHING & DSH .................................................................................. NO TEACHING/DSH ............................................................................... NO TEACHING/NO DSH ........................................................................ TEFRA: DSH NOT AVAIL 1 ..................................................................... TYPE OF OWNERSHIP: VOLUNTARY ........................................................................................... PROPRIETARY ....................................................................................... GOVERNMENT ....................................................................................... Col (1) Total Hospitals in 2006. Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral overall). Col (3) This column shows the adjustment for updating the wage index (budget neutral overall). Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall). Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update. Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes. 1 Complete DSH numbers are not available for hospitals that are not paid under IPPS. 15. On pages 42764–42775, Addendum A is corrected to read as follows: VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00005 Fmt 4701 Sfmt 4702 E:\FR\FM\26AUP3.SGM 26AUP3 50684 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006 APC 0001 0002 0003 0004 0005 0006 0007 0008 0009 0010 0011 0012 0013 0015 0016 0017 0018 0019 0020 0021 0022 0023 0024 0025 0027 0028 0029 0030 0033 0035 0036 0037 0039 0040 0041 0042 0043 0045 0046 0047 0048 0049 0050 0051 0052 0053 0054 0055 0056 0057 0058 0060 0068 0069 0070 0071 0072 0074 0075 0076 0077 0078 0079 0080 0081 0082 0083 0084 0085 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Relative weight Group title SI Level I Photochemotherapy ....................................................... Level I Fine Needle Biopsy/Aspiration ....................................... Bone Marrow Biopsy/Aspiration ................................................. Level I Needle Biopsy/ Aspiration Except Bone Marrow ........... Level II Needle Biopsy/Aspiration Except Bone Marrow ........... Level I Incision & Drainage ........................................................ Level II Incision & Drainage ....................................................... Level III Incision and Drainage .................................................. Nail Procedures ......................................................................... Level I Destruction of Lesion ..................................................... Level II Destruction of Lesion .................................................... Level I Debridement & Destruction ............................................ Level II Debridement & Destruction ........................................... Level III Debridement & Destruction .......................................... Level IV Debridement & Destruction ......................................... Level VI Debridement & Destruction ......................................... Biopsy of Skin/Puncture of Lesion ............................................. Level I Excision/ Biopsy ............................................................. Level II Excision/ Biopsy ............................................................ Level III Excision/ Biopsy ........................................................... Level IV Excision/ Biopsy .......................................................... Exploration Penetrating Wound ................................................. Level I Skin Repair .................................................................... Level II Skin Repair ................................................................... Level IV Skin Repair .................................................................. Level I Breast Surgery ............................................................... Level II Breast Surgery .............................................................. Level III Breast Surgery ............................................................. Partial Hospitalization ................................................................ Venous Cutdown ........................................................................ Level II Fine Needle Biopsy/Aspiration ...................................... Level IV Needle Biopsy/Aspiration Except Bone Marrow ......... Level I Implantation of Neurostimulator ..................................... Level I Implantation of Neurostimulator Electrodes ................... Level I Arthroscopy .................................................................... Level II Arthroscopy ................................................................... Closed Treatment Fracture Finger/Toe/Trunk ........................... Bone/Joint Manipulation Under Anesthesia ............................... Open/Percutaneous Treatment Fracture or Dislocation ............ Arthroplasty without Prosthesis ................................................. Level I Arthroplasty with Prosthesis .......................................... Level I Musculoskeletal Procedures Except Hand and Foot .... Level II Musculoskeletal Procedures Except Hand and Foot ... Level III Musculoskeletal Procedures Except Hand and Foot .. Level IV Musculoskeletal Procedures Except Hand and Foot .. Level I Hand Musculoskeletal Procedures ................................ Level II Hand Musculoskeletal Procedures ............................... Level I Foot Musculoskeletal Procedures .................................. Level II Foot Musculoskeletal Procedures ................................. Bunion Procedures .................................................................... Level I Strapping and Cast Application ..................................... Manipulation Therapy ................................................................ CPAP Initiation ........................................................................... Thoracoscopy ............................................................................. Thoracentesis/Lavage Procedures ............................................ Level I Endoscopy Upper Airway .............................................. Level II Endoscopy Upper Airway ............................................. Level IV Endoscopy Upper Airway ............................................ Level V Endoscopy Upper Airway ............................................. Level I Endoscopy Lower Airway .............................................. Level I Pulmonary Treatment .................................................... Level II Pulmonary Treatment ................................................... Ventilation Initiation and Management ...................................... Diagnostic Cardiac Catheterization ........................................... Non-Coronary Angioplasty or Atherectomy ............................... Coronary Atherectomy ............................................................... Coronary Angioplasty and Percutaneous Valvuloplasty ............ Level I Electrophysiologic Evaluation ........................................ Level II Electrophysiologic Evaluation ....................................... S ............ T ............ T ............. T ............. T ............. T ............. T ............. T ............. T ............ T ............. T ............ T ............ T ............. T ............. T ............ T ............ T ............. T ............. T ............. T ............ T ............. T ............ T ............. T ............ T ............. T ............ T ............. T ............. P ............ T ............ T ............. T ............. S ............ S ............ T ............. T ............. T ............ T ............ T ............ T ............. T ............. T ............. T ............. T ............. T ............ T ............. T ............. T ............. T ............ T ............. S ............ S ............ S ............ T ............ T ............. T ............ T ............ T ............. T ............. T ............ S ............ S ............ S ............ T ............. T ............. T ............ T ............. S ............ T ............. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00006 Fmt 4701 Sfmt 4702 0.4213 0.9559 2.6530 1.7646 3.5994 1.5500 11.4501 16.4989 0.6680 0.5719 2.0839 0.8497 1.1078 1.6514 2.5834 18.4211 1.1726 4.0547 6.9433 14.9776 19.6472 4.7775 1.6084 5.4938 18.4182 19.5801 32.0476 40.0825 4.0708 0.7158 2.1773 9.4751 181.4000 55.3297 28.1318 43.9753 1.7694 14.4945 37.7023 31.6107 43.1288 20.3707 23.9081 36.5271 43.9378 15.6795 25.3711 20.0692 40.2957 27.5493 1.0934 0.4935 1.2293 30.6775 3.2101 0.7915 1.4361 15.7757 21.3426 9.4592 0.3444 1.0236 2.3482 37.1361 34.4473 85.0126 50.8925 10.0205 35.1882 E:\FR\FM\26AUP3.SGM Payment rate National unadjusted copayment Minimum unadjusted copayment $25.00 $56.73 $157.44 $104.72 $213.60 $91.98 $679.48 $979.09 $39.64 $33.94 $123.66 $50.42 $65.74 $98.00 $153.31 $1,093.16 $69.59 $240.62 $412.04 $888.82 $1,165.92 $283.51 $95.45 $326.02 $1,092.99 $1,161.94 $1,901.80 $2,378.62 $241.57 $42.48 $129.21 $562.28 $10,764.82 $3,283.43 $1,669.43 $2,609.63 $105.00 $860.15 $2,237.37 $1,875.87 $2,559.39 $1,208.86 $1,418.78 $2,167.63 $2,607.40 $930.47 $1,505.60 $1,190.97 $2,391.27 $1,634.86 $64.89 $29.29 $72.95 $1,820.49 $190.50 $46.97 $85.22 $936.18 $1,266.53 $561.34 $20.44 $60.74 $139.35 $2,203.77 $2,044.21 $5,044.90 $3,020.11 $594.65 $2,088.17 $7.00 .................... .................... $22.36 $71.59 $22.28 .................... .................... $8.34 $9.65 $25.17 $11.18 $14.20 $20.29 $33.57 $227.84 $16.04 $71.87 $107.40 $219.48 $354.45 .................... $31.25 $101.85 $329.72 $303.74 $632.64 $763.55 .................... .................... .................... $224.91 .................... .................... .................... $804.74 .................... $268.47 $535.76 $537.03 $570.30 .................... .................... .................... .................... $253.49 .................... $355.34 .................... $475.91 .................... .................... $29.18 $591.64 .................... $11.31 $21.27 $295.70 $445.92 $189.82 $7.74 $14.55 .................... $838.92 .................... $1,085.20 .................... .................... $426.25 $5.00 $11.35 $31.49 $20.94 $42.72 $18.40 $135.90 $195.82 $7.93 $6.79 $24.73 $10.08 $13.15 $19.60 $30.66 $218.63 $13.92 $48.12 $82.41 $177.76 $233.18 $56.70 $19.09 $65.20 $218.60 $232.39 $380.36 $475.72 $48.31 $8.50 $25.84 $112.46 $2,152.96 $656.69 $333.89 $521.93 $21.00 $172.03 $447.47 $375.17 $511.88 $241.77 $283.76 $433.53 $521.48 $186.09 $301.12 $238.19 $478.25 $326.97 $12.98 $5.86 $14.59 $364.10 $38.10 $9.39 $17.04 $187.24 $253.31 $112.27 $4.09 $12.15 $27.87 $440.75 $408.84 $1,008.98 $604.02 $118.93 $417.63 26AUP3 50685 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 0086 0087 0088 0089 .... .... .... .... 0090 0091 0092 0093 0094 0095 0096 0097 0098 0099 0100 0101 0103 0104 0105 0106 0107 0108 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0109 0110 0111 0112 0113 0114 0115 0116 .... .... .... .... .... .... .... .... 0117 0120 0121 0122 0123 .... .... .... .... .... 0125 0130 0131 0132 0140 0141 0142 0143 0146 0147 0148 0149 0150 0151 0152 0153 0154 0155 0156 0157 0158 0159 0160 0161 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0162 .... 0163 .... 0164 .... Group title Ablate Heart Dysrhythm Focus .................................................. Cardiac Electrophysiologic Recording/Mapping ........................ Thrombectomy ........................................................................... Insertion/Replacement of Permanent Pacemaker and Electrodes. Insertion/Replacement of Pacemaker Pulse Generator ............ Level II Vascular Ligation .......................................................... Level I Vascular Ligation ........................................................... Vascular Reconstruction/Fistula Repair without Device ............ Level I Resuscitation and Cardioversion ................................... Cardiac Rehabilitation ................................................................ Non-Invasive Vascular Studies .................................................. Cardiac and Ambulatory Blood Pressure Monitoring ................ Injection of Sclerosing Solution ................................................. Electrocardiograms .................................................................... Cardiac Stress Tests ................................................................. Tilt Table Evaluation .................................................................. Miscellaneous Vascular Procedures .......................................... Transcatheter Placement of Intracoronary Stents ..................... Revision/Removal of Pacemakers, AICD, or Vascular ............. Insertion/Replacement/Repair of Pacemaker and/or Electrodes Insertion of Cardioverter-Defibrillator ......................................... Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads. Removal of Implanted Devices .................................................. Transfusion ................................................................................ Blood Product Exchange ........................................................... Apheresis, Photopheresis, and Plasmapheresis ....................... Excision Lymphatic System ....................................................... Thyroid/Lymphadenectomy Procedures .................................... Cannula/Access Device Procedures ......................................... Chemotherapy Administration by Other Technique Except Infusion. Chemotherapy Administration by Infusion Only ........................ Infusion Therapy Except Chemotherapy ................................... Level I Tube changes and Repositioning .................................. Level II Tube changes and Repositioning ................................. Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant. Refilling of Infusion Pump .......................................................... Level I Laparoscopy ................................................................... Level II Laparoscopy .................................................................. Level III Laparoscopy ................................................................. Esophageal Dilation without Endoscopy ................................... Level I Upper GI Procedures ..................................................... Small Intestine Endoscopy ........................................................ Lower GI Endoscopy ................................................................. Level I Sigmoidoscopy and Anoscopy ....................................... Level II Sigmoidoscopy and Anoscopy ...................................... Level I Anal/Rectal Procedures ................................................. Level III Anal/Rectal Procedures ............................................... Level IV Anal/Rectal Procedures ............................................... Endoscopic Retrograde Cholangio-Pancreatography (ERCP) .. Level I Percutaneous Abdominal and Biliary Procedures ......... Peritoneal and Abdominal Procedures ...................................... Hernia/Hydrocele Procedures .................................................... Level II Anal/Rectal Procedures ................................................ Level II Urinary and Anal Procedures ....................................... Colorectal Cancer Screening: Barium Enema ........................... Colorectal Cancer Screening: Colonoscopy .............................. Colorectal Cancer Screening: Flexible Sigmoidoscopy ............. Level I Cystourethroscopy and other Genitourinary Procedures Level II Cystourethroscopy and other Genitourinary Procedures. Level III Cystourethroscopy and other Genitourinary Procedures. Level IV Cystourethroscopy and other Genitourinary Procedures. Level I Urinary and Anal Procedures ........................................ VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00007 Fmt 4701 T T T T Payment rate Relative weight SI National unadjusted copayment Minimum unadjusted copayment ............ ............. ............ ............. 44.2596 30.7101 36.5617 105.6143 $2,626.50 $1,822.43 $2,169.68 $6,267.47 $833.33 .................... $655.22 $1,682.28 $525.30 $364.49 $433.94 $1,253.49 T ............ T ............. T ............. ................ S ............ S ............ S ............ X ............ T ............ S ............ X ............ S ............ T ............. T ............ T ............. T ............. T ............ T ............. 89.1574 28.9999 23.4516 .................... 2.5363 0.5885 1.6307 1.0223 1.1346 0.3821 2.4968 4.2787 14.7142 79.0094 22.3685 45.4851 260.0295 349.1681 $5,290.87 $1,720.94 $1,391.69 .................... $150.51 $34.92 $96.77 $60.67 $67.33 $22.67 $148.17 $253.91 $873.18 $4,688.65 $1,327.41 $2,699.22 $15,430.93 $20,720.68 $1,612.80 $348.23 .................... .................... $47.62 $13.96 $38.70 $23.79 .................... .................... $41.44 $101.56 $223.63 .................... $370.40 .................... $3,103.22 .................... $1,058.17 $344.19 $278.34 .................... $30.10 $6.98 $19.35 $12.13 $13.47 $4.53 $29.63 $50.78 $174.64 $937.73 $265.48 $539.84 $3,086.19 $4,144.14 T ............ S ............ S ............ S ............ T ............ T ............. T ............ S ............ 11.0433 3.6594 12.3956 26.7948 21.4653 40.7652 31.4727 1.1453 $655.34 $217.16 $735.59 $1,590.08 $1,273.82 $2,419.13 $1,867.68 $67.97 $131.49 .................... $200.18 $438.94 .................... $485.91 $459.35 .................... $131.07 $43.43 $147.12 $318.02 $254.76 $483.83 $373.54 $13.59 S ............ S ............ T ............ T ............. S ............ 3.2378 2.0193 2.2766 6.9721 22.9902 $192.14 $119.83 $135.10 $413.75 $1,364.31 $42.54 $28.21 $43.80 $84.85 .................... $38.43 $23.97 $27.02 $82.75 $272.86 T ............ T ............. T ............. T ............ T ............. T ............. T ............ T ............. T ............. T ............. T ............ T ............. T ............ T ............. T ............ T ............. T ............ T ............. T ............ S ............ T ............ S ............ T ............. T ............ 1.9331 31.9271 43.3389 62.9914 5.4737 8.1835 9.3487 8.6869 4.6374 7.9679 3.7383 18.0726 23.8654 18.7338 12.2833 21.6961 28.7847 16.2546 2.5751 2.2904 7.6588 3.1455 6.6753 18.5576 $114.72 $1,894.65 $2,571.86 $3,738.10 $324.83 $485.63 $554.78 $515.51 $275.20 $472.84 $221.84 $1,072.48 $1,416.24 $1,111.72 $728.93 $1,287.51 $1,708.17 $964.60 $152.81 $135.92 $454.50 $186.66 $396.13 $1,101.26 .................... $659.53 $1,001.89 $1,239.22 $94.18 $143.38 $152.78 $186.06 $64.40 .................... $57.21 $293.06 $437.12 $245.46 .................... $382.75 $464.85 .................... $40.52 .................... .................... .................... $105.06 $249.36 $22.94 $378.93 $514.37 $747.62 $64.97 $97.13 $110.96 $103.10 $55.04 $94.57 $44.37 $214.50 $283.25 $222.34 $145.79 $257.50 $341.63 $192.92 $30.56 $27.18 $113.63 $46.67 $79.23 $220.25 T ............. 23.3918 $1,388.14 .................... $277.63 T ............. 33.7354 $2,001.96 .................... $400.39 T ............. 1.1855 $70.35 $17.29 $14.07 Sfmt 4702 E:\FR\FM\26AUP3.SGM 26AUP3 50686 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 0165 0166 0168 0169 0170 0180 0181 0183 0184 0188 0189 0190 0191 0192 0193 0194 0195 0196 0197 0198 0200 0201 0202 0203 0204 0206 0207 0208 0209 0212 0213 0214 0215 0216 0218 0220 0221 0222 0223 0224 0225 0226 0227 0228 0229 0230 0231 0232 0233 0234 0235 0236 0237 0238 0239 0240 0241 0242 0243 0244 0245 0246 0247 0248 0249 0250 0251 0252 0253 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Relative weight Group title SI Level III Urinary and Anal Procedures ...................................... Level I Urethral Procedures ....................................................... Level II Urethral Procedures ...................................................... Lithotripsy ................................................................................... Dialysis ....................................................................................... Circumcision ............................................................................... Penile Procedures ...................................................................... Testes/Epididymis Procedures .................................................. Prostate Biopsy .......................................................................... Level II Female Reproductive Proc ........................................... Level III Female Reproductive Proc .......................................... Level I Hysteroscopy ................................................................. Level I Female Reproductive Proc ............................................ Level IV Female Reproductive Proc .......................................... Level V Female Reproductive Proc ........................................... Level VIII Female Reproductive Proc ........................................ Level IX Female Reproductive Proc .......................................... Dilation and Curettage ............................................................... Infertility Procedures .................................................................. Pregnancy and Neonatal Care Procedures ............................... Level VII Female Reproductive Proc ......................................... Level VI Female Reproductive Proc .......................................... Level X Female Reproductive Proc ........................................... Level IV Nerve Injections ........................................................... Level I Nerve Injections ............................................................. Level II Nerve Injections ............................................................ Level III Nerve Injections ........................................................... Laminotomies and Laminectomies ............................................ Extended EEG Studies and Sleep Studies, Level II ................. Nervous System Injections ........................................................ Extended EEG Studies and Sleep Studies, Level I .................. Electroencephalogram ............................................................... Level I Nerve and Muscle Tests ................................................ Level III Nerve and Muscle Tests .............................................. Level II Nerve and Muscle Tests ............................................... Level I Nerve Procedures .......................................................... Level II Nerve Procedures ......................................................... Implantation of Neurological Device .......................................... Implantation or Revision of Pain Management Catheter .......... Implantation of Reservoir/Pump/Shunt ...................................... Level II Implantation of Neurostimulator Electrodes .................. Implantation of Drug Infusion Reservoir .................................... Implantation of Drug Infusion Device ........................................ Creation of Lumbar Subarachnoid Shunt .................................. Transcatherter Placement of Intravascular Shunts ................... Level I Eye Tests & Treatments ................................................ Level III Eye Tests & Treatments .............................................. Level I Anterior Segment Eye Procedures ................................ Level II Anterior Segment Eye Procedures ............................... Level III Anterior Segment Eye Procedures .............................. Level I Posterior Segment Eye Procedures .............................. Level II Posterior Segment Eye Procedures ............................. Level III Posterior Segment Eye Procedures ............................ Level I Repair and Plastic Eye Procedures ............................... Level II Repair and Plastic Eye Procedures .............................. Level III Repair and Plastic Eye Procedures ............................. Level IV Repair and Plastic Eye Procedures ............................ Level V Repair and Plastic Eye Procedures ............................. Strabismus/Muscle Procedures ................................................. Corneal Transplant .................................................................... Level I Cataract Procedures without IOL Insert ........................ Cataract Procedures with IOL Insert ......................................... Laser Eye Procedures Except Retinal ....................................... Laser Retinal Procedures .......................................................... Level II Cataract Procedures without IOL Insert ....................... Nasal Cauterization/Packing ...................................................... Level I ENT Procedures ............................................................ Level II ENT Procedures ........................................................... Level III ENT Procedures .......................................................... T ............ T ............. T ............. T ............. S ............ T ............. T ............ T ............. T ............ T ............. T ............. T ............. T ............. T ............ T ............ T ............. T ............ T ............. T ............. T ............. T ............. T ............ T ............ T ............ T ............ T ............. T ............. T ............. S ............ T ............. S ............ S ............ S ............ S ............ S ............ T ............. T ............ T ............ T ............. T ............. S ............ T ............ T ............ T ............ T ............. S ............ S ............ T ............. T ............ T ............ T ............. T ............ T ............ T ............ T ............ T ............. T ............. T ............. T ............. T ............ T ............. T ............ T ............ T ............. T ............. T ............ T ............ T ............ T ............. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00008 Fmt 4701 Sfmt 4702 16.6689 17.6743 28.2685 43.0133 5.8994 19.8827 30.8663 23.6415 4.3566 1.1400 2.3710 21.0653 0.1670 4.3082 14.5843 20.7525 26.6791 17.0974 2.3572 1.3683 17.8728 17.6047 40.3866 10.4015 2.1910 5.4920 6.0109 42.3409 11.5713 2.9740 2.2932 1.1353 0.6115 2.6720 1.1408 17.3586 29.9209 179.0982 28.1230 40.6455 234.6925 138.8695 136.4922 51.7258 64.4545 0.7858 1.9278 6.6732 14.9673 21.9741 4.6593 17.0229 28.9401 2.5933 6.9097 18.1508 23.3036 30.5464 22.1671 38.3723 13.3625 23.4597 5.0330 4.6769 27.9369 1.2896 2.0101 7.8673 16.1357 E:\FR\FM\26AUP3.SGM Payment rate National unadjusted copayment Minimum unadjusted copayment $989.18 $1,048.85 $1,677.54 $2,552.54 $350.09 $1,179.90 $1,831.70 $1,402.96 $258.53 $67.65 $140.70 $1,250.08 $9.91 $255.66 $865.48 $1,231.52 $1,583.22 $1,014.61 $139.88 $81.20 $1,060.63 $1,044.72 $2,396.66 $617.26 $130.02 $325.91 $356.70 $2,512.64 $686.68 $176.49 $136.09 $67.37 $36.29 $158.56 $67.70 $1,030.11 $1,775.60 $10,628.22 $1,668.90 $2,412.03 $13,927.36 $8,240.93 $8,099.86 $3,069.56 $3,824.92 $46.63 $114.40 $396.01 $888.20 $1,304.01 $276.50 $1,010.19 $1,717.39 $153.89 $410.04 $1,077.12 $1,382.91 $1,812.72 $1,315.46 $2,277.13 $792.97 $1,392.17 $298.67 $277.54 $1,657.86 $76.53 $119.29 $466.87 $957.54 .................... $218.73 $388.03 $1,021.01 .................... $304.87 $621.82 .................... $96.27 .................... .................... $424.28 $2.78 .................... .................... $397.84 $483.80 $338.23 .................... $32.19 $263.69 $329.65 $958.66 $246.90 $40.13 $75.55 $86.92 .................... $274.67 $70.59 $54.43 $26.94 $14.51 .................... .................... .................... $463.62 .................... .................... .................... .................... .................... .................... .................... $771.23 $14.97 $44.61 $103.17 $266.33 $511.31 $67.40 .................... .................... .................... .................... $315.31 $384.47 $597.36 $431.39 $803.26 $221.89 $495.96 $104.31 $93.98 $524.67 $26.79 .................... $113.41 $282.29 $197.84 $209.77 $335.51 $510.51 $70.02 $235.98 $366.34 $280.59 $51.71 $13.53 $28.14 $250.02 $1.98 $51.13 $173.10 $246.30 $316.64 $202.92 $27.98 $16.24 $212.13 $208.94 $479.33 $123.45 $26.00 $65.18 $71.34 $502.53 $137.34 $35.30 $27.22 $13.47 $7.26 $31.71 $13.54 $206.02 $355.12 $2,125.64 $333.78 $482.41 $2,785.47 $1,648.19 $1,619.97 $613.91 $764.98 $9.33 $22.88 $79.20 $177.64 $260.80 $55.30 $202.04 $343.48 $30.78 $82.01 $215.42 $276.58 $362.54 $263.09 $455.43 $158.59 $278.43 $59.73 $55.51 $331.57 $15.31 $23.86 $93.37 $191.51 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50687 ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 0254 0256 0258 0259 0260 0261 .... .... .... .... .... .... 0262 0263 0264 0265 0266 0267 0268 0269 0270 0272 0274 0275 0276 0277 0278 0279 0280 0282 0283 0284 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0285 0288 0296 0297 0299 0300 0301 0302 0303 0304 0305 0310 0312 0313 0314 0315 0320 0321 0322 0323 0324 0325 0330 0332 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0333 .... 0335 .... 0336 .... 0337 .... 0339 0340 0341 0342 0343 0344 0345 0346 0347 .... .... .... .... .... .... .... .... .... Payment rate National unadjusted copayment Minimum unadjusted copayment 23.4040 37.3204 22.2466 366.3317 0.7555 1.2901 $1,388.86 $2,214.70 $1,320.18 $21,739.22 $44.83 $76.56 $321.35 .................... $437.25 $8,070.21 $17.93 .................... $277.77 $442.94 $264.04 $4,347.84 $8.97 $15.31 ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ 0.9228 1.7476 3.5240 1.0213 1.6393 2.6327 1.0610 3.2437 6.0192 1.3801 3.0413 3.5779 1.5319 2.3852 2.6434 8.9319 20.7902 1.6542 4.4253 6.4201 $54.76 $103.71 $209.12 $60.61 $97.28 $156.23 $62.96 $192.49 $357.20 $81.90 $180.48 $212.32 $90.91 $141.54 $156.87 $530.05 $1,233.75 $98.17 $262.61 $380.99 .................... $24.40 $79.41 $24.24 $38.91 $62.18 .................... $76.99 $142.88 $32.76 $72.19 $69.09 $36.36 $56.61 $62.74 $150.03 $353.85 $39.26 $105.04 $152.39 $10.95 $20.74 $41.82 $12.12 $19.46 $31.25 $12.59 $38.50 $71.44 $16.38 $36.10 $42.46 $18.18 $28.31 $31.37 $106.01 $246.75 $19.63 $52.52 $76.20 S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ X ............ X ............ X ............ X ............ S ............ S ............ S ............ T ............. S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ 17.1798 1.2568 2.2452 5.2530 5.8482 1.5198 2.2195 4.6145 2.8356 1.7738 4.0036 13.9490 5.0032 12.8655 5.9945 290.6470 5.3765 1.3579 1.2319 1.6227 2.0997 1.3189 7.1756 3.2694 $1,019.50 $74.58 $133.24 $311.73 $347.05 $90.19 $131.71 $273.84 $168.27 $105.26 $237.59 $827.78 $296.90 $763.48 $355.73 $17,247.86 $319.06 $80.58 $73.10 $96.30 $124.60 $78.27 $425.82 $194.02 $318.72 .................... $53.29 $122.13 .................... .................... .................... $103.74 $66.95 $41.52 $91.38 $325.27 .................... .................... $98.36 .................... $80.06 $21.71 .................... $20.08 .................... $17.10 .................... $77.60 $203.90 $14.92 $26.65 $62.35 $69.41 $18.04 $26.34 $54.77 $33.65 $21.05 $47.52 $165.56 $59.38 $152.70 $71.15 $3,449.57 $63.81 $16.12 $14.62 $19.26 $24.92 $15.65 $85.16 $38.80 S ............ 5.2836 $313.54 $125.41 $62.71 S ............ S ............ 5.1581 6.0742 $306.10 $360.46 $122.43 $144.18 $61.22 $72.09 S ............ 8.7945 $521.89 $208.75 $104.38 S X X X X X X X X 7.1403 0.6384 0.1112 0.1560 0.4786 0.7996 0.2277 0.3434 0.8434 $423.73 $37.88 $6.60 $9.26 $28.40 $47.45 $13.51 $20.38 $50.05 .................... .................... $2.62 $3.70 $11.10 $15.66 $3.01 $4.54 $12.35 $84.75 $7.58 $1.32 $1.85 $5.68 $9.49 $2.70 $4.08 $10.01 Relative weight Group title SI Level IV ENT Procedures .......................................................... Level V ENT Procedures ........................................................... Tonsil and Adenoid Procedures ................................................ Level VI ENT Procedures .......................................................... Level I Plain Film Except Teeth ................................................. Level II Plain Film Except Teeth Including Bone Density Measurement. Plain Film of Teeth ..................................................................... Level I Miscellaneous Radiology Procedures ............................ Level II Miscellaneous Radiology Procedures ........................... Level I Diagnostic Ultrasound .................................................... Level II Diagnostic Ultrasound ................................................... Level III Diagnostic Ultrasound .................................................. Ultrasound Guidance Procedures .............................................. Level III Echocardiogram Except Transesophageal .................. Transesophageal Echocardiogram ............................................ Level I Fluoroscopy .................................................................... Myelography ............................................................................... Arthrography .............................................................................. Level I Digestive Radiology ....................................................... Level II Digestive Radiology ...................................................... Diagnostic Urography ................................................................ Level II Angiography and Venography except Extremity .......... Level III Angiography and Venography except Extremity ......... Miscellaneous Computerized Axial Tomography ...................... Computerized Axial Tomography with Contrast Material .......... Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contras. Myocardial Positron Emission Tomography (PET) .................... Bone Density: Axial Skeleton .................................................... Level I Therapeutic Radiologic Procedures ............................... Level II Therapeutic Radiologic Procedures .............................. Miscellaneous Radiation Treatment .......................................... Level I Radiation Therapy .......................................................... Level II Radiation Therapy ......................................................... Level III Radiation Therapy ........................................................ Treatment Device Construction ................................................. Level I Therapeutic Radiation Treatment Preparation .............. Level II Therapeutic Radiation Treatment Preparation ............. Level III Therapeutic Radiation Treatment Preparation ............ Radioelement Applications ........................................................ Brachytherapy ............................................................................ Hyperthermic Therapies ............................................................. Level II Implantation of Neurostimulator .................................... Electroconvulsive Therapy ......................................................... Biofeedback and Other Training ................................................ Brief Individual Psychotherapy .................................................. Extended Individual Psychotherapy ........................................... Family Psychotherapy ................................................................ Group Psychotherapy ................................................................ Dental Procedures ..................................................................... Computerized Axial Tomography and Computerized Angiography without Contras. Computerized Axial Tomography and Computerized Angio w/o Contrast Material. Magnetic Resonance Imaging, Miscellaneous .......................... Magnetic Resonance Imaging and Magnetic Resonance Angiography without Cont. MRI and Magnetic Resonance Angiography without Contrast Material followed. Observation ................................................................................ Minor Ancillary Procedures ........................................................ Skin Tests .................................................................................. Level I Pathology ....................................................................... Level III Pathology ..................................................................... Level IV Pathology ..................................................................... Level I Transfusion Laboratory Procedures .............................. Level II Transfusion Laboratory Procedures ............................. Level III Transfusion Laboratory Procedures ............................ T ............. T ............. T ............. T ............. X ............ X ............ VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00009 Fmt 4701 X X X S S S S S S X S S S S S S S S S S ............ ............ ............ ............ ............ ............ ............ ............ ............ Sfmt 4702 E:\FR\FM\26AUP3.SGM 26AUP3 50688 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued 0348 0350 0352 0353 0359 0360 0361 0362 0363 0364 0365 0366 0367 0368 0369 0370 0372 0373 0374 0375 0376 0377 0378 0379 0381 0384 0385 0386 0387 0388 0389 0390 0391 0393 0394 0395 0396 0397 0398 0399 0400 0401 0402 0403 0404 0405 0406 0407 0409 0411 0412 0415 0416 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0417 0418 0421 0422 0423 0425 0426 0427 0428 0429 .... .... .... .... .... .... .... .... .... .... 0430 0432 0433 0434 .... .... .... .... Payment rate National unadjusted copayment Minimum unadjusted copayment 0.7927 0.3954 0.1413 0.3954 0.8312 1.4739 3.6216 2.6607 0.9128 0.4708 1.2356 1.7743 0.6659 0.9761 2.7519 1.1232 0.5700 2.1926 1.0414 42.5900 5.1975 6.8344 5.4997 .................... 0.1884 22.3392 75.6446 120.1694 32.5445 12.3294 1.4976 2.5562 2.8774 3.4438 4.4630 3.8699 4.1426 2.2646 4.3093 1.5192 4.1335 3.4150 5.1847 3.6138 3.8559 4.2674 4.3035 3.9839 0.1258 0.3869 5.3643 22.0955 19.5542 $47.04 $23.46 $8.39 $23.46 $49.33 $87.47 $214.92 $157.89 $54.17 $27.94 $73.32 $105.29 $39.52 $57.92 $163.31 $66.65 $33.83 $130.12 $61.80 $2,527.42 $308.44 $405.57 $326.37 $33.45 $11.18 $1,325.68 $4,488.98 $7,131.21 $1,931.29 $731.66 $88.87 $151.69 $170.75 $204.37 $264.85 $229.65 $245.83 $134.39 $255.73 $90.15 $245.29 $202.66 $307.68 $214.45 $228.82 $253.24 $255.38 $236.42 $7.47 $22.96 $318.33 $1,311.21 $1,160.40 .................... $0.00 .................... .................... .................... $34.98 $83.23 .................... $17.44 $9.06 $18.95 $30.04 $14.80 $23.16 $44.18 .................... $10.09 .................... .................... .................... $121.42 $162.22 $130.54 .................... $2.35 $287.93 .................... .................... $655.55 $292.66 $35.54 $60.67 $68.30 $81.74 $105.93 $91.86 $98.33 $53.75 $102.29 $36.06 $98.11 $81.06 $123.07 $85.78 $91.52 $101.29 $102.15 $94.56 $2.22 .................... .................... $459.92 .................... $9.41 $0.00 $1.68 $4.69 $9.87 $17.49 $42.98 $31.58 $10.83 $5.59 $14.66 $21.06 $7.90 $11.58 $32.66 $13.33 $6.77 $26.02 $12.36 $505.48 $61.69 $81.11 $65.27 $6.69 $2.24 $265.14 $897.80 $1,426.24 $386.26 $146.33 $17.77 $30.34 $34.15 $40.87 $52.97 $45.93 $49.17 $26.88 $51.15 $18.03 $49.06 $40.53 $61.54 $42.89 $45.76 $50.65 $51.08 $47.28 $1.49 $4.59 $63.67 $262.24 $232.08 S ............ T ............. X ............ T ............ T ............. T ............. S ............ T ............. T ............ T ............. 4.0750 109.3043 1.6600 22.9647 40.2866 100.2058 2.1243 10.1977 19.9022 42.3147 $241.82 $6,486.45 $98.51 $1,362.79 $2,390.73 $5,946.51 $126.06 $605.16 $1,181.06 $2,511.08 .................... .................... .................... $448.81 .................... $1,378.01 .................... $124.11 .................... .................... $48.36 $1,297.29 $19.70 $272.56 $478.15 $1,189.30 $25.21 $121.03 $236.21 $502.22 T ............. S ............ X ............ T ............. 11.4040 0.6949 0.2581 90.7877 $676.75 $41.24 $15.32 $5,387.61 .................... .................... $6.12 .................... $135.35 $8.25 $3.06 $1,077.52 Group title SI Relative weight Fertility Laboratory Procedures .................................................. Administration of flu and PPV vaccines .................................... Level I Injections ........................................................................ Level II Injections ....................................................................... Level III Injections ...................................................................... Level I Alimentary Tests ............................................................ Level II Alimentary Tests ........................................................... Contact Lens and Spectacle Services ....................................... Level I Otorhinolaryngologic Function Tests ............................. Level I Audiometry ..................................................................... Level II Audiometry .................................................................... Level III Audiometry ................................................................... Level I Pulmonary Test .............................................................. Level II Pulmonary Tests ........................................................... Level III Pulmonary Tests .......................................................... Allergy Tests .............................................................................. Therapeutic Phlebotomy ............................................................ Neuropsychological Testing ....................................................... Monitoring Psychiatric Drugs ..................................................... Ancillary Outpatient Services When Patient Expires ................. Level II Cardiac Imaging ............................................................ Level III Cardiac Imaging ........................................................... Level II Pulmonary Imaging ....................................................... Injection adenosine .................................................................... Single Allergy Tests ................................................................... GI Procedures with Stents ......................................................... Level I Prosthetic Urological Procedures .................................. Level II Prosthetic Urological Procedures ................................. Level II Hysteroscopy ................................................................ Discography ............................................................................... Non-imaging Nuclear Medicine .................................................. Level I Endocrine Imaging ......................................................... Level II Endocrine Imaging ........................................................ Red Cell/Plasma Studies ........................................................... Hepatobiliary Imaging ................................................................ GI Tract Imaging ........................................................................ Bone Imaging ............................................................................. Vascular Imaging ....................................................................... Level I Cardiac Imaging ............................................................. Nuclear Medicine Add-on Imaging ............................................ Hematopoietic Imaging .............................................................. Level I Pulmonary Imaging ........................................................ Brain Imaging ............................................................................. CSF Imaging .............................................................................. Renal and Genitourinary Studies Level I ................................... Renal and Genitourinary Studies Level II .................................. Tumor/Infection Imaging ............................................................ Radionuclide Therapy ................................................................ Red Blood Cell Tests ................................................................. Respiratory Procedures ............................................................. IMRT Treatment Delivery ........................................................... Level II Endoscopy Lower Airway ............................................. Level I Intravascular and Intracardiac Ultrasound and Flow Reserve. Computerized Reconstruction .................................................... Insertion of Left Ventricular Pacing Elect .................................. Prolonged Physiologic Monitoring ............................................. Level II Upper GI Procedures .................................................... Level II Percutaneous Abdominal and Biliary Procedures ........ Level II Arthroplasty with Prosthesis ......................................... Level II Strapping and Cast Application .................................... Level III Tube Changes and Repositioning ............................... Level III Sigmoidoscopy and Anoscopy ..................................... Level V Cystourethroscopy and other Genitourinary Procedures. Level IV Nerve and Muscle Tests ............................................. Health and Behavior Services ................................................... Level II Pathology ...................................................................... Cardiac Defect Repair ............................................................... X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ X ............ T ............ S ............ S ............ S ............ K ............ X ............ T ............. S ............ S ............ T ............. S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ X ............ S ............ S ............ T ............ S ............ APC VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00010 Fmt 4701 Sfmt 4702 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50689 ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 0600 0601 0602 0610 0611 0612 0620 0621 0622 0623 0648 0651 0652 0653 0654 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0655 .... 0656 0657 0658 0659 0660 0661 0662 0664 0665 0667 0668 0670 .... .... .... .... .... .... .... .... .... .... .... .... 0671 0672 0673 0674 0675 0676 0678 0679 0680 0681 0682 0683 0685 0686 0687 0688 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0689 0690 0691 0692 0693 0694 0695 0697 0698 0699 0700 0701 0702 0704 0705 0726 0728 0730 0731 0732 0733 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Payment rate National unadjusted copayment Minimum unadjusted copayment 0.8688 1.0038 1.4284 1.2947 2.2718 3.9853 8.2996 8.2986 21.2671 27.1105 50.4459 12.1448 28.8948 30.5339 100.9294 $51.56 $59.57 $84.77 $76.83 $134.82 $236.50 $492.52 $492.46 $1,262.05 $1,608.82 $2,993.61 $720.71 $1,714.70 $1,811.97 $5,989.45 .................... .................... .................... $19.48 $35.76 $54.12 $135.68 .................... .................... .................... .................... .................... .................... .................... .................... $10.31 $11.91 $16.95 $15.37 $26.96 $47.30 $98.50 $98.49 $252.41 $321.76 $598.72 $144.14 $342.94 $362.39 $1,197.89 T ............. 133.7768 $7,938.72 .................... $1,587.74 T S T S X X S S S S S S ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ 109.9237 1.7092 6.1049 1.5473 1.6419 3.3775 5.1621 12.9439 0.6464 15.4857 6.5024 25.4131 $6,523.20 $101.43 $362.28 $91.82 $97.44 $200.43 $306.33 $768.13 $38.36 $918.97 $385.87 $1,508.09 .................... .................... .................... .................... $30.66 $80.17 $122.53 .................... .................... .................... $114.67 $472.46 $1,304.64 $20.29 $72.46 $18.36 $19.49 $40.09 $61.27 $153.63 $7.67 $183.79 $77.17 $301.62 S ............ T ............. T ............. T ............ T ............ T ............. T ............ S ............ S ............ T ............ T ............. S ............ T ............ T ............ T ............. T ............. 1.7028 36.9284 29.2582 95.7856 43.7329 2.4105 1.7276 5.5774 62.9082 137.1630 6.9107 1.9006 6.0174 13.8287 19.2347 43.0444 $101.05 $2,191.44 $1,736.27 $5,684.20 $2,595.24 $143.05 $102.52 $330.98 $3,733.16 $8,139.66 $410.10 $112.79 $357.09 $820.64 $1,141.44 $2,554.38 $40.42 .................... $649.56 .................... .................... .................... .................... $95.30 .................... $2,081.48 $162.42 $25.34 $115.47 .................... $456.57 $1,021.75 $20.21 $438.29 $347.25 $1,136.84 $519.05 $28.61 $20.50 $66.20 $746.63 $1,627.93 $82.02 $22.56 $71.42 $164.13 $228.29 $510.88 S ............ S ............ S ............ S ............ T ............. T ............. T ............ S ............ S ............ T ............. T ............. H ............ H ............ H ............ H ............ K ............ K ............ K ............ K ............ K ............ K ............ 0.5735 0.3755 2.5252 2.0111 42.2254 3.8452 20.3164 1.5357 1.2438 10.0177 5.3614 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $34.03 $22.28 $149.85 $119.34 $2,505.78 $228.19 $1,205.64 $91.13 $73.81 $594.48 $318.16 .................... .................... .................... .................... $216.39 $178.39 $58.42 $21.11 $13.68 $9.99 .................... $8.91 $59.94 $30.16 $798.17 $61.86 $266.59 $36.45 $16.55 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.81 $4.46 $29.97 $23.87 $501.16 $45.64 $241.13 $18.23 $14.76 $118.90 $63.63 .................... .................... .................... .................... $43.28 $35.68 $11.68 $4.22 $2.74 $2.00 E:\FR\FM\26AUP3.SGM 26AUP3 Relative weight Group title SI Low Level Clinic Visits ............................................................... Mid Level Clinic Visits ................................................................ High Level Clinic Visits .............................................................. Low Level Emergency Visits ...................................................... Mid Level Emergency Visits ...................................................... High Level Emergency Visits ..................................................... Critical Care ............................................................................... Level I Vascular Access Procedures ......................................... Level II Vascular Access Procedures ........................................ Level III Vascular Access Procedures ....................................... Breast Reconstruction with Prosthesis ...................................... Complex Interstitial Radiation Source Application ..................... Insertion of Intraperitoneal Catheters ........................................ Vascular Reconstruction/Fistula Repair with Device ................. Insertion/Replacement of a permanent dual chamber pacemaker. Insertion/Replacement/Conversion of a permanent dual chamber pacemaker. Transcatheter Placement of Intracoronary Drug-Eluting Stents Placement of Tissue Clips ......................................................... Percutaneous Breast Biopsies ................................................... Hyperbaric Oxygen .................................................................... Level II Otorhinolaryngologic Function Tests ............................ Level V Pathology ...................................................................... CT Angiography ......................................................................... Level I Proton Beam Radiation Therapy ................................... Bone Density: AppendicularSkeleton ........................................ Level II Proton Beam Radiation Therapy .................................. Level I Angiography and Venography except Extremity ........... Level II Intravascular and Intracardiac Ultrasound and Flow Reserve. Level II Echocardiogram Except Transesophageal ................... Level IV Posterior Segment Eye Procedures ............................ Level IV Anterior Segment Eye Procedures .............................. Prostate Cryoablation ................................................................ Prostatic Thermotherapy ............................................................ Thrombolysis and Thrombectomy ............................................. External Counterpulsation .......................................................... Level II Resuscitation and Cardioversion .................................. Insertion of Patient Activated Event Recorders ......................... Knee Arthroplasty ...................................................................... Level V Debridement & Destruction .......................................... Level II Photochemotherapy ...................................................... Level III Needle Biopsy/Aspiration Except Bone Marrow .......... Level III Skin Repair .................................................................. Revision/Removal of Neurostimulator Electrodes ..................... Revision/Removal of Neurostimulator Pulse Generator Receiver. Electronic Analysis of Cardioverter-defibrillators ....................... Electronic Analysis of Pacemakers and other Cardiac Devices Electronic Analysis of Programmable Shunts/Pumps ............... Electronic Analysis of Neurostimulator Pulse Generators ......... Level II Breast Reconstruction ................................................... Mohs Surgery ............................................................................. Level VII Debridement & Destruction ........................................ Level I Echocardiogram Except Transesophageal .................... Level II Eye Tests & Treatments ............................................... Level IV Eye Tests & Treatments .............................................. Antepartum Manipulation ........................................................... SR 89 chloride, per mCi ............................................................ SM 153 lexidronam .................................................................... IN 111 Satumomab pendetide per dose ................................... Technetium TC99M tetrofosmin ................................................ Dexrazoxane hcl injection .......................................................... Filgrastim injection ..................................................................... Pamidronate disodium ............................................................... Sargramostim injection .............................................................. Mesna injection .......................................................................... Non esrd epoetin alpha inj ......................................................... V ............ V ............ V ............ V ............ V ............ V ............ S ............ T ............. T ............. T ............. T ............. S ............ T ............ T ............ T ............. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00011 Fmt 4701 Sfmt 4702 50690 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 0734 0735 0736 0737 0738 0750 0763 0764 0765 0768 0769 0800 0802 0807 0809 0810 0811 0812 0814 0819 0820 0821 0823 0827 0828 0830 0831 0832 0834 0835 0836 0838 0840 0842 0843 0844 0849 0850 0851 0852 0855 0856 0857 0858 0860 0861 0862 0863 0864 0865 0868 0869 0870 0871 0872 0876 0880 0884 0887 0888 0890 0891 0892 0893 0895 0900 0901 0902 0903 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Group title Injection, darbepoetin alfa (for non-ESRD) ............................... Ampho b cholesteryl sulfate ...................................................... Amphotericin b liposome inj ....................................................... Ammonia N-13, per dose ........................................................... Rasburicase ............................................................................... Dolasetron mesylate .................................................................. Dolasetron mesylate oral ........................................................... Granisetron HCl injection ........................................................... Granisetron HCl oral .................................................................. Ondansetron hcl injection .......................................................... Ondansetron hcl oral ................................................................. Leuprolide acetate ..................................................................... Etoposide oral ............................................................................ Aldesleukin/single use vial ......................................................... Bcg live intravesical vac ............................................................ Goserelin acetate implant .......................................................... Carboplatin injection .................................................................. Carmus bischl nitro inj ............................................................... Asparaginase injection ............................................................... Dacarbazine inj .......................................................................... Daunorubicin .............................................................................. Daunorubicin citrate liposom ..................................................... Docetaxel ................................................................................... Floxuridine injection ................................................................... Gemcitabine HCL ....................................................................... Irinotecan injection ..................................................................... Ifosfomide injection .................................................................... Idarubicin hcl injection ............................................................... Interferon alfa-2a inj ................................................................... Inj cosyntropin ............................................................................ Interferon alfa-2b inj recombinant, 1 million .............................. Interferon gamma 1-b inj ........................................................... Melphalan hydrochl .................................................................... Fludarabine phosphate inj ......................................................... Pegaspargase ............................................................................ Pentostatin injection ................................................................... Rituximab ................................................................................... Streptozocin injection ................................................................. Thiotepa injection ....................................................................... Topotecan .................................................................................. Vinorelbine tartrate ..................................................................... Porfimer sodium ......................................................................... Bleomycin sulfate injection ........................................................ Cladribine ................................................................................... Plicamycin (mithramycin) inj ...................................................... Leuprolide acetate injection ....................................................... Mitomycin ................................................................................... Paclitaxel injection ..................................................................... Mitoxantrone hcl ......................................................................... Interferon alfa-n3 inj, human leukocyte derived, 2 .................... Oral aprepitant ........................................................................... IVIG lyophil 1g ........................................................................... IVIG lyophil 10 mg ..................................................................... IVIG non-lyophil 1g .................................................................... IVIG non-lyophil 10 mg .............................................................. Caffeine citrate injection ............................................................ Penicillin g benzathine inj .......................................................... Rho d immune globulin inj ......................................................... Azathioprine parenteral .............................................................. Cyclosporine oral ....................................................................... Lymphocyte immune globulin .................................................... Tacrolimus oral .......................................................................... Edetate calcium disodium inj ..................................................... Calcitonin salmon injection ........................................................ Deferoxamine mesylate inj ........................................................ Alglucerase injection .................................................................. Alpha 1 proteinase inhibitor ....................................................... Botulinum toxin a, per unit ......................................................... Cytomegalovirus imm IV/vial ..................................................... VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.28 $12.24 $21.91 .................... $109.18 $6.55 $48.54 $7.24 $33.51 $3.80 $32.02 $441.78 $41.12 $701.76 $121.74 $196.25 $77.16 $141.29 $55.42 $6.20 $35.28 $57.56 $301.17 $60.17 $117.45 $129.08 $53.54 $314.00 $31.75 $69.27 $13.22 $277.79 $523.22 $262.41 $1,528.80 $1,868.91 $447.97 $153.33 $44.55 $755.51 $62.85 $2,457.97 $54.18 $39.37 $80.54 $10.96 $26.36 $19.11 $329.69 $8.77 $4.75 $39.46 $0.40 $57.26 $0.57 $3.34 $72.26 $113.91 $47.40 $3.94 $290.30 $3.37 $40.34 $35.68 $14.91 $39.94 $3.30 $4.80 $683.07 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.66 $2.45 $4.38 .................... $21.84 $1.31 $9.71 $1.45 $6.70 $0.76 $6.40 $88.36 $8.22 $140.35 $24.35 $39.25 $15.43 $28.26 $11.08 $1.24 $7.06 $11.51 $60.23 $12.03 $23.49 $25.82 $10.71 $62.80 $6.35 $13.85 $2.64 $55.56 $104.64 $52.48 $305.76 $373.78 $89.59 $30.67 $8.91 $151.10 $12.57 $491.59 $10.84 $7.87 $16.11 $2.19 $5.27 $3.82 $65.94 $1.75 $0.95 $7.89 $0.08 $11.45 $0.11 $0.67 $14.45 $22.78 $9.48 $0.79 $58.06 $0.67 $8.07 $7.14 $2.98 $7.99 $0.66 $0.96 $136.61 E:\FR\FM\26AUP3.SGM 26AUP3 SI Frm 00012 Fmt 4701 K K K H G K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K G K K K K K K K K K K K K K K K K K K ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ Sfmt 4702 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50691 ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 0906 0910 0911 0912 0913 0916 0917 0925 0926 0927 0928 0929 0931 0932 0935 0949 0950 0952 0954 0955 0956 0957 0958 0959 0960 0961 0963 0964 0965 0966 0967 0968 0969 1009 1010 1011 1013 1016 1017 1018 1019 1020 1021 1022 1045 1052 1064 1065 1080 1081 1082 1083 1084 1085 1086 1088 1091 1092 1093 1096 1150 1166 1167 1178 1201 1203 1207 1210 1280 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Group title RSV-ivig ..................................................................................... Interferon beta-1b ...................................................................... Streptokinase ............................................................................. Interferon alfacon-1 .................................................................... Ganciclovir long act implant ....................................................... Injection imiglucerase /unit ........................................................ Adenosine injection .................................................................... Factor viii .................................................................................... Factor VIII (porcine) ................................................................... Factor viii recombinant ............................................................... Factor ix complex ....................................................................... Anti-inhibitor per iu ..................................................................... Factor IX non-recombinant ........................................................ Factor IX recombinant ............................................................... Clonidine hydrochloride ............................................................. Plasma, Pooled Multiple Donor, Solvent/Detergent T ............... Blood (Whole) For Transfusion .................................................. Cryoprecipitate ........................................................................... RBC leukocytes reduced ........................................................... Plasma, Fresh Frozen ............................................................... Plasma Protein Fraction ............................................................ Platelet Concentrate .................................................................. Platelet Rich Plasma .................................................................. Red Blood Cells ......................................................................... Washed Red Blood Cells ........................................................... Infusion, Albumin (Human) 5%, 50 ml ....................................... Albumin (human), 5% ................................................................ Albumin (human), 25% .............................................................. Albumin (human), 25% .............................................................. Plasmaprotein fract, 5% ............................................................. Split unit of blood ....................................................................... Platelets leukocyte reduced irradiated ....................................... Red blood cell leukocyte reduced irradiated ............................. Cryoprecip reduced plasma ....................................................... Blood, L/R, CMV-neg ................................................................. Platelets, HLA-m, L/R, unit ........................................................ Platelet concentrate, L/R, unit ................................................... Blood, L/R, froz/deglycerol/washed ........................................... Platelets, aph/pher, L/R, CMV-neg, unit .................................... Blood, L/R, irradiated ................................................................. Platelets, aph/pher, L/R, irradiated, unit .................................... Pit, pher, L/R, CMV, irrad .......................................................... RBC, frz/deg/wsh, L/R, irrad ...................................................... RBC, L/R, CMV neg, irrad ......................................................... Iobenguane sulfate I-131 ........................................................... Injection, Voriconazole ............................................................... I–131 sodium iodide capsule ..................................................... I–131 sodium iodide solution ..................................................... I–131 tositumomab, dx .............................................................. I–131 tositumomab, tx ............................................................... Treprostinil ................................................................................. Injection, Adalimumab ................................................................ Denileukin diftitox ....................................................................... Injection, Gallium Nitrate ............................................................ Temozolomide,oral ..................................................................... Dx I131 so iodide cap millic ....................................................... IN 111 Oxyquinoline .................................................................. IN 111 Pentetate ........................................................................ TC99M fanolesomab .................................................................. TC 99M Exametazime, per dose ............................................... Th I131 so iodide sol millic ........................................................ Cytarabine liposome .................................................................. Epirubicin hcl .............................................................................. Busulfan IV ................................................................................. TC 99M SUCCIMER, PER Vial ................................................. Verteporfin for injection .............................................................. Octreotide injection, depot ......................................................... Inj dihydroergotamine mesylt ..................................................... Corticotropin injection ................................................................ VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.1956 2.0123 0.7395 2.7370 1.2934 1.1226 0.8317 5.1815 2.0301 2.9707 0.5119 1.3869 0.4878 1.1117 4.9564 1.2698 2.3639 3.6451 1.3062 2.9692 10.9690 1.6023 5.2631 8.5998 2.8004 9.5131 10.1551 4.8787 4.2901 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2851 .................... .................... .................... .................... .................... $15.56 $81.95 $83.36 $3.91 $4,318.68 $3.98 $71.53 $0.51 $1.75 $0.94 $0.52 $1.12 $0.75 $0.86 $57.47 $70.95 $119.42 $43.88 $162.42 $76.75 $66.62 $49.36 $307.49 $120.47 $176.29 $30.38 $82.30 $28.95 $65.97 $294.13 $75.35 $140.28 $216.31 $77.51 $176.20 $650.93 $95.09 $312.33 $510.34 $166.18 $564.54 $602.63 $289.52 $254.59 .................... $4.63 .................... .................... .................... .................... $55.02 $300.10 $1,235.33 $1.30 $7.28 .................... .................... .................... .................... .................... .................... $366.43 $25.15 $16.92 .................... $9.16 $87.40 $27.82 $95.44 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.11 $16.39 $16.67 $0.78 $863.74 $0.80 $14.31 $0.10 $0.35 $0.19 $0.10 $0.22 $0.15 $0.17 $11.49 $14.19 $23.88 $8.78 $32.48 $15.35 $13.32 $9.87 $61.50 $24.09 $35.26 $6.08 $16.46 $5.79 $13.19 $58.83 $15.07 $28.06 $43.26 $15.50 $35.24 $130.19 $19.02 $62.47 $102.07 $33.24 $112.91 $120.53 $57.90 $50.92 .................... $0.93 .................... .................... .................... .................... $11.00 $60.02 $247.07 $0.26 $1.46 .................... .................... .................... .................... .................... .................... $73.29 $5.03 $3.38 .................... $1.83 $17.48 $5.56 $19.09 E:\FR\FM\26AUP3.SGM 26AUP3 SI Frm 00013 Fmt 4701 K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K H K H H H H K K K K K H H H H H H K K K H K K K K ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ Sfmt 4702 50692 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued Group title SI Relative weight Apligraf ....................................................................................... Ergonovine maleate injection ..................................................... Factor viia recombinant ............................................................. Etidronate disodium inj .............................................................. New Technology—Level I ($0–$10) .......................................... New Technology—Level I ($10–$20) ........................................ New Technology—Level I ($20–$30) ........................................ New Technology—Level I ($30–$40) ........................................ New Technology—Level I ($40–$50) ........................................ New Technology—Level I ($0–$10) .......................................... New Technology—Level I ($10–$20) ........................................ New Technology—Level I ($20–$30) ........................................ New Technology—Level I ($30–$40) ........................................ New Technology—Level I ($40–$50) ........................................ New Technology—Level II ($50–$100) ..................................... New Technology—Level III ($100–$200) .................................. New Technology—Level IV ($200–$300) .................................. New Technology—Level V ($300–$400) ................................... New Technology—Level VI ($400–$500) .................................. New Technology—Level VII ($500–$600) ................................. New Technology—Level VIII ($600–$700) ................................ New Technology—Level IX ($700–$800) .................................. New Technology—Level X ($800–$900) ................................... New Technology—Level XI ($900–$1000) ................................ New Technology—Level XII ($1000–$1100) ............................. New Technology—Level XIII ($1100–$1200) ............................ New Technology—Level XIV ($1200–$1300) ........................... New Technology—Level XV ($1300–$1400) ............................ New Technology—Level XVI ($1400–$1500) ........................... New Technology—Level XVII ($1500–$1600) .......................... New Technology—Level XVIII ($1600–$1700) ......................... New Technology—Level IXX ($1700–$1800) ........................... New Technology—Level XX ($1800–$1900) ............................ New Technology—Level XXI ($1900–$2000) ........................... New Technology—Level XXII ($2000–$2500) .......................... New Technology—Level XXIII ($2500–$3000) ......................... New Technology—Level XIV ($3000–$3500) ........................... New Technology—Level XXV ($3500–$4000) .......................... New Technology—Level XXVI ($4000–$4500) ......................... New Technology—Level XXVII ($4500–$5000) ........................ New Technology—Level XXVIII ($5000–$5500) ....................... New Technology—Level XXIX ($5500–$6000) ......................... New Technology—Level XXX ($6000–$6500) .......................... New Technology—Level XXXI ($6500–$7000) ......................... New Technology—Level XXXII ($7000–$7500) ........................ New Technology—Level XXXIII ($7500–$8000) ....................... New Technology—Level XXXIV ($8000–$8500) ....................... New Technology—Level XXXV ($8500–$9000) ........................ New Technology—Level XXXVI ($9000–$9500) ....................... New Technology—Level XXXVII ($9500–$10000) .................... New Technology—Level II ($50–$100) ..................................... New Technology—Level III ($100–$200) .................................. New Technology—Level IV ($200–$300) .................................. New Technology—Level V ($300–$400) ................................... New Technology—Level VI ($400–$500) .................................. New Technology—Level VII ($500–$600) ................................. New Technology—Level VIII ($600–$700) ................................ New Technology—Level IX ($700–$800) .................................. New Technology—Level X ($800–$900) ................................... New Technology—Level XI ($900–$1000) ................................ New Technology—Level XII ($1000–$1100) ............................. New Technology—Level XIII ($1100–$1200) ............................ New Technology—Level XIV ($1200- $1300) ........................... New Technology—Level XV ($1300–$1400) ............................ New Technology—Level XVI ($1400–$1500) ........................... New Technology—Level XVII ($1500-$1600) ........................... New Technology—Level XVIII ($1600-$1700) .......................... New Technology—Level XIX ($1700-$1800) ............................ New Technology—Level XX ($1800-$1900) ............................. K ............ K ............ K ............ K ............ S ............ S ............ S ............ S ............ S ............ T ............ T ............. T ............. T ............. T ............. S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ S ............ T ............ T ............. T ............ T ............ T ............ T ............. T ............. T ............ T ............ T ............. T ............ T ............. T ............. T ............. T ............. T ............. T ............ T ............. T ............. 12.9222 0.5263 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... APC 1305 1330 1409 1436 1491 1492 1493 1494 1495 1496 1497 1498 1499 1500 1502 1503 1504 1505 1506 1507 1508 1509 1510 1511 1512 1513 1514 1515 1516 1517 1518 1519 1520 1521 1522 1523 1524 1525 1526 1527 1528 1529 1530 1531 1532 1533 1534 1535 1536 1537 1539 1540 1541 1542 1543 1544 1545 1546 1547 1548 1549 1550 1551 1552 1553 1554 1555 1556 1557 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00014 Fmt 4701 Sfmt 4702 E:\FR\FM\26AUP3.SGM Payment rate National unadjusted copayment Minimum unadjusted copayment $766.84 $31.23 $1,080.11 $68.69 $5.00 $15.00 $25.00 $35.00 $45.00 $5.00 $15.00 $25.00 $35.00 $45.00 $75.00 $150.00 $250.00 $350.00 $450.00 $550.00 $650.00 $750.00 $850.00 $950.00 $1,050.00 $1,150.00 $1,250.00 $1,350.00 $1,450.00 $1,550.00 $1,650.00 $1,750.00 $1,850.00 $1,950.00 $2,250.00 $2,750.00 $3,250.00 $3,750.00 $4,250.00 $4,750.00 $5,250.00 $5,750.00 $6,250.00 $6,750.00 $7,250.00 $7,750.00 $8,250.00 $8,750.00 $9,250.00 $9,750.00 $75.00 $150.00 $250.00 $350.00 $450.00 $550.00 $650.00 $750.00 $850.00 $950.00 $1,050.00 $1,150.00 $1,250.00 $1,350.00 $1,450.00 $1,550.00 $1,650.00 $1,750.00 $1,850.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $153.37 $6.25 $216.02 $13.74 $1.00 $3.00 $5.00 $7.00 $9.00 $1.00 $3.00 $5.00 $7.00 $9.00 $15.00 $30.00 $50.00 $70.00 $90.00 $110.00 $130.00 $150.00 $170.00 $190.00 $210.00 $230.00 $250.00 $270.00 $290.00 $310.00 $330.00 $350.00 $370.00 $390.00 $450.00 $550.00 $650.00 $750.00 $850.00 $950.00 $1,050.00 $1,150.00 $1,250.00 $1,350.00 $1,450.00 $1,550.00 $1,650.00 $1,750.00 $1,850.00 $1,950.00 $15.00 $30.00 $50.00 $70.00 $90.00 $110.00 $130.00 $150.00 $170.00 $190.00 $210.00 $230.00 $250.00 $270.00 $290.00 $310.00 $330.00 $350.00 $370.00 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50693 ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued Group title SI Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment New Technology—Level XXI ($1900-$2000) ............................ New Technology—Level XXII ($2000-$2500) ........................... New Technology—Level XXIII ($2500-$3000) .......................... New Technology—Level XXIV ($3000-$3500) .......................... New Technology—Level XXV ($3500-$4000) ........................... New Technology—Level XXVI ($4000-$4500) .......................... New Technology—Level XXVII ($4500-$5000) ......................... New Technology—Level XXVIII ($5000-$5500) ........................ New Technology—Level XXIX ($5500-$6000) .......................... New Technology—Level XXX ($6000-$6500) ........................... New Technology—Level XXXI ($6500-$7000) .......................... New Technology—Level XXXII ($7000-$7500) ......................... New Technology—Level XXXIII ($7500-$8000) ........................ New Technology—Level XXXIV ($8000-$8500) ....................... New Technology—Level XXXV ($8500-$9000) ........................ New Technology—Level XXXVI ($9000-$9500) ....................... New Technology—Level XXXVII ($9500-$10000) .................... Technetium TC 99m sestamibi .................................................. Thallous chloride TL 201 ........................................................... IN 111 capromab pendetide, per dose ...................................... Abciximab injection .................................................................... Eptifibatide injection ................................................................... Etanercept injection ................................................................... Rho(D) immune globulin h, sd ................................................... Hylan G–F 20 injection .............................................................. Daclizumab, parenteral .............................................................. Trastuzumab .............................................................................. Basiliximab ................................................................................. Vonwillebrandfactrcmplx, per iu ................................................. Gallium ga 67 ............................................................................. Technetium tc99m bicisate ........................................................ Technetium tc99m mertiatide .................................................... Sodium phosphate p32 .............................................................. Indium 111-in pentetreotide ....................................................... Chromic phosphate p32 ............................................................. Tinzaparin sodium injection ....................................................... Tetanus immune globulin inj ...................................................... Brachytx source, Gold 198 ........................................................ Brachytx source, HDR Ir–192 .................................................... Brachytx source, Iodine 125 ...................................................... Brachytx sour, Non-HDR Ir–192 ................................................ Brachytx sour, Palladium 103 .................................................... Diazoxide injection ..................................................................... FDG, per dose (4–40 mCi/ml) ................................................... Methyldopate hcl injection ......................................................... Brachytx source, Yttrium-90 ...................................................... Brachytx sol, I–125, per mCi ..................................................... Brachytx source, Cesium-131 .................................................... Brachytx source, HA, I–125 ....................................................... Brachytx source, HA, P–103 ..................................................... Brachytx linear source, P–103 ................................................... Pralidoxime chloride inj .............................................................. Quinupristin/dalfopristin .............................................................. Somatrem injection .................................................................... Sumatriptan succinate ............................................................... Amifostine .................................................................................. Gonadorelin hydroch .................................................................. Oprelvekin injection .................................................................... Busulfan, oral ............................................................................. Aprotinin ..................................................................................... Corticorelin ovine triflutat ........................................................... Digoxin immune FAB (ovine) ..................................................... Ethanolamine oleate .................................................................. Fomepizole ................................................................................. Fosphenytoin .............................................................................. Hemin ......................................................................................... Somatropin injection .................................................................. Teniposide .................................................................................. Urokinase inj .............................................................................. T ............. T ............. T ............ T ............. T ............ T ............. T ............. T ............. T ............. T ............ T ............. T ............. T ............. T ............ T ............ T ............ T ............. H ............ H ............ H ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ H ............ H ............ H ............ H ............ H ............ H ............ K ............ K ............ H ............ H ............ H ............ H ............ H ............ K ............ H ............ K ............ H ............ H ............ H ............ H ............ H ............ H ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ K ............ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,950.00 $2,250.00 $2,750.00 $3,250.00 $3,750.00 $4,250.00 $4,750.00 $5,250.00 $5,750.00 $6,250.00 $6,750.00 $7,250.00 $7,750.00 $8,250.00 $8,750.00 $9,250.00 $9,750.00 .................... .................... .................... $450.60 $12.73 $152.11 $12.04 $203.15 $381.48 $53.98 $1,473.57 $0.74 .................... .................... .................... .................... .................... .................... $2.53 $76.90 .................... .................... .................... .................... .................... $113.86 .................... $9.58 .................... .................... .................... .................... .................... .................... $76.68 $105.48 $43.14 $51.03 $436.01 $173.44 $249.06 $1.98 $2.20 $386.53 $552.18 $64.53 $12.31 $5.19 $6.51 $42.93 $266.23 $415.69 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $390.00 $450.00 $550.00 $650.00 $750.00 $850.00 $950.00 $1,050.00 $1,150.00 $1,250.00 $1,350.00 $1,450.00 $1,550.00 $1,650.00 $1,750.00 $1,850.00 $1,950.00 .................... .................... .................... $90.12 $2.55 $30.42 $2.41 $40.63 $76.30 $10.80 $294.71 $0.15 .................... .................... .................... .................... .................... .................... $0.51 $15.38 .................... .................... .................... .................... .................... $22.77 .................... $1.92 .................... .................... .................... .................... .................... .................... $15.34 $21.10 $8.63 $10.21 $87.20 $34.69 $49.81 $0.40 $0.44 $77.31 $110.44 $12.91 $2.46 $1.04 $1.30 $8.59 $53.25 $83.14 E:\FR\FM\26AUP3.SGM 26AUP3 APC 1558 1559 1560 1561 1562 1563 1564 1565 1566 1567 1568 1569 1570 1571 1572 1573 1574 1600 1603 1604 1605 1607 1608 1609 1611 1612 1613 1615 1618 1619 1620 1622 1624 1625 1628 1655 1670 1716 1717 1718 1719 1720 1740 1775 2210 2616 2632 2633 2634 2635 2636 2730 2770 2940 3030 7000 7005 7011 7015 7019 7024 7025 7026 7027 7028 7030 7034 7035 7036 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00015 Fmt 4701 Sfmt 4702 50694 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 7037 7038 7040 7041 7042 7043 7045 7046 7048 7049 7051 7308 7316 7515 9001 9002 9003 9004 9005 9006 9008 9009 9012 9015 9018 9019 9020 9022 9023 9024 9025 9030 9031 9032 9033 9038 9040 9042 9044 9045 9046 9047 9051 9054 9055 9057 9100 9104 9105 9108 9110 9112 9114 9115 9117 9118 9119 9120 9121 9122 9123 9124 9125 9126 9127 9128 9130 9132 9133 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Group title Urofollitropin ............................................................................... Monoclonal antibodies ............................................................... Pentastarch 10% solution .......................................................... Tirofiban hcl ............................................................................... Capecitabine, oral ...................................................................... Infliximab injection ...................................................................... Trimetrexate glucoronate ........................................................... Doxorubicin hcl liposome inj ...................................................... Alteplase recombinant ............................................................... Filgrastim injection ..................................................................... Leuprolide acetate implant ......................................................... Aminolevulinic acid hcl top ........................................................ Sodium hyaluronate injection ..................................................... Cyclosporine oral ....................................................................... Linezolid injection ....................................................................... Tenecteplase .............................................................................. Palivizumab ................................................................................ Gemtuzumab ozogamicin .......................................................... Reteplase injection ..................................................................... Tacrolimus injection ................................................................... Baclofen Refill Kit-500mcg ......................................................... Baclofen refill kit—per 2000 mcg ............................................... Arsenic Trioxide ......................................................................... Mycophenolate mofetil oral ........................................................ Botulinum toxin B ....................................................................... Caspofungin acetate .................................................................. Sirolimus tablet .......................................................................... IM inj interferon beta 1–a ........................................................... Rho d immune globulin .............................................................. Amphotericin b lipid complex ..................................................... Rubidium-Rb-82 ......................................................................... Amphotericin B ........................................................................... Arbutamine HCl injection ........................................................... Baclofen 10 MG injection ........................................................... Cidofovir injection ....................................................................... Inj estrogen conjugate ............................................................... Intraocular Fomivirsen na .......................................................... Glucagon hydrochloride ............................................................. Ibutilide fumarate injection ......................................................... Iron dextran ................................................................................ Iron sucrose injection ................................................................. Itraconazole injection ................................................................. Urea injection ............................................................................. Metabolically active tissue ......................................................... Injectable human tissue ............................................................. Lepirudin .................................................................................... Iodinated I-131 serumalbumin, per 5uci .................................... Anti-thymocycte globulin rabbit .................................................. Hep B imm glob ......................................................................... Thyrotropin alfa .......................................................................... Alemtuzumab injection ............................................................... Inj Perflutren lipid micros, ml ..................................................... Nesiritide .................................................................................... Inj, zoledronic acid ..................................................................... Yttrium 90 ibritumomab tiuxetan ................................................ In-111 ibritumomab tiuxetan ...................................................... Pegfilgrastim .............................................................................. Inj, Fulvestrant ........................................................................... Inj, Argatroban ........................................................................... Triptorelin pamoate .................................................................... Transcyte ................................................................................... Injection, daptomycin ................................................................. Risperidone, long acting ............................................................ Injection, natalizumab ................................................................ Paclitaxel protein pr ................................................................... Inj pegaptanib sodium ................................................................ Na chromateCr51, per 0.25mCi ................................................. 51 Na Chromate, 50mCi ............................................................ Rabies ig, im/sc ......................................................................... VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 4.1491 .................... .................... .................... 0.2447 0.7209 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.0454 .................... .................... .................... .................... .................... 1.8813 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.1897 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $44.74 $885.36 $12.45 $7.89 $3.30 $54.20 $139.85 $365.64 $30.65 $282.29 $2,262.19 $96.79 $110.65 $1.00 $24.15 $2,052.77 $246.22 $2,245.04 $898.81 $126.61 $14.52 $42.78 $33.76 $2.50 $7.89 $32.35 $6.85 $89.10 $25.08 $11.95 .................... $30.70 $163.15 $188.01 $782.98 $57.77 $203.93 $62.16 $243.34 $11.43 $0.38 $36.93 $62.04 $15.69 $3.54 $128.17 .................... $299.47 $111.64 $712.58 $516.87 $63.51 $75.19 $202.41 .................... .................... $2,178.28 $82.90 $11.26 $369.98 $719.41 $0.30 $4.71 $6.51 $8.59 $1,074.27 .................... .................... $64.56 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $8.95 $177.07 $2.49 $1.58 $0.66 $10.84 $27.97 $73.13 $6.13 $56.46 $452.44 $19.36 $22.13 $0.20 $4.83 $410.55 $49.24 $449.01 $179.76 $25.32 $2.90 $8.56 $6.75 $0.50 $1.58 $6.47 $1.37 $17.82 $5.02 $2.39 .................... $6.14 $32.63 $37.60 $156.60 $11.55 $40.79 $12.43 $48.67 $2.29 $0.08 $7.39 $12.41 $3.14 $0.71 $25.63 .................... $59.89 $22.33 $142.52 $103.37 $12.70 $15.04 $40.48 .................... .................... $435.66 $16.58 $2.25 $74.00 $143.88 $0.06 $0.94 $1.30 $1.72 $214.85 .................... .................... $12.91 E:\FR\FM\26AUP3.SGM 26AUP3 SI Frm 00016 Fmt 4701 K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K H K K K K K K K K K K K K K K K H K K K K K K K H H K K K K K G G G K K H H K ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ Sfmt 4702 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50695 ADDENDUM A.—LIST OF AMBULATORY PAYMENT CLASSIFICATIONS (APCS) WITH STATUS INDICATORS, RELATIVE WEIGHTS, PAYMENT RATES, AND COPAYMENT AMOUNTS CALENDAR YEAR 2006—Continued APC 9134 9135 9136 9137 9138 9139 9140 9141 9142 9143 9144 9145 9146 9147 9148 9149 9150 9151 9152 9153 9154 9155 9156 9157 9158 9159 9160 9161 9162 9163 9164 9165 9166 9167 9168 9169 9200 9201 9202 9203 9205 9206 9207 9208 9209 9210 9211 9212 9213 9214 9215 9216 9217 9218 9219 9220 9221 9222 9300 9500 9501 9502 9503 9504 9505 9506 9507 9508 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Group title Rabies ig, heat treated .............................................................. Varicella-zoster ig, im ................................................................ Adenovirus vaccine, type 4 ........................................................ Bcg vaccine, percut ................................................................... Hep a/hep b vacc, adult im ........................................................ Rabies vaccine, im ..................................................................... Rabies vaccine, id ...................................................................... Measles-rubella vaccine, sc ....................................................... Chicken pox vaccine, sc ............................................................ Meningococcal vaccine, sc ........................................................ Encephalitis vaccine, sc ............................................................. Meningococcal vaccine, im ........................................................ Technetium TC99m Disofenin ................................................... Technetium TC 99M Depreotide ............................................... I–123 sodium iodide capsule ..................................................... Dx I131 so iodide microcurie ..................................................... I–125 serum albumin micro ....................................................... Tc 99M ARCITUMOMAB PER VIAL ......................................... Baclofen Intrathecal kit-1am ...................................................... Na Iothalamate I–125, 10 uCi .................................................... Technetium tc99m glucepatate .................................................. Technetium tc99mlabeledrbcs ................................................... Nonmetabolic active tissue ........................................................ LOCM <=149 mg/ml iodine ........................................................ LOCM 150-199mg/ml iodine ...................................................... LOCM 200–249mg/ml iodine ..................................................... LOCM 250–299mg/ml iodine ..................................................... LOCM 300–349mg/ml iodine ..................................................... LOCM 350–399mg/ml iodine ..................................................... LOCM >= 400 mg/ml iodine ...................................................... Inj Gad-base MR contrast .......................................................... Oral MR contrast ........................................................................ Dyphylline injection .................................................................... Valrubicin ................................................................................... Pegademase bovine .................................................................. Anthrax vaccine, sc .................................................................... Orcel ........................................................................................... Dermagraft ................................................................................. Inj Octafluoropropane mic,ml ..................................................... Inj Perflexane lipid micros, ml .................................................... Oxaliplatin .................................................................................. Integra ........................................................................................ Injection, bortezomib .................................................................. Injection, agalsidase beta .......................................................... Injection, laronidase ................................................................... Injection, palonosetron HCL ...................................................... Inj, alefacept, IV ......................................................................... Inj, alefacept, IM ........................................................................ Injection, Pemetrexed ................................................................ Injection, Bevacizumab .............................................................. Injection, Cetuximab .................................................................. Abarelix Injection ........................................................................ Leuprolide acetate suspnsion .................................................... Injection, Azacitidine .................................................................. Mycophenolic Acid ..................................................................... Sodium hyaluronate ................................................................... Graftjacket Reg Matrix ............................................................... Graftjacket SftTis ....................................................................... Injection, Omalizumab ............................................................... Platelets, irradiated .................................................................... Platelets, pheresis, leukocytes reduced .................................... Platelet pheresis irradiated ........................................................ Fresh frozen plasma, ea unit ..................................................... RBC deglycerolized ................................................................... RBC irradiated ........................................................................... Granulocytes, pheresis .............................................................. Platelets, pheresis ...................................................................... Plasma, frozen w/in 8 hours ...................................................... VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment .................... .................... 0.9499 .................... 0.9674 .................... 1.4959 0.9467 .................... .................... .................... 0.8948 .................... .................... .................... .................... .................... .................... 0.8562 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 2.6893 6.2066 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.3589 8.1495 5.1895 1.6241 6.4314 2.3876 15.6155 6.8988 1.2038 $69.79 $96.58 $56.37 $124.54 $57.41 $128.04 $88.77 $56.18 $64.29 $56.75 $67.73 $53.10 .................... .................... .................... .................... .................... .................... $50.81 .................... .................... .................... $53.76 $0.51 $2.00 $0.78 $0.66 $0.41 $0.27 $0.20 $3.01 $9.01 $7.74 $376.87 $161.16 $128.95 $159.59 $368.32 $41.42 $13.49 $84.06 $9.23 $28.90 $123.35 $23.16 18.42 $571.01 $402.00 $41.29 $58.17 $50.59 $66.96 $230.87 $4.03 $2.47 $203.84 $1,234.36 $890.74 $15.98 $80.64 $483.62 $307.96 $96.38 $381.66 $141.69 $926.67 $409.40 $71.44 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $13.96 $19.32 $11.27 $24.91 $11.48 $25.61 $17.75 $11.24 $12.86 $11.35 $13.55 $10.62 .................... .................... .................... .................... .................... .................... $10.16 .................... .................... .................... $10.75 $0.10 $0.40 $0.16 $0.13 $0.08 $0.05 $0.04 $0.60 $1.80 $1.55 $75.37 $32.23 $25.79 $31.92 $73.66 $8.28 $2.70 $16.81 $1.85 $5.78 $24.67 $4.63 $3.68 $114.20 $80.40 $8.26 $11.63 $10.12 $13.39 $46.17 $0.81 $0.49 $40.77 $246.87 $178.15 $3.20 $16.13 $96.72 $61.59 $19.28 $76.33 $28.34 $185.33 $81.88 $14.29 E:\FR\FM\26AUP3.SGM 26AUP3 SI Frm 00017 Fmt 4701 K K K K K K K K K K K K H H H H H H K H H H K K K K K K K K K K K K K K K K K K K K K K K K K K G G G G K K G G G G G K K K K K K K K K ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ Sfmt 4702 50696 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 6. On pages 42776–42965, Addendum B is corrected to read as follows: ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006 CPT/ HCPCS 0003T 0008T 00100 00102 00103 00104 0010T 00120 00124 00126 00140 00142 00144 00145 00147 00148 00160 00162 00164 0016T 00170 00172 00174 00176 0017T 0018T 00190 00192 0019T 0020T 00210 00212 00214 00215 00216 00218 0021T 00220 00222 0023T 0024T 0026T 0027T 0028T 0029T 00300 0030T 0031T 00320 00322 00326 0032T 0033T 0034T 00350 00352 0035T 0036T 0037T 0038T 0039T 00400 ...... ...... ....... ....... ....... ....... ...... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ...... ....... ....... ....... ....... ...... ...... ....... ....... ...... ...... ....... ....... ....... ....... ....... ....... ...... ....... ....... ...... ...... ...... ...... ...... ...... ....... ...... ...... ....... ....... ....... ...... ...... ...... ....... ....... ...... ...... ...... ...... ...... ....... SI S T N N N N A N N N N N N N N N N N N T N N N C E S N C E B N N C C N N C N N A C A T N A N A N N N N N C C N N C C C C C N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Cervicography .......................................... Upper gi endoscopy w/suture .................. Anesth, salivary gland ............................. Anesth, repair of cleft lip .......................... Anesth, blepharoplasty ............................ Anesth, electroshock ............................... Tb test, gamma interferon ....................... Anesth, ear surgery ................................. Anesth, ear exam .................................... Anesth, tympanotomy .............................. Anesth, procedures on eye ..................... Anesth, lens surgery ................................ Anesth, corneal transplant ....................... Anesth, vitreoretinal surg ......................... Anesth, iridectomy ................................... Anesth, eye exam .................................... Anesth, nose/sinus surgery ..................... Anesth, nose/sinus surgery ..................... Anesth, biopsy of nose ............................ Thermotx choroid vasc lesion .................. Anesth, procedure on mouth ................... Anesth, cleft palate repair ........................ Anesth, pharyngeal surgery ..................... Anesth, pharyngeal surgery ..................... Photocoagulat macular drusen ................ Transcranial magnetic stimul ................... Anesth, face/skull bone surg ................... Anesth, facial bone surgery ..................... Extracorp shock wave tx, ms .................. Extracorp shock wave tx, ft ..................... Anesth, open head surgery ..................... Anesth, skull drainage ............................. Anesth, skull drainage ............................. Anesth, skull repair/fract .......................... Anesth, head vessel surgery ................... Anesth, special head surgery .................. Fetal oximetry, trnsvag/cerv .................... Anesth, intrcrn nerve ............................... Anesth, head nerve surgery .................... Phenotype drug test, hiv 1 ...................... Transcath cardiac reduction .................... Measure remnant lipoproteins ................. Endoscopic epidural lysis ........................ Dexa body composition study ................. Magnetic tx for incontinence .................... Anesth, head/neck/ptrunk ........................ Antiprothrombin antibody ......................... Speculoscopy ........................................... Anesth, neck organ, 1 & over .................. Anesth, biopsy of thyroid ......................... Anesth, larynx/trach, < 1 yr ..................... Speculoscopy w/direct sample ................ Endovasc taa repr incl subcl ................... Endovasc taa repr w/o subcl ................... Anesth, neck vessel surgery ................... Anesth, neck vessel surgery ................... 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 ................... Anesth, skin, ext/per/atrunk ..................... 1492 0422 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0235 .................... .................... .................... .................... .................... 0215 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0220 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 22.9647 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 4.6593 .................... .................... .................... .................... .................... 0.6115 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 17.3586 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.00 $1,362.79 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $276.50 .................... .................... .................... .................... .................... $36.29 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,030.11 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $448.81 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $67.40 .................... .................... .................... .................... .................... $14.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.00 $272.56 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $55.30 .................... .................... .................... .................... .................... $7.26 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $206.02 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00018 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50697 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 00402 00404 00406 0040T 00410 0041T 0042T 0043T 0044T 00450 00452 00454 0045T 0046T 00470 00472 00474 0047T 0048T 0049T 00500 0050T 0051T 00520 00522 00524 00528 00529 0052T 00530 00532 00534 00537 00539 0053T 00540 00541 00542 00546 00548 0054T 00550 0055T 00560 00561 00562 00563 00566 0056T 00580 0058T 0059T 00600 00604 0060T 0061T 00620 00622 0062T 00630 00632 00634 00635 0063T 00640 0064T ....... ....... ....... ...... ....... ...... ...... ...... ...... ....... ....... ....... ...... ...... ....... ....... ....... ...... ...... ...... ....... ...... ...... ....... ....... ....... ....... ....... ...... ....... ....... ....... ....... ....... ...... ....... ....... ....... ....... ....... ...... ....... ...... ....... ....... ....... ....... ....... ...... ....... ...... ...... ....... ....... ...... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ...... SI N C C C N A N A N N C N N T N N C T C C N C C N N C N N C N N N N N C C N C C N B N B C C C N N B C X X N C B B N C T N C N N T N A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Anesth, surgery of breast ........................ Anesth, surgery of breast ........................ Anesth, surgery of breast ........................ Rad s/i, endovasc taa prosth ................... Anesth, correct heart rhythm ................... Detect ur infect agnt w/cpas .................... Ct perfusion w/contrast, cbf ..................... Co expired gas analysis .......................... Whole body photography ......................... Anesth, surgery of shoulder .................... Anesth, surgery of shoulder .................... Anesth, collar bone biopsy ...................... Whole body photography ......................... Cath lavage, mammary duct(s) ............... Anesth, removal of rib ............................. Anesth, chest wall repair ......................... Anesth, surgery of rib(s) .......................... Cath lavage, mammary duct(s) ............... Implant ventricular device ........................ External circulation assist ........................ Anesth, esophageal surgery .................... Removal circulation assist ....................... Implant total heart system ....................... Anesth, chest procedure .......................... Anesth, chest lining biopsy ...................... Anesth, chest drainage ............................ Anesth, chest partition view ..................... Anesth, chest partition view ..................... Replace component heart syst ................ Anesth, pacemaker insertion ................... Anesth, vascular access .......................... Anesth, cardioverter/defib ........................ Anesth, cardiac electrophys .................... Anesth, trach-bronch reconst .................. Replace component heart syst ................ Anesth, chest surgery .............................. Anesth, one lung ventilation .................... Anesth, release of lung ............................ Anesth, lung,chest wall surg .................... Anesth, trachea,bronchi surg ................... Bone surgery using computer ................. Anesth, sternal debridement .................... Bone surgery using computer ................. Anesth, open heart surgery ..................... Anesth, heart surg < age 1 ...................... Anesth, open heart surgery ..................... Anesth, heart proc w/pump ..................... Anesth, cabg w/o pump ........................... Bone surgery using computer ................. Anesth, heart/lung transplnt ..................... Cryopreservation, ovary tiss .................... Cryopreservation, oocyte ......................... Anesth, spine, cord surgery ..................... Anesth, sitting procedure ......................... Electrical impedance scan ....................... Destruction of tumor, breast .................... Anesth, spine, cord surgery ..................... Anesth, removal of nerves ....................... Rep intradisc annulus1 lev ...................... Anesth, spine, cord surgery ..................... Anesth, removal of nerves ....................... Anesth for chemonucleolysis ................... Anesth, lumbar puncture ......................... Rep intradisc annulus>1lev ..................... Anesth, spine manipulation ..................... Spectroscop eval expired gas ................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0021 .................... .................... .................... 0021 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0348 0348 .................... .................... .................... .................... .................... .................... 0203 .................... .................... .................... .................... 0203 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 14.9776 .................... .................... .................... 14.9776 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.7927 0.7927 .................... .................... .................... .................... .................... .................... 10.4015 .................... .................... .................... .................... 10.4015 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $888.82 .................... .................... .................... $888.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $47.04 $47.04 .................... .................... .................... .................... .................... .................... $617.26 .................... .................... .................... .................... $617.26 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $219.48 .................... .................... .................... $219.48 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $246.90 .................... .................... .................... .................... $246.90 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $177.76 .................... .................... .................... $177.76 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.41 $9.41 .................... .................... .................... .................... .................... .................... $123.45 .................... .................... .................... .................... $123.45 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00019 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50698 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 0065T ...... 0066T ...... 00670 ....... 0067T* ..... 0068T ...... 0069T ...... 00700 ....... 00702 ....... 0070T ...... 0071T ...... 0072T ...... 00730 ....... 0073T ...... 00740 ....... 0074T ...... 00750 ....... 00752 ....... 00754 ....... 00756 ....... 0075T ...... 0076T ...... 00770 ....... 0077T ...... 0078T ...... 00790 ....... 00792 ....... 00794 ....... 00796 ....... 00797 ....... 0079T ...... 00800 ....... 00802 ....... 0080T ...... 00810 ....... 0081T ...... 00820 ....... 0082T ...... 00830 ....... 00832 ....... 00834 ....... 00836 ....... 0083T ...... 00840 ....... 00842 ....... 00844 ....... 00846 ....... 00848 ....... 0084T ...... 00851 ....... 0085T ...... 00860 ....... 00862 ....... 00864 ....... 00865 ....... 00866 ....... 00868 ....... 0086T ...... 00870 ....... 00872 ....... 00873 ....... 0087T ...... 00880 ....... 00882 ....... 0088T ...... 00902 ....... 00904 ....... SI A E C S B N N N N T T N S N E N N N N C C N C C N C C C N C N C C N C N B N N N N N N N C C C T N X N N C C C C N N N N X N C T N C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Ocular photoscreen bilat .......................... Ct colonography screen ........................... Anesth, spine, cord surgery ..................... Ct colonography dx .................................. Interp/rept heart sound ............................ Analysis only heart sound ....................... Anesth, abdominal wall surg ................... Anesth, for liver biopsy ............................ Interp only heart sound ............................ U/s leiomyomata ablate <200 .................. U/s leiomyomata ablate >200 .................. Anesth, abdominal wall surg ................... Delivery, comp imrt .................................. Anesth, upper gi visualize ....................... Online physician e/m ............................... Anesth, repair of hernia ........................... Anesth, repair of hernia ........................... Anesth, repair of hernia ........................... Anesth, repair of hernia ........................... Perq stent/chest vert art .......................... S&i stent/chest vert art ............................ Anesth, blood vessel repair ..................... Cereb therm perfusion probe .................. Endovasc aort repr w/device ................... Anesth, surg upper abdomen .................. Anesth, hemorr/excise liver ..................... Anesth, pancreas removal ....................... Anesth, for liver transplant ....................... Anesth, surgery for obesity ...................... Endovasc visc extnsn repr ...................... Anesth, abdominal wall surg ................... Anesth, fat layer removal ......................... Endovasc aort repr rad s&i ...................... Anesth, low intestine scope ..................... Endovasc visc extnsn s&i ........................ Anesth, abdominal wall surg ................... Stereotactic rad delivery .......................... Anesth, repair of hernia ........................... Anesth, repair of hernia ........................... Anesth, hernia repair< 1 yr ...................... Anesth hernia repair preemie .................. Stereotactic rad tx mngmt ....................... Anesth, surg lower abdomen ................... Anesth, amniocentesis ............................. Anesth, pelvis surgery ............................. Anesth, hysterectomy .............................. Anesth, pelvic organ surg ........................ Temp prostate urethral stent ................... Anesth, tubal ligation ............................... Breath test heart reject ............................ Anesth, surgery of abdomen ................... Anesth, kidney/ureter surg ....................... Anesth, removal of bladder ..................... Anesth, removal of prostate .................... Anesth, removal of adrenal ..................... Anesth, kidney transplant ........................ L ventricle fill pressure ............................. Anesth, bladder stone surg ..................... Anesth kidney stone destruct .................. Anesth kidney stone destruct .................. Sperm eval hyaluronan ............................ Anesth, abdomen vessel surg ................. Anesth, major vein ligation ...................... Rf tongue base vol reduxn ...................... Anesth, anorectal surgery ........................ Anesth, perineal surgery .......................... .................... .................... .................... 0333 .................... .................... .................... .................... .................... 0193 0193 .................... 0412 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0164 .................... 0340 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0348 .................... .................... 0253 .................... .................... .................... .................... .................... 5.2836 .................... .................... .................... .................... .................... 14.5843 14.5843 .................... 5.3643 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.1855 .................... 0.6384 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.7927 .................... .................... 16.1357 .................... .................... .................... .................... .................... $313.54 .................... .................... .................... .................... .................... $865.48 $865.48 .................... $318.33 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $70.35 .................... $37.88 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $47.04 .................... .................... $957.54 .................... .................... .................... .................... .................... $125.41 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $17.29 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $282.29 .................... .................... .................... .................... .................... $62.71 .................... .................... .................... .................... .................... $173.10 $173.10 .................... $63.67 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.07 .................... $7.58 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.41 .................... .................... $191.51 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00020 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50699 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 00906 00908 00910 00912 00914 00916 00918 00920 00921 00922 00924 00926 00928 00930 00932 00934 00936 00938 00940 00942 00944 00948 00950 00952 01112 01120 01130 01140 01150 01160 01170 01173 01180 01190 01200 01202 01210 01212 01214 01215 01220 01230 01232 01234 01250 01260 01270 01272 01274 01320 01340 01360 01380 01382 01390 01392 01400 01402 01404 01420 01430 01432 01440 01442 01444 01462 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N C N N N N N N N N N N N N C C C N N N C N N N N N N C C N N N N N N N N C C N N N C C N N N C C N N N N N N N N C C N N N N C C N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... APC Description Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, Anesth, removal of vulva ......................... removal of prostate .................... bladder surgery .......................... bladder tumor surg ..................... removal of prostate .................... bleeding control .......................... stone removal ............................. genitalia surgery ......................... vasectomy .................................. sperm duct surgery .................... testis exploration ........................ removal of testis ......................... removal of testis ......................... testis suspension ........................ amputation of penis .................... penis, nodes removal ................. penis, nodes removal ................. insert penis device ..................... vaginal procedures ..................... surg on vag/urethral ................... vaginal hysterectomy .................. repair of cervix ............................ vaginal endoscopy ...................... hysteroscope/graph .................... bone aspirate/bx ......................... pelvis surgery ............................. body cast procedure ................... amputation at pelvis ................... pelvic tumor surgery ................... pelvis procedure ......................... pelvis surgery ............................. fx repair, pelvis ........................... pelvis nerve removal .................. pelvis nerve removal .................. hip joint procedure ...................... arthroscopy of hip ....................... hip joint surgery .......................... hip disarticulation ........................ hip arthroplasty ........................... revise hip repair .......................... procedure on femur .................... surgery of femur ......................... amputation of femur ................... radical femur surg ...................... upper leg surgery ....................... upper leg veins surg ................... thigh arteries surg ...................... femoral artery surg ..................... femoral embolectomy ................. knee area surgery ...................... knee area procedure .................. knee area surgery ...................... knee joint procedure ................... dx knee arthroscopy ................... knee area procedure .................. knee area surgery ...................... knee joint surgery ....................... knee arthroplasty ........................ amputation at knee ..................... knee joint casting ....................... knee veins surgery ..................... knee vessel surg ........................ knee arteries surg ...................... knee artery surg ......................... knee artery repair ....................... lower leg procedure .................... Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00021 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50700 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 01464 01470 01472 01474 01480 01482 01484 01486 01490 01500 01502 01520 01522 01610 01620 01622 01630 01632 01634 01636 01638 01650 01652 01654 01656 01670 01680 01682 01710 01712 01714 01716 01730 01732 01740 01742 01744 01756 01758 01760 01770 01772 01780 01782 01810 01820 01829 01830 01832 01840 01842 01844 01850 01852 01860 01905 01916 01920 01922 01924 01925 01926 01930 01931 01932 01933 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N N N N N N N C N N C N N N N N N C C C C N C C C N N N N N N N N N N N N C N N N N N N N N N N N N N N N N N N N N N N N N N N N N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Anesth, ankle/ft arthroscopy .................... Anesth, lower leg surgery ........................ Anesth, achilles tendon surg ................... Anesth, lower leg surgery ........................ Anesth, lower leg bone surg .................... Anesth, radical leg surgery ...................... Anesth, lower leg revision ....................... Anesth, ankle replacement ...................... Anesth, lower leg casting ........................ Anesth, leg arteries surg ......................... Anesth, lwr leg embolectomy .................. Anesth, lower leg vein surg ..................... Anesth, lower leg vein surg ..................... Anesth, surgery of shoulder .................... Anesth, shoulder procedure .................... Anes dx shoulder arthroscopy ................. Anesth, surgery of shoulder .................... Anesth, surgery of shoulder .................... Anesth, shoulder joint amput ................... Anesth, forequarter amput ....................... Anesth, shoulder replacement ................. Anesth, shoulder artery surg ................... Anesth, shoulder vessel surg .................. Anesth, shoulder vessel surg .................. Anesth, arm-leg vessel surg .................... Anesth, shoulder vein surg ...................... Anesth, shoulder casting ......................... Anesth, airplane cast ............................... Anesth, elbow area surgery ..................... Anesth, uppr arm tendon surg ................. Anesth, uppr arm tendon surg ................. Anesth, biceps tendon repair ................... Anesth, uppr arm procedure .................... Anesth, dx elbow arthroscopy ................. Anesth, upper arm surgery ...................... Anesth, humerus surgery ........................ Anesth, humerus repair ........................... Anesth, radical humerus surg .................. Anesth, humeral lesion surg .................... Anesth, elbow replacement ..................... Anesth, uppr arm artery surg .................. Anesth, uppr arm embolectomy .............. Anesth, upper arm vein surg ................... Anesth, uppr arm vein repair ................... Anesth, lower arm surgery ...................... Anesth, lower arm procedure .................. Anesth, dx wrist arthroscopy ................... Anesth, lower arm surgery ...................... Anesth, wrist replacement ....................... Anesth, lwr arm artery surg ..................... Anesth, lwr arm embolectomy ................. Anesth, vascular shunt surg .................... Anesth, lower arm vein surg .................... Anesth, lwr arm vein repair ..................... Anesth, lower arm casting ....................... Anes, spine inject, x-ray/re ...................... Anesth, dx arteriography ......................... Anesth, catheterize heart ......................... Anesth, cat or MRI scan .......................... Anes, ther interven rad, art ...................... Anes, ther interven rad, car ..................... Anes, tx interv rad hrt/cran ...................... Anes, ther interven rad, vei ..................... Anes, ther interven rad, tip ...................... Anes, tx interv rad, th vein ...................... Anes, tx interv rad, cran v ....................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00022 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50701 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 01951 01952 01953 01958 01960 01961 01962 01963 01964 01967 01968 01969 01990 01991 01992 01995 01996 01999 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ...... ...... ...... ...... ...... ...... ....... ....... ...... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N N N N N N N N N N N N C N N N N N E E E E E E T T E T T T T T T T T T T T T C C C C T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Anesth, burn, less 4 percent ................... Anesth, burn, 4-9 percent ........................ Anesth, burn, each 9 percent .................. Anesth, antepartum manipul .................... Anesth, vaginal delivery ........................... Anesth, cs delivery .................................. Anesth, emer hysterectomy ..................... Anesth, cs hysterectomy ......................... Anesth, abortion procedures ................... Anesth/analg, vag delivery ...................... Anes/analg cs deliver add-on .................. Anesth/analg cs hyst add-on ................... Support for organ donor .......................... Anesth, nerve block/inj ............................ Anesth, n block/inj, prone ........................ Regional anesthesia limb ........................ Hosp manage cont drug admin ............... Unlisted anesth procedure ....................... 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 ..................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0002 0036 .................... 0010 0006 0006 0006 0007 0006 0021 0007 0018 0008 0015 0012 .................... .................... .................... .................... 0019 0019 0019 0015 0015 0016 0016 0682 0012 0012 0013 0018 0018 0013 0015 0012 0012 0013 0015 0013 0013 0013 0013 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.9559 2.1773 .................... 0.5719 1.55 1.55 1.55 11.4501 1.55 14.9776 11.4501 1.1726 16.4989 1.6514 0.8497 .................... .................... .................... .................... 4.0547 4.0547 4.0547 1.6514 1.6514 2.5834 2.5834 6.9107 0.8497 0.8497 1.1078 1.1726 1.1726 1.1078 1.6514 0.8497 0.8497 1.1078 1.6514 1.1078 1.1078 1.1078 1.1078 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $56.73 $129.21 .................... $33.94 $91.98 $91.98 $91.98 $679.48 $91.98 $888.82 $679.48 $69.59 $979.09 $98.00 $50.42 .................... .................... .................... .................... $240.62 $240.62 $240.62 $98.00 $98.00 $153.31 $153.31 $410.10 $50.42 $50.42 $65.74 $69.59 $69.59 $65.74 $98.00 $50.42 $50.42 $65.74 $98.00 $65.74 $65.74 $65.74 $65.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.65 $22.28 $22.28 $22.28 .................... $22.28 $219.48 .................... $16.04 .................... $20.29 $11.18 .................... .................... .................... .................... $71.87 $71.87 $71.87 $20.29 $20.29 $33.57 $33.57 $162.42 $11.18 $11.18 $14.20 $16.04 $16.04 $14.20 $20.29 $11.18 $11.18 $14.20 $20.29 $14.20 $14.20 $14.20 $14.20 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $11.35 $25.84 .................... $6.79 $18.40 $18.40 $18.40 $135.90 $18.40 $177.76 $135.90 $13.92 $195.82 $19.60 $10.08 .................... .................... .................... .................... $48.12 $48.12 $48.12 $19.60 $19.60 $30.66 $30.66 $82.02 $10.08 $10.08 $13.15 $13.92 $13.92 $13.15 $19.60 $10.08 $10.08 $13.15 $19.60 $13.15 $13.15 $13.15 $13.15 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00023 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50702 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 11310 11311 11312 11313 11400 11401 11402 11403 11404 11406 11420 11421 11422 11423 11424 11426 11440 11441 11442 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Shave skin lesion ..................................... Shave skin lesion ..................................... Shave skin lesion ..................................... Shave skin lesion ..................................... Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal, sweat gland lesion ................... Removal, sweat gland lesion ................... Removal, sweat gland lesion ................... Removal, sweat gland lesion ................... Removal, sweat gland lesion ................... Removal, sweat gland lesion ................... Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ Removal of skin lesion ............................ 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 ........................ Relative weight APC 0013 0013 0013 0016 0019 0019 0019 0020 0021 0021 0020 0020 0020 0021 0021 0022 0019 0019 0020 0020 0020 0022 0022 0022 0022 0022 0022 0022 0019 0019 0019 0020 0020 0021 0020 0019 0020 0021 0021 0022 0020 0020 0020 0020 0021 0022 0009 0009 0009 0013 0012 0009 0019 0022 0019 0024 0024 0015 0022 0022 0022 0012 0012 0024 0024 0024 1.1078 1.1078 1.1078 2.5834 4.0547 4.0547 4.0547 6.9433 14.9776 14.9776 6.9433 6.9433 6.9433 14.9776 14.9776 19.6472 4.0547 4.0547 6.9433 6.9433 6.9433 19.6472 19.6472 19.6472 19.6472 19.6472 19.6472 19.6472 4.0547 4.0547 4.0547 6.9433 6.9433 14.9776 6.9433 4.0547 6.9433 14.9776 14.9776 19.6472 6.9433 6.9433 6.9433 6.9433 14.9776 19.6472 0.668 0.668 0.668 1.1078 0.8497 0.668 4.0547 19.6472 4.0547 1.6084 1.6084 1.6514 19.6472 19.6472 19.6472 0.8497 0.8497 1.6084 1.6084 1.6084 Payment rate $65.74 $65.74 $65.74 $153.31 $240.62 $240.62 $240.62 $412.04 $888.82 $888.82 $412.04 $412.04 $412.04 $888.82 $888.82 $1,165.92 $240.62 $240.62 $412.04 $412.04 $412.04 $1,165.92 $1,165.92 $1,165.92 $1,165.92 $1,165.92 $1,165.92 $1,165.92 $240.62 $240.62 $240.62 $412.04 $412.04 $888.82 $412.04 $240.62 $412.04 $888.82 $888.82 $1,165.92 $412.04 $412.04 $412.04 $412.04 $888.82 $1,165.92 $39.64 $39.64 $39.64 $65.74 $50.42 $39.64 $240.62 $1,165.92 $240.62 $95.45 $95.45 $98.00 $1,165.92 $1,165.92 $1,165.92 $50.42 $50.42 $95.45 $95.45 $95.45 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00024 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 National unadjusted copayment Minimum unadjusted copayment $14.20 $14.20 $14.20 $33.57 $71.87 $71.87 $71.87 $107.40 $219.48 $219.48 $107.40 $107.40 $107.40 $219.48 $219.48 $354.45 $71.87 $71.87 $107.40 $107.40 $107.40 $354.45 $354.45 $354.45 $354.45 $354.45 $354.45 $354.45 $71.87 $71.87 $71.87 $107.40 $107.40 $219.48 $107.40 $71.87 $107.40 $219.48 $219.48 $354.45 $107.40 $107.40 $107.40 $107.40 $219.48 $354.45 $8.34 $8.34 $8.34 $14.20 $11.18 $8.34 $71.87 $354.45 $71.87 $31.25 $31.25 $20.29 $354.45 $354.45 $354.45 $11.18 $11.18 $31.25 $31.25 $31.25 $13.15 $13.15 $13.15 $30.66 $48.12 $48.12 $48.12 $82.41 $177.76 $177.76 $82.41 $82.41 $82.41 $177.76 $177.76 $233.18 $48.12 $48.12 $82.41 $82.41 $82.41 $233.18 $233.18 $233.18 $233.18 $233.18 $233.18 $233.18 $48.12 $48.12 $48.12 $82.41 $82.41 $177.76 $82.41 $48.12 $82.41 $177.76 $177.76 $233.18 $82.41 $82.41 $82.41 $82.41 $177.76 $233.18 $7.93 $7.93 $7.93 $13.15 $10.08 $7.93 $48.12 $233.18 $48.12 $19.09 $19.09 $19.60 $233.18 $233.18 $233.18 $10.08 $10.08 $19.09 $19.09 $19.09 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50703 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T E T E X X X X T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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) ..................... 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 ....................... 0024 0024 0024 0024 0027 0027 0022 .................... 0019 .................... 0340 0340 0340 0340 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0024 0025 0024 0024 0024 0024 0024 0025 0024 0024 0024 0024 0024 0024 0025 0025 0025 0024 0024 0024 0024 0024 0024 0024 0025 0024 0025 0024 0027 0686 0027 0686 0027 1.6084 1.6084 1.6084 1.6084 18.4182 18.4182 19.6472 .................... 4.0547 .................... 0.6384 0.6384 0.6384 0.6384 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 5.4938 1.6084 1.6084 1.6084 1.6084 1.6084 5.4938 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 5.4938 5.4938 5.4938 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 1.6084 5.4938 1.6084 5.4938 1.6084 18.4182 13.8287 18.4182 13.8287 18.4182 $95.45 $95.45 $95.45 $95.45 $1,092.99 $1,092.99 $1,165.92 .................... $240.62 .................... $37.88 $37.88 $37.88 $37.88 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $326.02 $95.45 $95.45 $95.45 $95.45 $95.45 $326.02 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $326.02 $326.02 $326.02 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $95.45 $326.02 $95.45 $326.02 $95.45 $1,092.99 $820.64 $1,092.99 $820.64 $1,092.99 $31.25 $31.25 $31.25 $31.25 $329.72 $329.72 $354.45 .................... $71.87 .................... .................... .................... .................... .................... $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $101.85 $31.25 $31.25 $31.25 $31.25 $31.25 $101.85 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $101.85 $101.85 $101.85 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $101.85 $31.25 $101.85 $31.25 $329.72 .................... $329.72 .................... $329.72 $19.09 $19.09 $19.09 $19.09 $218.60 $218.60 $233.18 .................... $48.12 .................... $7.58 $7.58 $7.58 $7.58 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $65.20 $19.09 $19.09 $19.09 $19.09 $19.09 $65.20 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $65.20 $65.20 $65.20 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $19.09 $65.20 $19.09 $65.20 $19.09 $218.60 $164.13 $218.60 $164.13 $218.60 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00025 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50704 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................................................. 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 muscle 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 ....................... Dressing change not for burn .................. 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 .......................... 0686 0027 0027 0686 0027 0027 0025 0025 0025 0027 0027 0027 0027 0027 0025 0027 0025 0686 0025 0686 0025 0024 0024 0686 0686 0025 0025 0027 0027 0027 0686 0027 0027 0027 0027 0027 0027 0027 0027 0027 0686 0027 .................... .................... .................... 0027 0027 0025 0025 0022 0019 0019 0016 0013 0013 0012 0015 0013 0012 0016 0016 0025 0027 0027 0027 0027 13.8287 18.4182 18.4182 13.8287 18.4182 18.4182 5.4938 5.4938 5.4938 18.4182 18.4182 18.4182 18.4182 18.4182 5.4938 18.4182 5.4938 13.8287 5.4938 13.8287 5.4938 1.6084 1.6084 13.8287 13.8287 5.4938 5.4938 18.4182 18.4182 18.4182 13.8287 18.4182 18.4182 18.4182 18.4182 18.4182 18.4182 18.4182 18.4182 18.4182 13.8287 18.4182 .................... .................... .................... 18.4182 18.4182 5.4938 5.4938 19.6472 4.0547 4.0547 2.5834 1.1078 1.1078 0.8497 1.6514 1.1078 0.8497 2.5834 2.5834 5.4938 18.4182 18.4182 18.4182 18.4182 $820.64 $1,092.99 $1,092.99 $820.64 $1,092.99 $1,092.99 $326.02 $326.02 $326.02 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $326.02 $1,092.99 $326.02 $820.64 $326.02 $820.64 $326.02 $95.45 $95.45 $820.64 $820.64 $326.02 $326.02 $1,092.99 $1,092.99 $1,092.99 $820.64 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $820.64 $1,092.99 .................... .................... .................... $1,092.99 $1,092.99 $326.02 $326.02 $1,165.92 $240.62 $240.62 $153.31 $65.74 $65.74 $50.42 $98.00 $65.74 $50.42 $153.31 $153.31 $326.02 $1,092.99 $1,092.99 $1,092.99 $1,092.99 .................... $329.72 $329.72 .................... $329.72 $329.72 $101.85 $101.85 $101.85 $329.72 $329.72 $329.72 $329.72 $329.72 $101.85 $329.72 $101.85 .................... $101.85 .................... $101.85 $31.25 $31.25 .................... .................... $101.85 $101.85 $329.72 $329.72 $329.72 .................... $329.72 $329.72 $329.72 $329.72 $329.72 $329.72 $329.72 $329.72 $329.72 .................... $329.72 .................... .................... .................... $329.72 $329.72 $101.85 $101.85 $354.45 $71.87 $71.87 $33.57 $14.20 $14.20 $11.18 $20.29 $14.20 $11.18 $33.57 $33.57 $101.85 $329.72 $329.72 $329.72 $329.72 $164.13 $218.60 $218.60 $164.13 $218.60 $218.60 $65.20 $65.20 $65.20 $218.60 $218.60 $218.60 $218.60 $218.60 $65.20 $218.60 $65.20 $164.13 $65.20 $164.13 $65.20 $19.09 $19.09 $164.13 $164.13 $65.20 $65.20 $218.60 $218.60 $218.60 $164.13 $218.60 $218.60 $218.60 $218.60 $218.60 $218.60 $218.60 $218.60 $218.60 $164.13 $218.60 .................... .................... .................... $218.60 $218.60 $65.20 $65.20 $233.18 $48.12 $48.12 $30.66 $13.15 $13.15 $10.08 $19.60 $13.15 $10.08 $30.66 $30.66 $65.20 $218.60 $218.60 $218.60 $218.60 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00026 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50705 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 15956 15958 15999 16000 16010 16015 16020 16025 16030 16035 16036 17000 17003 17004 17106 17107 17108 17110 17111 17250 17260 17261 17262 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T X X T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... 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 addl 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 ....................... 0027 0027 0027 0027 0027 0022 0022 0022 0022 0025 0021 0021 0021 0021 0027 0027 0027 0027 0016 0016 0340 0359 0027 0027 0686 0027 0019 0027 0022 0022 0027 0027 0027 0027 0022 0022 0027 0027 0027 0022 0022 0027 0027 0027 0027 0019 0012 0016 0017 0013 0013 0015 .................... .................... 0010 0010 0011 0011 0011 0011 0010 0010 0013 0015 0015 0015 18.4182 18.4182 18.4182 18.4182 18.4182 19.6472 19.6472 19.6472 19.6472 5.4938 14.9776 14.9776 14.9776 14.9776 18.4182 18.4182 18.4182 18.4182 2.5834 2.5834 0.6384 0.8312 18.4182 18.4182 13.8287 18.4182 4.0547 18.4182 19.6472 19.6472 18.4182 18.4182 18.4182 18.4182 19.6472 19.6472 18.4182 18.4182 18.4182 19.6472 19.6472 18.4182 18.4182 18.4182 18.4182 4.0547 0.8497 2.5834 18.4211 1.1078 1.1078 1.6514 .................... .................... 0.5719 0.5719 2.0839 2.0839 2.0839 2.0839 0.5719 0.5719 1.1078 1.6514 1.6514 1.6514 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,165.92 $1,165.92 $1,165.92 $1,165.92 $326.02 $888.82 $888.82 $888.82 $888.82 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $153.31 $153.31 $37.88 $49.33 $1,092.99 $1,092.99 $820.64 $1,092.99 $240.62 $1,092.99 $1,165.92 $1,165.92 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $1,165.92 $1,165.92 $1,092.99 $1,092.99 $1,092.99 $1,165.92 $1,165.92 $1,092.99 $1,092.99 $1,092.99 $1,092.99 $240.62 $50.42 $153.31 $1,093.16 $65.74 $65.74 $98.00 .................... .................... $33.94 $33.94 $123.66 $123.66 $123.66 $123.66 $33.94 $33.94 $65.74 $98.00 $98.00 $98.00 $329.72 $329.72 $329.72 $329.72 $329.72 $354.45 $354.45 $354.45 $354.45 $101.85 $219.48 $219.48 $219.48 $219.48 $329.72 $329.72 $329.72 $329.72 $33.57 $33.57 .................... .................... $329.72 $329.72 .................... $329.72 $71.87 $329.72 $354.45 $354.45 $329.72 $329.72 $329.72 $329.72 $354.45 $354.45 $329.72 $329.72 $329.72 $354.45 $354.45 $329.72 $329.72 $329.72 $329.72 $71.87 $11.18 $33.57 $227.84 $14.20 $14.20 $20.29 .................... .................... $9.65 $9.65 $25.17 $25.17 $25.17 $25.17 $9.65 $9.65 $14.20 $20.29 $20.29 $20.29 $218.60 $218.60 $218.60 $218.60 $218.60 $233.18 $233.18 $233.18 $233.18 $65.20 $177.76 $177.76 $177.76 $177.76 $218.60 $218.60 $218.60 $218.60 $30.66 $30.66 $7.58 $9.87 $218.60 $218.60 $164.13 $218.60 $48.12 $218.60 $233.18 $233.18 $218.60 $218.60 $218.60 $218.60 $233.18 $233.18 $218.60 $218.60 $218.60 $233.18 $233.18 $218.60 $218.60 $218.60 $218.60 $48.12 $10.08 $30.66 $218.63 $13.15 $13.15 $19.60 .................... .................... $6.79 $6.79 $24.73 $24.73 $24.73 $24.73 $6.79 $6.79 $13.15 $19.60 $19.60 $19.60 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00027 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50706 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 19296 19297 19298 19316 19318 19324 19325 19328 19330 19340 19342 19350 19355 19357 19361 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T C C T T C C N N S S S S T T T T T T T T T T T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Chemosurgery of skin lesion ................... 2 stage mohs, up to 5 spec ..................... 3 stage mohs, up to 5 spec ..................... Mohs addl stage up to 5 spec ................. Extensive skin chemosurgery .................. 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 ......................... Removal of breast tissue ......................... Remove breast tissue, nodes .................. 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 .......................... 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 ............................... 0015 0015 0016 0015 0013 0015 0015 0016 0016 0015 0015 0015 0015 0016 0015 0694 0694 0694 0694 0694 0012 0013 0013 0006 0004 0004 0008 .................... 0005 0028 0005 0658 0028 0028 0028 0028 0028 0028 0028 0693 0029 0029 .................... .................... 0030 0021 .................... .................... .................... .................... 0657 1524 1523 1524 0029 0693 0693 0648 0029 0029 0030 0648 0028 0029 0648 .................... 1.6514 1.6514 2.5834 1.6514 1.1078 1.6514 1.6514 2.5834 2.5834 1.6514 1.6514 1.6514 1.6514 2.5834 1.6514 3.8452 3.8452 3.8452 3.8452 3.8452 0.8497 1.1078 1.1078 1.55 1.7646 1.7646 16.4989 .................... 3.5994 19.5801 3.5994 6.1049 19.5801 19.5801 19.5801 19.5801 19.5801 19.5801 19.5801 42.2254 32.0476 32.0476 .................... .................... 40.0825 14.9776 .................... .................... .................... .................... 1.7092 .................... .................... .................... 32.0476 42.2254 42.2254 50.4459 32.0476 32.0476 40.0825 50.4459 19.5801 32.0476 50.4459 .................... $98.00 $98.00 $153.31 $98.00 $65.74 $98.00 $98.00 $153.31 $153.31 $98.00 $98.00 $98.00 $98.00 $153.31 $98.00 $228.19 $228.19 $228.19 $228.19 $228.19 $50.42 $65.74 $65.74 $91.98 $104.72 $104.72 $979.09 .................... $213.60 $1,161.94 $213.60 $362.28 $1,161.94 $1,161.94 $1,161.94 $1,161.94 $1,161.94 $1,161.94 $1,161.94 $2,505.78 $1,901.80 $1,901.80 .................... .................... $2,378.62 $888.82 .................... .................... .................... .................... $101.43 $3,250.00 $2,750.00 $3,250.00 $1,901.80 $2,505.78 $2,505.78 $2,993.61 $1,901.80 $1,901.80 $2,378.62 $2,993.61 $1,161.94 $1,901.80 $2,993.61 .................... $20.29 $20.29 $33.57 $20.29 $14.20 $20.29 $20.29 $33.57 $33.57 $20.29 $20.29 $20.29 $20.29 $33.57 $20.29 $61.86 $61.86 $61.86 $61.86 $61.86 $11.18 $14.20 $14.20 $22.28 $22.36 $22.36 .................... .................... $71.59 $303.74 $71.59 .................... $303.74 $303.74 $303.74 $303.74 $303.74 $303.74 $303.74 $798.17 $632.64 $632.64 .................... .................... $763.55 $219.48 .................... .................... .................... .................... .................... .................... .................... .................... $632.64 $798.17 $798.17 .................... $632.64 $632.64 $763.55 .................... $303.74 $632.64 .................... .................... $19.60 $19.60 $30.66 $19.60 $13.15 $19.60 $19.60 $30.66 $30.66 $19.60 $19.60 $19.60 $19.60 $30.66 $19.60 $45.64 $45.64 $45.64 $45.64 $45.64 $10.08 $13.15 $13.15 $18.40 $20.94 $20.94 $195.82 .................... $42.72 $232.39 $42.72 $72.46 $232.39 $232.39 $232.39 $232.39 $232.39 $232.39 $232.39 $501.16 $380.36 $380.36 .................... .................... $475.72 $177.76 .................... .................... .................... .................... $20.29 $650.00 $550.00 $650.00 $380.36 $501.16 $501.16 $598.72 $380.36 $380.36 $475.72 $598.72 $232.39 $380.36 $598.72 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00028 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50707 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 20824 20827 20838 20900 20902 20910 20912 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ...... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C T C C C T T T T T T T E T T T T T T T T T T T T T T T N T T T T T T T T T T T T T C C T T C X T T T T T T C C C C T C C C T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Inject tendon/ligament/cyst ...................... 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 .................... 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 ....................... .................... 0029 .................... .................... .................... 0029 0029 0030 0029 0028 0006 0049 .................... 0023 0027 0027 0023 0051 0021 0021 0005 0019 0020 0022 0022 0049 0049 0251 .................... 0019 0022 0204 0204 0204 0204 0204 0204 0204 0204 0204 0004 0049 .................... .................... 0049 0049 .................... 0340 0021 0022 0050 0050 0049 0049 .................... .................... .................... .................... 0054 .................... .................... .................... 0050 0050 0027 0027 .................... 32.0476 .................... .................... .................... 32.0476 32.0476 40.0825 32.0476 19.5801 1.55 20.3707 .................... 4.7775 18.4182 18.4182 4.7775 36.5271 14.9776 14.9776 3.5994 4.0547 6.9433 19.6472 19.6472 20.3707 20.3707 2.0101 .................... 4.0547 19.6472 2.191 2.191 2.191 2.191 2.191 2.191 2.191 2.191 2.191 1.7646 20.3707 .................... .................... 20.3707 20.3707 .................... 0.6384 14.9776 19.6472 23.9081 23.9081 20.3707 20.3707 .................... .................... .................... .................... 25.3711 .................... .................... .................... 23.9081 23.9081 18.4182 18.4182 .................... $1,901.80 .................... .................... .................... $1,901.80 $1,901.80 $2,378.62 $1,901.80 $1,161.94 $91.98 $1,208.86 .................... $283.51 $1,092.99 $1,092.99 $283.51 $2,167.63 $888.82 $888.82 $213.60 $240.62 $412.04 $1,165.92 $1,165.92 $1,208.86 $1,208.86 $119.29 .................... $240.62 $1,165.92 $130.02 $130.02 $130.02 $130.02 $130.02 $130.02 $130.02 $130.02 $130.02 $104.72 $1,208.86 .................... .................... $1,208.86 $1,208.86 .................... $37.88 $888.82 $1,165.92 $1,418.78 $1,418.78 $1,208.86 $1,208.86 .................... .................... .................... .................... $1,505.60 .................... .................... .................... $1,418.78 $1,418.78 $1,092.99 $1,092.99 .................... $632.64 .................... .................... .................... $632.64 $632.64 $763.55 $632.64 $303.74 $22.28 .................... .................... .................... $329.72 $329.72 .................... .................... $219.48 $219.48 $71.59 $71.87 $107.40 $354.45 $354.45 .................... .................... .................... .................... $71.87 $354.45 $40.13 $40.13 $40.13 $40.13 $40.13 $40.13 $40.13 $40.13 $40.13 $22.36 .................... .................... .................... .................... .................... .................... .................... $219.48 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $329.72 $329.72 .................... $380.36 .................... .................... .................... $380.36 $380.36 $475.72 $380.36 $232.39 $18.40 $241.77 .................... $56.70 $218.60 $218.60 $56.70 $433.53 $177.76 $177.76 $42.72 $48.12 $82.41 $233.18 $233.18 $241.77 $241.77 $23.86 .................... $48.12 $233.18 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $20.94 $241.77 .................... .................... $241.77 $241.77 .................... $7.58 $177.76 $233.18 $283.76 $283.76 $241.77 $241.77 .................... .................... .................... .................... $301.12 .................... .................... .................... $283.76 $283.76 $218.60 $218.60 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00029 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50708 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T C C C C C T C C C C C C T T A X A T T T T T T T T T T T T T C T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................... Removal of face bone lesion ................... Remove exostosis, mandible ................... Remove exostosis, maxilla ...................... Removal of face bone lesion ................... Removal of jaw bone 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 ............................. 0686 0027 0050 0686 .................... .................... .................... .................... .................... 0006 .................... .................... .................... .................... .................... .................... 0056 0056 .................... 0340 .................... 1557 0049 0254 0253 0256 0256 0256 0254 0254 0254 0256 0254 0256 .................... 0256 0256 0256 0256 0256 0256 0256 0254 0256 0256 0256 0256 0256 0256 0256 0253 0256 0256 0256 0251 0256 0252 .................... 0254 0254 0254 0254 0254 0256 0254 0256 13.8287 18.4182 23.9081 13.8287 .................... .................... .................... .................... .................... 1.55 .................... .................... .................... .................... .................... .................... 40.2957 40.2957 .................... 0.6384 .................... .................... 20.3707 23.404 16.1357 37.3204 37.3204 37.3204 23.404 23.404 23.404 37.3204 23.404 37.3204 .................... 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 16.1357 37.3204 37.3204 37.3204 2.0101 37.3204 7.8673 .................... 23.404 23.404 23.404 23.404 23.404 37.3204 23.404 37.3204 $820.64 $1,092.99 $1,418.78 $820.64 .................... .................... .................... .................... .................... $91.98 .................... .................... .................... .................... .................... .................... $2,391.27 $2,391.27 .................... $37.88 .................... $1,850.00 $1,208.86 $1,388.86 $957.54 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $1,388.86 $1,388.86 $2,214.70 $1,388.86 $2,214.70 .................... $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $957.54 $2,214.70 $2,214.70 $2,214.70 $119.29 $2,214.70 $466.87 .................... $1,388.86 $1,388.86 $1,388.86 $1,388.86 $1,388.86 $2,214.70 $1,388.86 $2,214.70 .................... $329.72 .................... .................... .................... .................... .................... .................... .................... $22.28 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $321.35 $282.29 .................... .................... .................... $321.35 $321.35 $321.35 .................... $321.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... $282.29 .................... .................... .................... .................... .................... $113.41 .................... $321.35 $321.35 $321.35 $321.35 $321.35 .................... $321.35 .................... $164.13 $218.60 $283.76 $164.13 .................... .................... .................... .................... .................... $18.40 .................... .................... .................... .................... .................... .................... $478.25 $478.25 .................... $7.58 .................... $370.00 $241.77 $277.77 $191.51 $442.94 $442.94 $442.94 $277.77 $277.77 $277.77 $442.94 $277.77 $442.94 .................... $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $191.51 $442.94 $442.94 $442.94 $23.86 $442.94 $93.37 .................... $277.77 $277.77 $277.77 $277.77 $277.77 $442.94 $277.77 $442.94 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00030 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50709 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 21139 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T C C C C C C T C C C C C C T C C T C C C C C C T C T T T T T T T T T T T T T T T C T T C C T T T T C T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Reduction of forehead ............................. 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 ....................... 0256 .................... .................... .................... .................... .................... .................... 0256 .................... .................... .................... .................... .................... .................... 0256 .................... .................... 0254 .................... .................... .................... .................... .................... .................... 0256 .................... 0256 0256 0256 0256 0256 0256 0256 0256 0254 0256 0256 0256 0256 0256 0256 .................... 0256 0256 .................... .................... 0256 0256 0256 0256 .................... 0256 0256 0256 0253 0252 0254 0251 0253 0251 0251 0252 0254 0254 0254 0046 37.3204 .................... .................... .................... .................... .................... .................... 37.3204 .................... .................... .................... .................... .................... .................... 37.3204 .................... .................... 23.404 .................... .................... .................... .................... .................... .................... 37.3204 .................... 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 .................... 37.3204 37.3204 .................... .................... 37.3204 37.3204 37.3204 37.3204 .................... 37.3204 37.3204 37.3204 16.1357 7.8673 23.404 2.0101 16.1357 2.0101 2.0101 7.8673 23.404 23.404 23.404 37.7023 $2,214.70 .................... .................... .................... .................... .................... .................... $2,214.70 .................... .................... .................... .................... .................... .................... $2,214.70 .................... .................... $1,388.86 .................... .................... .................... .................... .................... .................... $2,214.70 .................... $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... $2,214.70 $2,214.70 .................... .................... $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... $2,214.70 $2,214.70 $2,214.70 $957.54 $466.87 $1,388.86 $119.29 $957.54 $119.29 $119.29 $466.87 $1,388.86 $1,388.86 $1,388.86 $2,237.37 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $282.29 $113.41 $321.35 .................... $282.29 .................... .................... $113.41 $321.35 $321.35 $321.35 $535.76 $442.94 .................... .................... .................... .................... .................... .................... $442.94 .................... .................... .................... .................... .................... .................... $442.94 .................... .................... $277.77 .................... .................... .................... .................... .................... .................... $442.94 .................... $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 .................... $442.94 $442.94 .................... .................... $442.94 $442.94 $442.94 $442.94 .................... $442.94 $442.94 $442.94 $191.51 $93.37 $277.77 $23.86 $191.51 $23.86 $23.86 $93.37 $277.77 $277.77 $277.77 $447.47 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00031 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50710 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 21337 21338 21339 21340 21343 21344 21345 21346 21347 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T C C T C C C T T C C C C C C T C T T T T T T C C C C C C C T T T T T T T T T T T T T T T T T T T T T C T T T T T T C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............................ 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 ...................... 0253 0254 0254 0256 .................... .................... 0254 .................... .................... .................... 0256 0254 .................... .................... .................... .................... .................... .................... 0256 .................... 0252 0253 0256 0256 0256 0254 .................... .................... .................... .................... .................... .................... .................... 0254 0254 0251 0252 0253 0256 0254 0256 0256 0256 0256 0251 0253 0256 0252 0252 0253 0253 0251 0008 0049 .................... 0021 0022 0022 0022 0050 0050 .................... .................... .................... .................... .................... 16.1357 23.404 23.404 37.3204 .................... .................... 23.404 .................... .................... .................... 37.3204 23.404 .................... .................... .................... .................... .................... .................... 37.3204 .................... 7.8673 16.1357 37.3204 37.3204 37.3204 23.404 .................... .................... .................... .................... .................... .................... .................... 23.404 23.404 2.0101 7.8673 16.1357 37.3204 23.404 37.3204 37.3204 37.3204 37.3204 2.0101 16.1357 37.3204 7.8673 7.8673 16.1357 16.1357 2.0101 16.4989 20.3707 .................... 14.9776 19.6472 19.6472 19.6472 23.9081 23.9081 .................... .................... .................... .................... .................... $957.54 $1,388.86 $1,388.86 $2,214.70 .................... .................... $1,388.86 .................... .................... .................... $2,214.70 $1,388.86 .................... .................... .................... .................... .................... .................... $2,214.70 .................... $466.87 $957.54 $2,214.70 $2,214.70 $2,214.70 $1,388.86 .................... .................... .................... .................... .................... .................... .................... $1,388.86 $1,388.86 $119.29 $466.87 $957.54 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $119.29 $957.54 $2,214.70 $466.87 $466.87 $957.54 $957.54 $119.29 $979.09 $1,208.86 .................... $888.82 $1,165.92 $1,165.92 $1,165.92 $1,418.78 $1,418.78 .................... .................... .................... .................... .................... $282.29 $321.35 $321.35 .................... .................... .................... $321.35 .................... .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... .................... $113.41 $282.29 .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... $321.35 $321.35 .................... $113.41 $282.29 .................... $321.35 .................... .................... .................... .................... .................... $282.29 .................... $113.41 $113.41 $282.29 $282.29 .................... .................... .................... .................... $219.48 $354.45 $354.45 $354.45 .................... .................... .................... .................... .................... .................... .................... $191.51 $277.77 $277.77 $442.94 .................... .................... $277.77 .................... .................... .................... $442.94 $277.77 .................... .................... .................... .................... .................... .................... $442.94 .................... $93.37 $191.51 $442.94 $442.94 $442.94 $277.77 .................... .................... .................... .................... .................... .................... .................... $277.77 $277.77 $23.86 $93.37 $191.51 $442.94 $277.77 $442.94 $442.94 $442.94 $442.94 $23.86 $191.51 $442.94 $93.37 $93.37 $191.51 $191.51 $23.86 $195.82 $241.77 .................... $177.76 $233.18 $233.18 $233.18 $283.76 $283.76 .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00032 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50711 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 21632 21685 21700 21705 21720 21725 21740 21742 21743 21750 21800 21805 21810 21820 21825 21899 21920 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C T T C T T C T T C T T C T C T T T T T T T T T C C C C C C C C C T C C T T T C C C C C C T T T T C C C C C C C C C C C C T T C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................ 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 ........................................ .................... 0252 0049 .................... 0049 0006 .................... 0051 0051 .................... 0043 0046 .................... 0043 .................... 0251 0020 0022 0022 0022 0208 0208 0208 0208 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0208 .................... .................... 0043 0043 0043 .................... .................... .................... .................... .................... .................... 0045 0050 0050 0050 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0208 0208 .................... .................... .................... .................... 7.8673 20.3707 .................... 20.3707 1.55 .................... 36.5271 36.5271 .................... 1.7694 37.7023 .................... 1.7694 .................... 2.0101 6.9433 19.6472 19.6472 19.6472 42.3409 42.3409 42.3409 42.3409 .................... .................... .................... .................... .................... .................... .................... .................... .................... 42.3409 .................... .................... 1.7694 1.7694 1.7694 .................... .................... .................... .................... .................... .................... 14.4945 23.9081 23.9081 23.9081 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 42.3409 42.3409 .................... .................... .................... .................... $466.87 $1,208.86 .................... $1,208.86 $91.98 .................... $2,167.63 $2,167.63 .................... $105.00 $2,237.37 .................... $105.00 .................... $119.29 $412.04 $1,165.92 $1,165.92 $1,165.92 $2,512.64 $2,512.64 $2,512.64 $2,512.64 .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,512.64 .................... .................... $105.00 $105.00 $105.00 .................... .................... .................... .................... .................... .................... $860.15 $1,418.78 $1,418.78 $1,418.78 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,512.64 $2,512.64 .................... .................... .................... .................... $113.41 .................... .................... .................... $22.28 .................... .................... .................... .................... .................... $535.76 .................... .................... .................... .................... $107.40 $354.45 $354.45 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $268.47 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $93.37 $241.77 .................... $241.77 $18.40 .................... $433.53 $433.53 .................... $21.00 $447.47 .................... $21.00 .................... $23.86 $82.41 $233.18 $233.18 $233.18 $502.53 $502.53 $502.53 $502.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... $502.53 .................... .................... $21.00 $21.00 $21.00 .................... .................... .................... .................... .................... .................... $172.03 $283.76 $283.76 $283.76 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $502.53 $502.53 .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00033 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50712 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C C C C C C C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... 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 ............... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0043 0022 0019 0021 0051 0008 0008 0049 0050 0050 0021 0022 0021 0022 0022 0049 0050 0050 0050 0050 0051 0051 0051 0049 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 .................... .................... .................... .................... .................... 0020 0022 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.7694 19.6472 4.0547 14.9776 36.5271 16.4989 16.4989 20.3707 23.9081 23.9081 14.9776 19.6472 14.9776 19.6472 19.6472 20.3707 23.9081 23.9081 23.9081 23.9081 36.5271 36.5271 36.5271 20.3707 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 .................... .................... .................... .................... .................... 6.9433 19.6472 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $105.00 $1,165.92 $240.62 $888.82 $2,167.63 $979.09 $979.09 $1,208.86 $1,418.78 $1,418.78 $888.82 $1,165.92 $888.82 $1,165.92 $1,165.92 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $2,167.63 $2,167.63 $2,167.63 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 .................... .................... .................... .................... .................... $412.04 $1,165.92 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $354.45 $71.87 $219.48 .................... .................... .................... .................... .................... .................... $219.48 $354.45 $219.48 $354.45 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $107.40 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $21.00 $233.18 $48.12 $177.76 $433.53 $195.82 $195.82 $241.77 $283.76 $283.76 $177.76 $233.18 $177.76 $233.18 $233.18 $241.77 $283.76 $283.76 $283.76 $283.76 $433.53 $433.53 $433.53 $241.77 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 .................... .................... .................... .................... .................... $82.41 $233.18 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00034 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50713 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C N T T T T T T T T T T T T T T T T T T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 of tendon(s) .................................. 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 ......................... 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 ................... .................... .................... 0051 0052 0050 0050 0050 0052 0052 0051 0052 0052 0052 0052 0052 0052 0052 0052 0052 0425 .................... 0051 0051 0051 0051 0043 0043 0046 0043 0043 0046 0046 0043 0043 0046 0046 0043 0043 0046 0043 0043 0046 0046 0043 0043 0046 0043 0045 0046 0043 0046 0043 0046 0045 0051 0051 .................... .................... 0025 0043 0008 0008 0049 0050 0050 0021 .................... .................... 36.5271 43.9378 23.9081 23.9081 23.9081 43.9378 43.9378 36.5271 43.9378 43.9378 43.9378 43.9378 43.9378 43.9378 43.9378 43.9378 43.9378 100.2058 .................... 36.5271 36.5271 36.5271 36.5271 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 14.4945 37.7023 1.7694 37.7023 1.7694 37.7023 14.4945 36.5271 36.5271 .................... .................... 5.4938 1.7694 16.4989 16.4989 20.3707 23.9081 23.9081 14.9776 .................... .................... $2,167.63 $2,607.40 $1,418.78 $1,418.78 $1,418.78 $2,607.40 $2,607.40 $2,167.63 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $5,946.51 .................... $2,167.63 $2,167.63 $2,167.63 $2,167.63 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $860.15 $2,237.37 $105.00 $2,237.37 $105.00 $2,237.37 $860.15 $2,167.63 $2,167.63 .................... .................... $326.02 $105.00 $979.09 $979.09 $1,208.86 $1,418.78 $1,418.78 $888.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,378.01 .................... .................... .................... .................... .................... .................... .................... $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 .................... $268.47 $535.76 .................... $535.76 .................... $535.76 $268.47 .................... .................... .................... .................... $101.85 .................... .................... .................... .................... .................... .................... $219.48 .................... .................... $433.53 $521.48 $283.76 $283.76 $283.76 $521.48 $521.48 $433.53 $521.48 $521.48 $521.48 $521.48 $521.48 $521.48 $521.48 $521.48 $521.48 $1,189.30 .................... $433.53 $433.53 $433.53 $433.53 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $172.03 $447.47 $21.00 $447.47 $21.00 $447.47 $172.03 $433.53 $433.53 .................... .................... $65.20 $21.00 $195.82 $195.82 $241.77 $283.76 $283.76 $177.76 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00035 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50714 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .......................... 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 .................................. 0021 0021 0022 0022 0049 0050 0050 0049 0049 0050 0050 0049 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0052 0052 0052 0052 0051 0050 0050 0019 0021 .................... 0045 0050 0050 0049 0051 0051 0051 0049 0051 0051 0051 0050 0051 0050 0051 0050 0050 0050 0050 0050 0047 0425 0048 0425 0047 0425 0050 0050 0051 0051 0051 0051 0050 0051 14.9776 14.9776 19.6472 19.6472 20.3707 23.9081 23.9081 20.3707 20.3707 23.9081 23.9081 20.3707 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 43.9378 43.9378 43.9378 43.9378 36.5271 23.9081 23.9081 4.0547 14.9776 .................... 14.4945 23.9081 23.9081 20.3707 36.5271 36.5271 36.5271 20.3707 36.5271 36.5271 36.5271 23.9081 36.5271 23.9081 36.5271 23.9081 23.9081 23.9081 23.9081 23.9081 31.6107 100.2058 43.1288 100.2058 31.6107 100.2058 23.9081 23.9081 36.5271 36.5271 36.5271 36.5271 23.9081 36.5271 $888.82 $888.82 $1,165.92 $1,165.92 $1,208.86 $1,418.78 $1,418.78 $1,208.86 $1,208.86 $1,418.78 $1,418.78 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $2,607.40 $2,607.40 $2,607.40 $2,607.40 $2,167.63 $1,418.78 $1,418.78 $240.62 $888.82 .................... $860.15 $1,418.78 $1,418.78 $1,208.86 $2,167.63 $2,167.63 $2,167.63 $1,208.86 $2,167.63 $2,167.63 $2,167.63 $1,418.78 $2,167.63 $1,418.78 $2,167.63 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,875.87 $5,946.51 $2,559.39 $5,946.51 $1,875.87 $5,946.51 $1,418.78 $1,418.78 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $1,418.78 $2,167.63 $219.48 $219.48 $354.45 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $71.87 $219.48 .................... $268.47 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $537.03 $1,378.01 $570.30 $1,378.01 $537.03 $1,378.01 .................... .................... .................... .................... .................... .................... .................... .................... $177.76 $177.76 $233.18 $233.18 $241.77 $283.76 $283.76 $241.77 $241.77 $283.76 $283.76 $241.77 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $521.48 $521.48 $521.48 $521.48 $433.53 $283.76 $283.76 $48.12 $177.76 .................... $172.03 $283.76 $283.76 $241.77 $433.53 $433.53 $433.53 $241.77 $433.53 $433.53 $433.53 $283.76 $433.53 $283.76 $433.53 $283.76 $283.76 $283.76 $283.76 $283.76 $375.17 $1,189.30 $511.88 $1,189.30 $375.17 $1,189.30 $283.76 $283.76 $433.53 $433.53 $433.53 $433.53 $283.76 $433.53 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00036 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50715 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 25031 25035 25040 25065 25066 25075 25076 25077 25085 25100 25101 25105 25107 25110 25111 25112 25115 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T C C T C T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ...................... Drainage of forearm bursa ...................... Treat forearm bone lesion ....................... Explore/treat wrist joint ............................ Biopsy forearm soft tissues ..................... Biopsy forearm soft tissues ..................... Removel forearm lesion subcu ................ Removel 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 ................... 0043 0043 0046 0046 0043 0043 0046 0046 0046 0043 0043 0046 0046 0043 0043 0046 0046 0046 0046 0043 0045 0046 0043 0046 0043 0043 0043 0046 0046 0043 0043 0046 0051 0051 .................... .................... 0049 .................... .................... 0052 .................... 0043 0049 0049 0049 0050 0050 0050 0049 0049 0049 0050 0021 0022 0021 0022 0022 0049 0049 0050 0050 0050 0049 0053 0053 0049 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 37.7023 37.7023 1.7694 14.4945 37.7023 1.7694 37.7023 1.7694 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 36.5271 36.5271 .................... .................... 20.3707 .................... .................... 43.9378 .................... 1.7694 20.3707 20.3707 20.3707 23.9081 23.9081 23.9081 20.3707 20.3707 20.3707 23.9081 14.9776 19.6472 14.9776 19.6472 19.6472 20.3707 20.3707 23.9081 23.9081 23.9081 20.3707 15.6795 15.6795 20.3707 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $2,237.37 $2,237.37 $105.00 $860.15 $2,237.37 $105.00 $2,237.37 $105.00 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,167.63 $2,167.63 .................... .................... $1,208.86 .................... .................... $2,607.40 .................... $105.00 $1,208.86 $1,208.86 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,208.86 $1,208.86 $1,208.86 $1,418.78 $888.82 $1,165.92 $888.82 $1,165.92 $1,165.92 $1,208.86 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,208.86 $930.47 $930.47 $1,208.86 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 $535.76 $535.76 .................... $268.47 $535.76 .................... $535.76 .................... .................... .................... $535.76 $535.76 .................... .................... $535.76 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $219.48 $354.45 $219.48 $354.45 $354.45 .................... .................... .................... .................... .................... .................... $253.49 $253.49 .................... $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $447.47 $447.47 $21.00 $172.03 $447.47 $21.00 $447.47 $21.00 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $433.53 $433.53 .................... .................... $241.77 .................... .................... $521.48 .................... $21.00 $241.77 $241.77 $241.77 $283.76 $283.76 $283.76 $241.77 $241.77 $241.77 $283.76 $177.76 $233.18 $177.76 $233.18 $233.18 $241.77 $241.77 $283.76 $283.76 $283.76 $241.77 $186.09 $186.09 $241.77 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00037 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50716 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 25425 25426 25430 25431 25440 25441 25442 25443 25444 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................ 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 ............................. 0049 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0052 0054 0054 0050 0050 .................... 0049 0050 0050 0043 0050 0050 0050 0050 0050 0050 0050 0050 0050 0049 0050 0050 0051 0051 0051 0051 0051 0047 0051 0051 0051 0051 0050 0050 0051 0051 0050 0051 0050 0051 0053 0050 0050 0050 0051 0051 0051 0054 0054 0051 0425 0425 0048 0048 20.3707 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 43.9378 25.3711 25.3711 23.9081 23.9081 .................... 20.3707 23.9081 23.9081 1.7694 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 20.3707 23.9081 23.9081 36.5271 36.5271 36.5271 36.5271 36.5271 31.6107 36.5271 36.5271 36.5271 36.5271 23.9081 23.9081 36.5271 36.5271 23.9081 36.5271 23.9081 36.5271 15.6795 23.9081 23.9081 23.9081 36.5271 36.5271 36.5271 25.3711 25.3711 36.5271 100.2058 100.2058 43.1288 43.1288 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $2,607.40 $1,505.60 $1,505.60 $1,418.78 $1,418.78 .................... $1,208.86 $1,418.78 $1,418.78 $105.00 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,208.86 $1,418.78 $1,418.78 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $1,875.87 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $1,418.78 $1,418.78 $2,167.63 $2,167.63 $1,418.78 $2,167.63 $1,418.78 $2,167.63 $930.47 $1,418.78 $1,418.78 $1,418.78 $2,167.63 $2,167.63 $2,167.63 $1,505.60 $1,505.60 $2,167.63 $5,946.51 $5,946.51 $2,559.39 $2,559.39 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $537.03 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $253.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,378.01 $1,378.01 $570.30 $570.30 $241.77 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $521.48 $301.12 $301.12 $283.76 $283.76 .................... $241.77 $283.76 $283.76 $21.00 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $241.77 $283.76 $283.76 $433.53 $433.53 $433.53 $433.53 $433.53 $375.17 $433.53 $433.53 $433.53 $433.53 $283.76 $283.76 $433.53 $433.53 $283.76 $433.53 $283.76 $433.53 $186.09 $283.76 $283.76 $283.76 $433.53 $433.53 $433.53 $301.12 $301.12 $433.53 $1,189.30 $1,189.30 $511.88 $511.88 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00038 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50717 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 26025 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T C C C T C C T C T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Drainage of palm bursa ........................... 0048 0425 0047 0047 0051 0051 0051 0051 0051 0043 0043 0046 0043 0046 0046 0043 0043 0046 0043 0043 0046 0046 0043 0043 0046 0046 0043 0043 0046 0043 0043 0046 0043 0046 0046 0043 0046 0046 0043 0046 0043 0046 0043 0046 0051 0051 0051 0053 0054 0051 .................... .................... 0049 .................... .................... .................... 0049 .................... .................... 0686 .................... 0043 0006 0007 0053 0053 43.1288 100.2058 31.6107 31.6107 36.5271 36.5271 36.5271 36.5271 36.5271 1.7694 1.7694 37.7023 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 1.7694 37.7023 37.7023 1.7694 37.7023 37.7023 1.7694 37.7023 1.7694 37.7023 1.7694 37.7023 36.5271 36.5271 36.5271 15.6795 25.3711 36.5271 .................... .................... 20.3707 .................... .................... .................... 20.3707 .................... .................... 13.8287 .................... 1.7694 1.55 11.4501 15.6795 15.6795 $2,559.39 $5,946.51 $1,875.87 $1,875.87 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $105.00 $105.00 $2,237.37 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $2,237.37 $2,237.37 $105.00 $2,237.37 $2,237.37 $105.00 $2,237.37 $105.00 $2,237.37 $105.00 $2,237.37 $2,167.63 $2,167.63 $2,167.63 $930.47 $1,505.60 $2,167.63 .................... .................... $1,208.86 .................... .................... .................... $1,208.86 .................... .................... $820.64 .................... $105.00 $91.98 $679.48 $930.47 $930.47 $570.30 $1,378.01 $537.03 $537.03 .................... .................... .................... .................... .................... .................... .................... $535.76 .................... $535.76 $535.76 .................... .................... $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 .................... .................... $535.76 .................... $535.76 $535.76 .................... $535.76 $535.76 .................... $535.76 .................... $535.76 .................... $535.76 .................... .................... .................... $253.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $22.28 .................... $253.49 $253.49 $511.88 $1,189.30 $375.17 $375.17 $433.53 $433.53 $433.53 $433.53 $433.53 $21.00 $21.00 $447.47 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $21.00 $447.47 $447.47 $21.00 $447.47 $447.47 $21.00 $447.47 $21.00 $447.47 $21.00 $447.47 $433.53 $433.53 $433.53 $186.09 $301.12 $433.53 .................... .................... $241.77 .................... .................... .................... $241.77 .................... .................... $164.13 .................... $21.00 $18.40 $135.90 $186.09 $186.09 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00039 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50718 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................... Removel hand lesion subcut ................... Removel 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 ................. Relative weight APC 0053 0053 0053 0053 0054 0054 0053 0053 0053 0053 0053 0053 0053 0053 0022 0022 0022 0054 0054 0053 0053 0054 0053 0053 0053 0053 0053 0053 0053 0054 0053 0053 0053 0053 0053 0053 0054 0053 0053 0053 0021 0043 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0053 0054 0054 0054 0053 0054 0054 0054 0053 0053 0054 0053 0053 0054 15.6795 15.6795 15.6795 15.6795 25.3711 25.3711 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 19.6472 19.6472 19.6472 25.3711 25.3711 15.6795 15.6795 25.3711 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 25.3711 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 25.3711 15.6795 15.6795 15.6795 14.9776 1.7694 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 15.6795 25.3711 25.3711 25.3711 15.6795 25.3711 25.3711 25.3711 15.6795 15.6795 25.3711 15.6795 15.6795 25.3711 Payment rate National unadjusted copayment Minimum unadjusted copayment $930.47 $930.47 $930.47 $930.47 $1,505.60 $1,505.60 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $1,165.92 $1,165.92 $1,165.92 $1,505.60 $1,505.60 $930.47 $930.47 $1,505.60 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $1,505.60 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $1,505.60 $930.47 $930.47 $930.47 $888.82 $105.00 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $930.47 $1,505.60 $1,505.60 $1,505.60 $930.47 $1,505.60 $1,505.60 $1,505.60 $930.47 $930.47 $1,505.60 $930.47 $930.47 $1,505.60 $253.49 $253.49 $253.49 $253.49 .................... .................... $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $354.45 $354.45 $354.45 .................... .................... $253.49 $253.49 .................... $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 .................... $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 .................... $253.49 $253.49 $253.49 $219.48 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $253.49 .................... .................... .................... $253.49 .................... .................... .................... $253.49 $253.49 .................... $253.49 $253.49 .................... $186.09 $186.09 $186.09 $186.09 $301.12 $301.12 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $233.18 $233.18 $233.18 $301.12 $301.12 $186.09 $186.09 $301.12 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $301.12 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $301.12 $186.09 $186.09 $186.09 $177.76 $21.00 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $186.09 $301.12 $301.12 $301.12 $186.09 $301.12 $301.12 $301.12 $186.09 $186.09 $301.12 $186.09 $186.09 $301.12 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00040 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50719 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 26445 26449 26450 26455 26460 26471 26474 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T C T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .......................... 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 ........................... 0053 0054 0053 0053 0053 0053 0053 0053 0053 0053 0053 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0053 0054 0054 0053 0054 0054 0054 0054 0053 0053 0047 0048 0047 0048 0053 0054 0053 0054 0054 0054 0054 .................... .................... .................... 0054 .................... 0053 0054 0054 0054 0054 0054 0053 0053 0053 0054 0053 0053 0043 0043 0043 0046 0046 0043 15.6795 25.3711 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 15.6795 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 15.6795 25.3711 25.3711 15.6795 25.3711 25.3711 25.3711 25.3711 15.6795 15.6795 31.6107 43.1288 31.6107 43.1288 15.6795 25.3711 15.6795 25.3711 25.3711 25.3711 25.3711 .................... .................... .................... 25.3711 .................... 15.6795 25.3711 25.3711 25.3711 25.3711 25.3711 15.6795 15.6795 15.6795 25.3711 15.6795 15.6795 1.7694 1.7694 1.7694 37.7023 37.7023 1.7694 $930.47 $1,505.60 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $930.47 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $930.47 $1,505.60 $1,505.60 $930.47 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $930.47 $930.47 $1,875.87 $2,559.39 $1,875.87 $2,559.39 $930.47 $1,505.60 $930.47 $1,505.60 $1,505.60 $1,505.60 $1,505.60 .................... .................... .................... $1,505.60 .................... $930.47 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $930.47 $930.47 $930.47 $1,505.60 $930.47 $930.47 $105.00 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $253.49 .................... $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 $253.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $253.49 .................... .................... $253.49 .................... .................... .................... .................... $253.49 $253.49 $537.03 $570.30 $537.03 $570.30 $253.49 .................... $253.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... $253.49 .................... .................... .................... .................... .................... $253.49 $253.49 $253.49 .................... $253.49 $253.49 .................... .................... .................... $535.76 $535.76 .................... $186.09 $301.12 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $186.09 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $186.09 $301.12 $301.12 $186.09 $301.12 $301.12 $301.12 $301.12 $186.09 $186.09 $375.17 $511.88 $375.17 $511.88 $186.09 $301.12 $186.09 $301.12 $301.12 $301.12 $301.12 .................... .................... .................... $301.12 .................... $186.09 $301.12 $301.12 $301.12 $301.12 $301.12 $186.09 $186.09 $186.09 $301.12 $186.09 $186.09 $21.00 $21.00 $21.00 $447.47 $447.47 $21.00 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00041 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50720 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 26645 26650 26665 26670 26675 26676 26685 26686 26700 26705 26706 26715 26720 26725 26727 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C T T T C C C C T T C T T T T T T T C T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... 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 ..................... 0043 0046 0046 0043 0043 0046 0046 0046 0043 0043 0043 0046 0043 0043 0046 0046 0043 0043 0046 0043 0043 0046 0046 0043 0045 0046 0046 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0053 0053 0043 0049 0049 .................... 0049 0050 0050 .................... .................... .................... .................... 0051 0052 .................... 0020 0020 0022 0022 0022 0049 0049 .................... 0049 0049 0049 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 37.7023 1.7694 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 14.4945 37.7023 37.7023 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 25.3711 15.6795 15.6795 1.7694 20.3707 20.3707 .................... 20.3707 23.9081 23.9081 .................... .................... .................... .................... 36.5271 43.9378 .................... 6.9433 6.9433 19.6472 19.6472 19.6472 20.3707 20.3707 .................... 20.3707 20.3707 20.3707 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $2,237.37 $105.00 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $860.15 $2,237.37 $2,237.37 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $1,505.60 $930.47 $930.47 $105.00 $1,208.86 $1,208.86 .................... $1,208.86 $1,418.78 $1,418.78 .................... .................... .................... .................... $2,167.63 $2,607.40 .................... $412.04 $412.04 $1,165.92 $1,165.92 $1,165.92 $1,208.86 $1,208.86 .................... $1,208.86 $1,208.86 $1,208.86 .................... $535.76 $535.76 .................... .................... $535.76 $535.76 $535.76 .................... .................... .................... $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 .................... .................... $535.76 $535.76 .................... $268.47 $535.76 $535.76 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $253.49 $253.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $107.40 $107.40 $354.45 $354.45 $354.45 .................... .................... .................... .................... .................... .................... $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $447.47 $21.00 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $172.03 $447.47 $447.47 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $301.12 $186.09 $186.09 $21.00 $241.77 $241.77 .................... $241.77 $283.76 $283.76 .................... .................... .................... .................... $433.53 $521.48 .................... $82.41 $82.41 $233.18 $233.18 $233.18 $241.77 $241.77 .................... $241.77 $241.77 $241.77 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00042 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50721 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 27066 27067 27070 27071 27075 27076 27077 27078 27079 27080 27086 27087 27090 27091 27093 27095 27096 27097 27098 27100 27105 27110 27111 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T C C C C C C C T T T C C N N B T T T T T T 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 T T T T C T C C T C C C C T C T C T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................... 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 .................................. 0050 0050 .................... .................... .................... .................... .................... .................... .................... 0050 0020 0049 .................... .................... .................... .................... .................... 0050 0050 0051 0051 0051 0051 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0043 0045 0043 0046 .................... 0050 .................... .................... 0043 .................... .................... .................... .................... 0043 .................... 0050 .................... 0043 23.9081 23.9081 .................... .................... .................... .................... .................... .................... .................... 23.9081 6.9433 20.3707 .................... .................... .................... .................... .................... 23.9081 23.9081 36.5271 36.5271 36.5271 36.5271 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.7694 14.4945 1.7694 37.7023 .................... 23.9081 .................... .................... 1.7694 .................... .................... .................... .................... 1.7694 .................... 23.9081 .................... 1.7694 $1,418.78 $1,418.78 .................... .................... .................... .................... .................... .................... .................... $1,418.78 $412.04 $1,208.86 .................... .................... .................... .................... .................... $1,418.78 $1,418.78 $2,167.63 $2,167.63 $2,167.63 $2,167.63 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $105.00 $860.15 $105.00 $2,237.37 .................... $1,418.78 .................... .................... $105.00 .................... .................... .................... .................... $105.00 .................... $1,418.78 .................... $105.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $107.40 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $268.47 .................... $535.76 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $283.76 $283.76 .................... .................... .................... .................... .................... .................... .................... $283.76 $82.41 $241.77 .................... .................... .................... .................... .................... $283.76 $283.76 $433.53 $433.53 $433.53 $433.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $21.00 $172.03 $21.00 $447.47 .................... $283.76 .................... .................... $21.00 .................... .................... .................... .................... $21.00 .................... $283.76 .................... $21.00 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00043 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50722 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C T C T T C C T T C C T T T C C C C C C T T C T T T T T T T T T T T T T T T T T T T T T T T T T T C N T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ..................... 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 ................... .................... .................... .................... 0043 .................... 0043 0045 .................... .................... 0043 0045 .................... .................... 0043 0045 0045 .................... .................... .................... .................... .................... .................... 0043 0008 .................... 0049 0049 0049 0050 0220 0220 0021 0022 0022 0022 0022 0050 0050 0050 0050 0050 0050 0049 0049 0049 0050 0050 0050 0050 0050 0050 .................... .................... 0022 0049 0049 0049 0049 0049 0049 0049 0050 0050 0051 0050 0051 .................... .................... .................... 1.7694 .................... 1.7694 14.4945 .................... .................... 1.7694 14.4945 .................... .................... 1.7694 14.4945 14.4945 .................... .................... .................... .................... .................... .................... 1.7694 16.4989 .................... 20.3707 20.3707 20.3707 23.9081 17.3586 17.3586 14.9776 19.6472 19.6472 19.6472 19.6472 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 20.3707 20.3707 20.3707 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 .................... .................... 19.6472 20.3707 20.3707 20.3707 20.3707 20.3707 20.3707 20.3707 23.9081 23.9081 36.5271 23.9081 36.5271 .................... .................... .................... $105.00 .................... $105.00 $860.15 .................... .................... $105.00 $860.15 .................... .................... $105.00 $860.15 $860.15 .................... .................... .................... .................... .................... .................... $105.00 $979.09 .................... $1,208.86 $1,208.86 $1,208.86 $1,418.78 $1,030.11 $1,030.11 $888.82 $1,165.92 $1,165.92 $1,165.92 $1,165.92 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,208.86 $1,208.86 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 .................... .................... $1,165.92 $1,208.86 $1,208.86 $1,208.86 $1,208.86 $1,208.86 $1,208.86 $1,208.86 $1,418.78 $1,418.78 $2,167.63 $1,418.78 $2,167.63 .................... .................... .................... .................... .................... .................... $268.47 .................... .................... .................... $268.47 .................... .................... .................... $268.47 $268.47 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $219.48 $354.45 $354.45 $354.45 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $21.00 .................... $21.00 $172.03 .................... .................... $21.00 $172.03 .................... .................... $21.00 $172.03 $172.03 .................... .................... .................... .................... .................... .................... $21.00 $195.82 .................... $241.77 $241.77 $241.77 $283.76 $206.02 $206.02 $177.76 $233.18 $233.18 $233.18 $233.18 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $241.77 $241.77 $241.77 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 .................... .................... $233.18 $241.77 $241.77 $241.77 $241.77 $241.77 $241.77 $241.77 $283.76 $283.76 $433.53 $283.76 $433.53 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00044 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50723 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T C T C C C C C C C C C C C T C C C C C C C T T T T T T T T C C T T T C C C T T C T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................. Lateral retinacular release ....................... 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 ...................... 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 .................................. 0051 0050 0051 0051 0051 0042 0042 0051 0051 0051 0051 0050 0052 0052 0052 0051 0051 0047 0048 0047 0047 0047 0047 .................... 0681 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0050 .................... .................... .................... .................... .................... .................... .................... 0049 0049 0049 0049 0043 0043 0043 0043 .................... .................... 0043 0046 0043 .................... .................... .................... 0043 0043 .................... 0043 0046 0043 36.5271 23.9081 36.5271 36.5271 36.5271 43.9753 43.9753 36.5271 36.5271 36.5271 36.5271 23.9081 43.9378 43.9378 43.9378 36.5271 36.5271 31.6107 43.1288 31.6107 31.6107 31.6107 31.6107 .................... 137.163 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 23.9081 .................... .................... .................... .................... .................... .................... .................... 20.3707 20.3707 20.3707 20.3707 1.7694 1.7694 1.7694 1.7694 .................... .................... 1.7694 37.7023 1.7694 .................... .................... .................... 1.7694 1.7694 .................... 1.7694 37.7023 1.7694 $2,167.63 $1,418.78 $2,167.63 $2,167.63 $2,167.63 $2,609.63 $2,609.63 $2,167.63 $2,167.63 $2,167.63 $2,167.63 $1,418.78 $2,607.40 $2,607.40 $2,607.40 $2,167.63 $2,167.63 $1,875.87 $2,559.39 $1,875.87 $1,875.87 $1,875.87 $1,875.87 .................... $8,139.66 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,418.78 .................... .................... .................... .................... .................... .................... .................... $1,208.86 $1,208.86 $1,208.86 $1,208.86 $105.00 $105.00 $105.00 $105.00 .................... .................... $105.00 $2,237.37 $105.00 .................... .................... .................... $105.00 $105.00 .................... $105.00 $2,237.37 $105.00 .................... .................... .................... .................... .................... $804.74 $804.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $537.03 $570.30 $537.03 $537.03 $537.03 $537.03 .................... $2,081.48 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $535.76 .................... .................... .................... .................... .................... .................... .................... .................... $535.76 .................... $433.53 $283.76 $433.53 $433.53 $433.53 $521.93 $521.93 $433.53 $433.53 $433.53 $433.53 $283.76 $521.48 $521.48 $521.48 $433.53 $433.53 $375.17 $511.88 $375.17 $375.17 $375.17 $375.17 .................... $1,627.93 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $283.76 .................... .................... .................... .................... .................... .................... .................... $241.77 $241.77 $241.77 $241.77 $21.00 $21.00 $21.00 $21.00 .................... .................... $21.00 $447.47 $21.00 .................... .................... .................... $21.00 $21.00 .................... $21.00 $447.47 $21.00 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00045 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50724 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 27646 27647 27648 27650 27652 27654 27656 27658 27659 27664 27665 27675 27676 27680 27681 27685 27686 27687 27690 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T C C T C T T C C C T T T T C C C C T C C T T T T T T T T T T T T T T T T T T T T T T T T T C C T N T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................... 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 .......................... 0043 .................... .................... 0043 .................... 0043 0045 .................... .................... .................... 0043 0045 0046 0045 .................... .................... .................... .................... 0049 .................... .................... 0043 0049 0049 0049 0008 0049 0055 0049 0049 0050 0050 0020 0022 0046 0021 0022 0050 0050 0050 0049 0050 0050 0050 0051 0050 .................... .................... 0051 .................... 0051 0051 0051 0049 0049 0049 0049 0050 0049 0050 0050 0050 0050 0050 0050 0051 1.7694 .................... .................... 1.7694 .................... 1.7694 14.4945 .................... .................... .................... 1.7694 14.4945 37.7023 14.4945 .................... .................... .................... .................... 20.3707 .................... .................... 1.7694 20.3707 20.3707 20.3707 16.4989 20.3707 20.0692 20.3707 20.3707 23.9081 23.9081 6.9433 19.6472 37.7023 14.9776 19.6472 23.9081 23.9081 23.9081 20.3707 23.9081 23.9081 23.9081 36.5271 23.9081 .................... .................... 36.5271 .................... 36.5271 36.5271 36.5271 20.3707 20.3707 20.3707 20.3707 23.9081 20.3707 23.9081 23.9081 23.9081 23.9081 23.9081 23.9081 36.5271 $105.00 .................... .................... $105.00 .................... $105.00 $860.15 .................... .................... .................... $105.00 $860.15 $2,237.37 $860.15 .................... .................... .................... .................... $1,208.86 .................... .................... $105.00 $1,208.86 $1,208.86 $1,208.86 $979.09 $1,208.86 $1,190.97 $1,208.86 $1,208.86 $1,418.78 $1,418.78 $412.04 $1,165.92 $2,237.37 $888.82 $1,165.92 $1,418.78 $1,418.78 $1,418.78 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $2,167.63 $1,418.78 .................... .................... $2,167.63 .................... $2,167.63 $2,167.63 $2,167.63 $1,208.86 $1,208.86 $1,208.86 $1,208.86 $1,418.78 $1,208.86 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $1,418.78 $2,167.63 .................... .................... .................... .................... .................... .................... $268.47 .................... .................... .................... .................... $268.47 $535.76 $268.47 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $355.34 .................... .................... .................... .................... $107.40 $354.45 $535.76 $219.48 $354.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $21.00 .................... .................... $21.00 .................... $21.00 $172.03 .................... .................... .................... $21.00 $172.03 $447.47 $172.03 .................... .................... .................... .................... $241.77 .................... .................... $21.00 $241.77 $241.77 $241.77 $195.82 $241.77 $238.19 $241.77 $241.77 $283.76 $283.76 $82.41 $233.18 $447.47 $177.76 $233.18 $283.76 $283.76 $283.76 $241.77 $283.76 $283.76 $283.76 $433.53 $283.76 .................... .................... $433.53 .................... $433.53 $433.53 $433.53 $241.77 $241.77 $241.77 $241.77 $283.76 $241.77 $283.76 $283.76 $283.76 $283.76 $283.76 $283.76 $433.53 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00046 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50725 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 27840 27842 27846 27848 27860 27870 27871 27880 27881 27882 27884 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T C C T T T T C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Treat ankle dislocation ............................. Treat ankle dislocation ............................. Treat ankle dislocation ............................. Treat ankle dislocation ............................. Fixation of ankle joint ............................... Fusion of ankle joint ................................ Fusion of tibiofibular joint ......................... Amputation of lower leg ........................... Amputation of lower leg ........................... Amputation of lower leg ........................... Amputation follow-up surgery .................. 0051 0051 0050 0050 0050 0047 .................... .................... 0049 0051 0049 0050 .................... .................... .................... .................... .................... .................... .................... 0050 0050 0050 0050 0051 0051 0043 0043 0046 0046 0046 0043 0043 0046 0043 0043 0046 0043 0043 0046 0043 0043 0046 0043 0043 0046 0046 0043 0043 0046 0046 0046 0046 0043 0043 0046 0043 0045 0046 0046 0045 0051 0051 .................... .................... .................... 0049 36.5271 36.5271 23.9081 23.9081 23.9081 31.6107 .................... .................... 20.3707 36.5271 20.3707 23.9081 .................... .................... .................... .................... .................... .................... .................... 23.9081 23.9081 23.9081 23.9081 36.5271 36.5271 1.7694 1.7694 37.7023 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 14.4945 37.7023 37.7023 14.4945 36.5271 36.5271 .................... .................... .................... 20.3707 $2,167.63 $2,167.63 $1,418.78 $1,418.78 $1,418.78 $1,875.87 .................... .................... $1,208.86 $2,167.63 $1,208.86 $1,418.78 .................... .................... .................... .................... .................... .................... .................... $1,418.78 $1,418.78 $1,418.78 $1,418.78 $2,167.63 $2,167.63 $105.00 $105.00 $2,237.37 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $860.15 $2,237.37 $2,237.37 $860.15 $2,167.63 $2,167.63 .................... .................... .................... $1,208.86 .................... .................... .................... .................... .................... $537.03 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $535.76 $535.76 $535.76 .................... .................... $535.76 .................... .................... $535.76 .................... .................... $535.76 .................... .................... $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 $535.76 $535.76 .................... .................... $535.76 .................... $268.47 $535.76 $535.76 $268.47 .................... .................... .................... .................... .................... .................... $433.53 $433.53 $283.76 $283.76 $283.76 $375.17 .................... .................... $241.77 $433.53 $241.77 $283.76 .................... .................... .................... .................... .................... .................... .................... $283.76 $283.76 $283.76 $283.76 $433.53 $433.53 $21.00 $21.00 $447.47 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $172.03 $447.47 $447.47 $172.03 $433.53 $433.53 .................... .................... .................... $241.77 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00047 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50726 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 28193 28200 28202 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................. Removal of foot foreign body .................. Repair of foot tendon ............................... Repair/graft of foot tendon ....................... .................... .................... 0050 0049 0049 0049 0043 0007 0049 0049 0055 0055 0055 0055 0055 0055 0055 0220 0220 0021 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0056 0056 0055 0056 0056 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0019 0021 0020 0055 0055 .................... .................... 23.9081 20.3707 20.3707 20.3707 1.7694 11.4501 20.3707 20.3707 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 17.3586 17.3586 14.9776 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 40.2957 40.2957 20.0692 40.2957 40.2957 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 4.0547 14.9776 6.9433 20.0692 20.0692 .................... .................... $1,418.78 $1,208.86 $1,208.86 $1,208.86 $105.00 $679.48 $1,208.86 $1,208.86 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,030.11 $1,030.11 $888.82 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $2,391.27 $2,391.27 $1,190.97 $2,391.27 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $240.62 $888.82 $412.04 $1,190.97 $1,190.97 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 .................... .................... $219.48 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 .................... .................... $355.34 .................... .................... $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $71.87 $219.48 $107.40 $355.34 $355.34 .................... .................... $283.76 $241.77 $241.77 $241.77 $21.00 $135.90 $241.77 $241.77 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $206.02 $206.02 $177.76 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $478.25 $478.25 $238.19 $478.25 $478.25 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $48.12 $177.76 $82.41 $238.19 $238.19 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00048 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50727 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ......................... Relative weight APC 0055 0056 0055 0055 0055 0055 0055 0055 0055 0056 0055 0055 0055 0055 0055 0056 0055 0055 0055 0055 0055 0055 0055 0057 0057 0057 0057 0057 0057 0057 0057 0056 0055 0056 0056 0055 0055 0055 0056 0055 0055 0055 0055 0056 0056 0055 0055 0055 0055 0056 0043 0043 0046 0046 0046 0043 0043 0046 0046 0043 0043 0046 0046 0043 0043 0046 20.0692 40.2957 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 40.2957 20.0692 20.0692 20.0692 20.0692 20.0692 40.2957 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 20.0692 27.5493 27.5493 27.5493 27.5493 27.5493 27.5493 27.5493 27.5493 40.2957 20.0692 40.2957 40.2957 20.0692 20.0692 20.0692 40.2957 20.0692 20.0692 20.0692 20.0692 40.2957 40.2957 20.0692 20.0692 20.0692 20.0692 40.2957 1.7694 1.7694 37.7023 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 Payment rate National unadjusted copayment Minimum unadjusted copayment $1,190.97 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $1,634.86 $1,634.86 $1,634.86 $1,634.86 $1,634.86 $1,634.86 $1,634.86 $1,634.86 $2,391.27 $1,190.97 $2,391.27 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $2,391.27 $2,391.27 $1,190.97 $1,190.97 $1,190.97 $1,190.97 $2,391.27 $105.00 $105.00 $2,237.37 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $355.34 .................... $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 .................... $355.34 $355.34 $355.34 $355.34 $355.34 .................... $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $355.34 $475.91 $475.91 $475.91 $475.91 $475.91 $475.91 $475.91 $475.91 .................... $355.34 .................... .................... $355.34 $355.34 $355.34 .................... $355.34 $355.34 $355.34 $355.34 .................... .................... $355.34 $355.34 $355.34 $355.34 .................... .................... .................... $535.76 $535.76 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $238.19 $478.25 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $478.25 $238.19 $238.19 $238.19 $238.19 $238.19 $478.25 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $238.19 $326.97 $326.97 $326.97 $326.97 $326.97 $326.97 $326.97 $326.97 $478.25 $238.19 $478.25 $478.25 $238.19 $238.19 $238.19 $478.25 $238.19 $238.19 $238.19 $238.19 $478.25 $478.25 $238.19 $238.19 $238.19 $238.19 $478.25 $21.00 $21.00 $447.47 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00049 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50728 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 28485 28490 28495 28496 28505 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T S S S S S S S S S S S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Treat metatarsal fracture ......................... Treat big toe fracture ............................... Treat big toe fracture ............................... Treat big toe fracture ............................... Treat big toe fracture ............................... 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 ....................... 0046 0043 0043 0046 0046 0043 0043 0046 0043 0046 0043 0045 0046 0046 0043 0043 0046 0046 0043 0043 0046 0046 0043 0045 0046 0046 0043 0045 0046 0046 0056 0056 0056 0056 0056 0056 0056 0056 0055 0056 .................... .................... 0055 0055 0055 0043 0058 0426 0426 0058 0058 0426 0058 0426 0426 0058 0426 0058 0426 0426 0058 0058 0058 0058 0058 0058 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 1.7694 37.7023 1.7694 14.4945 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 1.7694 37.7023 37.7023 1.7694 14.4945 37.7023 37.7023 1.7694 14.4945 37.7023 37.7023 40.2957 40.2957 40.2957 40.2957 40.2957 40.2957 40.2957 40.2957 20.0692 40.2957 .................... .................... 20.0692 20.0692 20.0692 1.7694 1.0934 2.1243 2.1243 1.0934 1.0934 2.1243 1.0934 2.1243 2.1243 1.0934 2.1243 1.0934 2.1243 2.1243 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $105.00 $2,237.37 $105.00 $860.15 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $105.00 $2,237.37 $2,237.37 $105.00 $860.15 $2,237.37 $2,237.37 $105.00 $860.15 $2,237.37 $2,237.37 $2,391.27 $2,391.27 $2,391.27 $2,391.27 $2,391.27 $2,391.27 $2,391.27 $2,391.27 $1,190.97 $2,391.27 .................... .................... $1,190.97 $1,190.97 $1,190.97 $105.00 $64.89 $126.06 $126.06 $64.89 $64.89 $126.06 $64.89 $126.06 $126.06 $64.89 $126.06 $64.89 $126.06 $126.06 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 .................... $535.76 .................... $268.47 $535.76 $535.76 .................... .................... $535.76 $535.76 .................... .................... $535.76 $535.76 .................... $268.47 $535.76 $535.76 .................... $268.47 $535.76 $535.76 .................... .................... .................... .................... .................... .................... .................... .................... $355.34 .................... .................... .................... $355.34 $355.34 $355.34 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $21.00 $447.47 $21.00 $172.03 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $21.00 $447.47 $447.47 $21.00 $172.03 $447.47 $447.47 $21.00 $172.03 $447.47 $447.47 $478.25 $478.25 $478.25 $478.25 $478.25 $478.25 $478.25 $478.25 $238.19 $478.25 .................... .................... $238.19 $238.19 $238.19 $21.00 $12.98 $25.21 $25.21 $12.98 $12.98 $25.21 $12.98 $25.21 $25.21 $12.98 $25.21 $12.98 $25.21 $25.21 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00050 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50729 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 29131 29200 29220 29240 29260 29280 29305 29325 29345 29355 29358 29365 29405 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................................. 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 .................................... 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 ....................... Relative weight APC 0058 0058 0058 0058 0058 0058 0426 0426 0426 0426 0426 0426 0426 0426 0426 0058 0426 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0426 0058 0058 0058 0058 0058 0058 0041 0041 0041 0042 0042 0041 0041 0041 0041 0041 0041 0041 0042 0042 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0042 0042 0041 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 2.1243 2.1243 2.1243 2.1243 2.1243 2.1243 2.1243 2.1243 2.1243 1.0934 2.1243 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 2.1243 1.0934 1.0934 1.0934 1.0934 1.0934 1.0934 28.1318 28.1318 28.1318 43.9753 43.9753 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 43.9753 43.9753 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 43.9753 43.9753 28.1318 Payment rate National unadjusted copayment Minimum unadjusted copayment $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $126.06 $126.06 $126.06 $126.06 $126.06 $126.06 $126.06 $126.06 $126.06 $64.89 $126.06 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $126.06 $64.89 $64.89 $64.89 $64.89 $64.89 $64.89 $1,669.43 $1,669.43 $1,669.43 $2,609.63 $2,609.63 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $2,609.63 $2,609.63 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $2,609.63 $2,609.63 $1,669.43 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $804.74 $804.74 .................... .................... .................... .................... .................... .................... .................... $804.74 $804.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $804.74 $804.74 .................... $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $25.21 $25.21 $25.21 $25.21 $25.21 $25.21 $25.21 $25.21 $25.21 $12.98 $25.21 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $25.21 $12.98 $12.98 $12.98 $12.98 $12.98 $12.98 $333.89 $333.89 $333.89 $521.93 $521.93 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $521.93 $521.93 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $521.93 $521.93 $333.89 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00051 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50730 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 29860 29861 29862 29863 29866 29867 29868 29870 29871 29873 29874 29875 29876 29877 29879 29880 29881 29882 29883 29884 29885 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T X T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................ 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 .............................. Relative weight APC 0041 0041 0042 0042 0042 0042 0042 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0042 0041 0041 0042 0042 0041 0041 0055 0041 0041 0041 0041 0042 0053 0053 0053 0041 0251 0251 0252 0253 0253 0253 0254 0253 0252 0256 0253 0254 0256 0256 0252 0252 0252 0340 0253 0253 0256 0256 0256 0254 0256 0256 0256 0256 0256 28.1318 28.1318 43.9753 43.9753 43.9753 43.9753 43.9753 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 28.1318 43.9753 28.1318 28.1318 43.9753 43.9753 28.1318 28.1318 20.0692 28.1318 28.1318 28.1318 28.1318 43.9753 15.6795 15.6795 15.6795 28.1318 2.0101 2.0101 7.8673 16.1357 16.1357 16.1357 23.404 16.1357 7.8673 37.3204 16.1357 23.404 37.3204 37.3204 7.8673 7.8673 7.8673 0.6384 16.1357 16.1357 37.3204 37.3204 37.3204 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 Payment rate National unadjusted copayment Minimum unadjusted copayment $1,669.43 $1,669.43 $2,609.63 $2,609.63 $2,609.63 $2,609.63 $2,609.63 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $2,609.63 $1,669.43 $1,669.43 $2,609.63 $2,609.63 $1,669.43 $1,669.43 $1,190.97 $1,669.43 $1,669.43 $1,669.43 $1,669.43 $2,609.63 $930.47 $930.47 $930.47 $1,669.43 $119.29 $119.29 $466.87 $957.54 $957.54 $957.54 $1,388.86 $957.54 $466.87 $2,214.70 $957.54 $1,388.86 $2,214.70 $2,214.70 $466.87 $466.87 $466.87 $37.88 $957.54 $957.54 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... .................... $804.74 $804.74 $804.74 $804.74 $804.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $804.74 .................... .................... $804.74 $804.74 .................... .................... $355.34 .................... .................... .................... .................... $804.74 $253.49 $253.49 $253.49 .................... .................... .................... $113.41 $282.29 $282.29 $282.29 $321.35 $282.29 $113.41 .................... $282.29 $321.35 .................... .................... $113.41 $113.41 $113.41 .................... $282.29 $282.29 .................... .................... .................... $321.35 .................... .................... .................... .................... .................... $333.89 $333.89 $521.93 $521.93 $521.93 $521.93 $521.93 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $333.89 $521.93 $333.89 $333.89 $521.93 $521.93 $333.89 $333.89 $238.19 $333.89 $333.89 $333.89 $333.89 $521.93 $186.09 $186.09 $186.09 $333.89 $23.86 $23.86 $93.37 $191.51 $191.51 $191.51 $277.77 $191.51 $93.37 $442.94 $191.51 $277.77 $442.94 $442.94 $93.37 $93.37 $93.37 $7.58 $191.51 $191.51 $442.94 $442.94 $442.94 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00052 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50731 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T C C T T T T T T C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .......................... 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 .......................... 0254 0256 0256 0251 0256 0256 0256 0254 0252 0252 0250 0250 0250 0250 0091 0092 0253 0251 0251 0252 0254 0256 0256 0254 0256 0256 0254 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 .................... .................... 0072 0072 0074 0075 0074 0075 0074 0075 0075 0075 0075 0075 0075 0075 .................... .................... 0075 0075 0075 0251 0254 0256 .................... .................... .................... .................... 23.404 37.3204 37.3204 2.0101 37.3204 37.3204 37.3204 23.404 7.8673 7.8673 1.2896 1.2896 1.2896 1.2896 28.9999 26.482 16.1357 2.0101 2.0101 7.8673 23.404 37.3204 37.3204 23.404 37.3204 37.3204 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 .................... .................... 1.4361 1.4361 15.7757 21.3426 15.7757 21.3426 15.7757 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 .................... .................... 21.3426 21.3426 21.3426 2.0101 23.404 37.3204 .................... .................... .................... .................... $1,388.86 $2,214.70 $2,214.70 $119.29 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $466.87 $466.87 $76.53 $76.53 $76.53 $76.53 $1,720.94 $1,571.52 $957.54 $119.29 $119.29 $466.87 $1,388.86 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... .................... $85.22 $85.22 $936.18 $1,266.53 $936.18 $1,266.53 $936.18 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 .................... .................... $1,266.53 $1,266.53 $1,266.53 $119.29 $1,388.86 $2,214.70 .................... .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... $321.35 $113.41 $113.41 $26.79 $26.79 $26.79 $26.79 $348.23 $505.37 $282.29 .................... .................... $113.41 $321.35 .................... .................... $321.35 .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $21.27 $21.27 $295.70 $445.92 $295.70 $445.92 $295.70 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 .................... .................... $445.92 $445.92 $445.92 .................... $321.35 .................... .................... .................... .................... .................... $277.77 $442.94 $442.94 $23.86 $442.94 $442.94 $442.94 $277.77 $93.37 $93.37 $15.31 $15.31 $15.31 $15.31 $344.19 $314.30 $191.51 $23.86 $23.86 $93.37 $277.77 $442.94 $442.94 $277.77 $442.94 $442.94 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 .................... .................... $17.04 $17.04 $187.24 $253.31 $187.24 $253.31 $187.24 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 .................... .................... $253.31 $253.31 $253.31 $23.86 $277.77 $442.94 .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00053 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50732 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C T T S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C T T C T T T T T T T T T T T T T T S T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... 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 ............... .................... .................... .................... .................... .................... .................... 0256 0256 0094 0121 0071 0074 0072 0074 0072 0074 0072 0074 0075 0075 0074 0074 0075 0075 0075 0075 0075 0075 0075 0075 0075 0075 0074 0075 0072 0075 0073 0075 0073 0256 0256 .................... 0253 0256 .................... 0256 0256 0256 0251 0254 0254 0252 0252 0254 0254 0254 0254 0256 0076 0670 0076 0076 0076 0076 0076 0076 .................... .................... .................... .................... .................... .................... 37.3204 37.3204 2.5363 2.2766 0.7915 15.7757 1.4361 15.7757 1.4361 15.7757 1.4361 15.7757 21.3426 21.3426 15.7757 15.7757 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 21.3426 15.7757 21.3426 1.4361 21.3426 4.1609 21.3426 4.1609 37.3204 37.3204 .................... 16.1357 37.3204 .................... 37.3204 37.3204 37.3204 2.0101 23.404 23.404 7.8673 7.8673 23.404 23.404 23.404 23.404 37.3204 9.4592 25.4131 9.4592 9.4592 9.4592 9.4592 9.4592 9.4592 .................... .................... .................... .................... .................... .................... $2,214.70 $2,214.70 $150.51 $135.10 $46.97 $936.18 $85.22 $936.18 $85.22 $936.18 $85.22 $936.18 $1,266.53 $1,266.53 $936.18 $936.18 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $1,266.53 $936.18 $1,266.53 $85.22 $1,266.53 $246.92 $1,266.53 $246.92 $2,214.70 $2,214.70 .................... $957.54 $2,214.70 .................... $2,214.70 $2,214.70 $2,214.70 $119.29 $1,388.86 $1,388.86 $466.87 $466.87 $1,388.86 $1,388.86 $1,388.86 $1,388.86 $2,214.70 $561.34 $1,508.09 $561.34 $561.34 $561.34 $561.34 $561.34 $561.34 .................... .................... .................... .................... .................... .................... .................... .................... $47.62 $43.80 $11.31 $295.70 $21.27 $295.70 $21.27 $295.70 $21.27 $295.70 $445.92 $445.92 $295.70 $295.70 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 $445.92 $295.70 $445.92 $21.27 $445.92 $73.38 $445.92 $73.38 .................... .................... .................... $282.29 .................... .................... .................... .................... .................... .................... $321.35 $321.35 $113.41 $113.41 $321.35 $321.35 $321.35 $321.35 .................... $189.82 $472.46 $189.82 $189.82 $189.82 $189.82 $189.82 $189.82 .................... .................... .................... .................... .................... .................... $442.94 $442.94 $30.10 $27.02 $9.39 $187.24 $17.04 $187.24 $17.04 $187.24 $17.04 $187.24 $253.31 $253.31 $187.24 $187.24 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $187.24 $253.31 $17.04 $253.31 $49.38 $253.31 $49.38 $442.94 $442.94 .................... $191.51 $442.94 .................... $442.94 $442.94 $442.94 $23.86 $277.77 $277.77 $93.37 $93.37 $277.77 $277.77 $277.77 $277.77 $442.94 $112.27 $301.62 $112.27 $112.27 $112.27 $112.27 $112.27 $112.27 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00054 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50733 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 32095 32100 32110 32120 32124 32140 32141 32150 32151 32160 32200 32201 32215 32220 32225 32310 32320 32400 32402 32405 32420 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T N N N T T C T T T C C C C C C T C C C T T T T T T T T T C C C C C C C C C C C C C T C C C C C T C T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................................. 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 .................................. 0415 0415 0076 0076 0076 0415 0076 0415 0415 0415 0076 0076 0076 0076 0072 .................... .................... .................... 0073 0071 .................... 0073 0256 0256 .................... .................... .................... .................... .................... .................... 0254 .................... .................... .................... 0253 0254 0254 0076 0070 0070 0070 0070 0070 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0070 .................... .................... .................... .................... .................... 0685 .................... 0685 0070 22.0955 22.0955 9.4592 9.4592 9.4592 22.0955 9.4592 22.0955 22.0955 22.0955 9.4592 9.4592 9.4592 9.4592 1.4361 .................... .................... .................... 4.1609 0.7915 .................... 4.1609 37.3204 37.3204 .................... .................... .................... .................... .................... .................... 23.404 .................... .................... .................... 16.1357 23.404 23.404 9.4592 3.2101 3.2101 3.2101 3.2101 3.2101 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 3.2101 .................... .................... .................... .................... .................... 6.0174 .................... 6.0174 3.2101 $1,311.21 $1,311.21 $561.34 $561.34 $561.34 $1,311.21 $561.34 $1,311.21 $1,311.21 $1,311.21 $561.34 $561.34 $561.34 $561.34 $85.22 .................... .................... .................... $246.92 $46.97 .................... $246.92 $2,214.70 $2,214.70 .................... .................... .................... .................... .................... .................... $1,388.86 .................... .................... .................... $957.54 $1,388.86 $1,388.86 $561.34 $190.50 $190.50 $190.50 $190.50 $190.50 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $190.50 .................... .................... .................... .................... .................... $357.09 .................... $357.09 $190.50 $459.92 $459.92 $189.82 $189.82 $189.82 $459.92 $189.82 $459.92 $459.92 $459.92 $189.82 $189.82 $189.82 $189.82 $21.27 .................... .................... .................... $73.38 $11.31 .................... $73.38 .................... .................... .................... .................... .................... .................... .................... .................... $321.35 .................... .................... .................... $282.29 $321.35 $321.35 $189.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $115.47 .................... $115.47 .................... $262.24 $262.24 $112.27 $112.27 $112.27 $262.24 $112.27 $262.24 $262.24 $262.24 $112.27 $112.27 $112.27 $112.27 $17.04 .................... .................... .................... $49.38 $9.39 .................... $49.38 $442.94 $442.94 .................... .................... .................... .................... .................... .................... $277.77 .................... .................... .................... $191.51 $277.77 $277.77 $112.27 $38.10 $38.10 $38.10 $38.10 $38.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $38.10 .................... .................... .................... .................... .................... $71.42 .................... $71.42 $38.10 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00055 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50734 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 32850 32851 32852 32853 32854 32855 32856 32900 32905 32906 32940 32960 32997 32999 33010 33011 33015 33020 33025 33030 33031 33050 33120 33130 33140 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C C C C C C C T T T T T T 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 T C T T T C C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................ Donor pneumonectomy ........................... 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 ..................................... 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) ......................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0069 0069 0069 0069 0069 0069 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0070 .................... 0070 0070 0070 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 30.6775 30.6775 30.6775 30.6775 30.6775 30.6775 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 3.2101 .................... 3.2101 3.2101 3.2101 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,820.49 $1,820.49 $1,820.49 $1,820.49 $1,820.49 $1,820.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $190.50 .................... $190.50 $190.50 $190.50 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $591.64 $591.64 $591.64 $591.64 $591.64 $591.64 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $364.10 $364.10 $364.10 $364.10 $364.10 $364.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $38.10 .................... $38.10 $38.10 $38.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00056 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50735 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 33416 33417 33420 33422 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C T T T T T T T T T T T T T T T T T T T T T C C C B T C T C C B C C C C S T 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 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... Revise eltrd pacing-defib ......................... Insert lead pace-defib, dual ..................... Repair lead pace-defib, one .................... Repair lead pace-defib, dual ................... Revise pocket, acemaker ........................ 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 .................... Revise ventricle muscle ........................... Repair of aortic valve ............................... Revision of mitral valve ........................... Revision of mitral valve ........................... .................... .................... .................... 0089 0089 0655 0106 0106 0090 0654 0655 0105 0106 0106 0106 0106 0027 0027 0418 0418 0105 0105 0105 0105 .................... .................... .................... .................... 0105 .................... 0105 .................... .................... .................... .................... .................... .................... .................... 0680 0109 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 105.6143 105.6143 133.7768 45.4851 45.4851 89.1574 100.9294 133.7768 22.3685 45.4851 45.4851 45.4851 45.4851 18.4182 18.4182 109.3043 109.3043 22.3685 22.3685 22.3685 22.3685 .................... .................... .................... .................... 22.3685 .................... 22.3685 .................... .................... .................... .................... .................... .................... .................... 62.9082 11.0433 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6,267.47 $6,267.47 $7,938.72 $2,699.22 $2,699.22 $5,290.87 $5,989.45 $7,938.72 $1,327.41 $2,699.22 $2,699.22 $2,699.22 $2,699.22 $1,092.99 $1,092.99 $6,486.45 $6,486.45 $1,327.41 $1,327.41 $1,327.41 $1,327.41 .................... .................... .................... .................... $1,327.41 .................... $1,327.41 .................... .................... .................... .................... .................... .................... .................... $3,733.16 $655.34 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,682.28 $1,682.28 .................... .................... .................... $1,612.80 .................... .................... $370.40 .................... .................... .................... .................... $329.72 $329.72 .................... .................... $370.40 $370.40 $370.40 $370.40 .................... .................... .................... .................... $370.40 .................... $370.40 .................... .................... .................... .................... .................... .................... .................... .................... $131.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,253.49 $1,253.49 $1,587.74 $539.84 $539.84 $1,058.17 $1,197.89 $1,587.74 $265.48 $539.84 $539.84 $539.84 $539.84 $218.60 $218.60 $1,297.29 $1,297.29 $265.48 $265.48 $265.48 $265.48 .................... .................... .................... .................... $265.48 .................... $265.48 .................... .................... .................... .................... .................... .................... .................... $746.63 $131.07 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00057 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50736 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI 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 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 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00058 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50737 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 33694 33697 33702 33710 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 33930 33933 33935 33940 33944 33945 33960 33961 33967 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI 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 C C C C C C C C C C C C C C C C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Repair of heart defects ............................ Repair of heart defects ............................ Repair of heart defects ............................ Repair of heart defects ............................ 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 ........................ Removal of donor heart/lung ................... Prepare donor heart/lung ......................... Transplantation, heart/lung ...................... Removal of donor heart ........................... Prepare donor heart ................................ Transplantation of heart ........................... External circulation assist ........................ External circulation assist ........................ Insert ia percut device ............................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00059 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50738 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 33968 33970 33971 33973 33974 33975 33976 33977 33978 33979 33980 33999 34001 34051 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C C C T C C T T C T T C T C T T T C T T T C C C C C C C C C C C C C C C C C C C C T C C C C C C C C C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............................. 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 ........................................ Endovasc abdo repair w/tube .................. Endovasc abdo repr w/device ................. Endovas aaa repr w/3-p part ................... Endovasc abdo repr w/device ................. Endovasc abdo repair w/pros .................. Endovasc abdo occlud device ................. Xpose for endoprosth, aortic ................... 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 ..................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0070 .................... .................... 0088 0088 .................... 0088 0088 .................... 0088 .................... 0088 0088 0088 .................... 0088 0088 0088 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0653 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 3.2101 .................... .................... 36.5617 36.5617 .................... 36.5617 36.5617 .................... 36.5617 .................... 36.5617 36.5617 36.5617 .................... 36.5617 36.5617 36.5617 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 30.5339 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $190.50 .................... .................... $2,169.68 $2,169.68 .................... $2,169.68 $2,169.68 .................... $2,169.68 .................... $2,169.68 $2,169.68 $2,169.68 .................... $2,169.68 $2,169.68 $2,169.68 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,811.97 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $655.22 $655.22 .................... $655.22 $655.22 .................... $655.22 .................... $655.22 $655.22 $655.22 .................... $655.22 $655.22 $655.22 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $38.10 .................... .................... $433.94 $433.94 .................... $433.94 $433.94 .................... $433.94 .................... $433.94 $433.94 $433.94 .................... $433.94 $433.94 $433.94 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $362.39 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00060 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50739 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 35141 35142 35151 35152 35180 35182 35184 35188 35189 35190 35201 35206 35207 35211 35216 35221 35226 35231 35236 35241 35246 35251 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C T C T T C T T T T C C C T T T C C C T T T C C C T C C T C C C C C C C C C C C C C C C T T T T T T T T T T C C C C T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ...................... 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 ..................... .................... .................... .................... .................... 0093 .................... 0093 0088 .................... 0093 0093 0093 0088 .................... .................... .................... 0093 0093 0093 .................... .................... .................... 0093 0653 0653 .................... .................... .................... 0653 .................... .................... 0093 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0081 0081 0081 0081 0081 0081 0081 0081 0081 0081 .................... .................... .................... .................... 0081 0081 0081 0081 0081 .................... .................... .................... .................... 23.4516 .................... 23.4516 36.5617 .................... 23.4516 23.4516 23.4516 36.5617 .................... .................... .................... 23.4516 23.4516 23.4516 .................... .................... .................... 23.4516 30.5339 30.5339 .................... .................... .................... 30.5339 .................... .................... 23.4516 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 34.4473 34.4473 34.4473 34.4473 34.4473 34.4473 34.4473 34.4473 34.4473 34.4473 .................... .................... .................... .................... 34.4473 34.4473 34.4473 34.4473 34.4473 .................... .................... .................... .................... $1,391.69 .................... $1,391.69 $2,169.68 .................... $1,391.69 $1,391.69 $1,391.69 $2,169.68 .................... .................... .................... $1,391.69 $1,391.69 $1,391.69 .................... .................... .................... $1,391.69 $1,811.97 $1,811.97 .................... .................... .................... $1,811.97 .................... .................... $1,391.69 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 .................... .................... .................... .................... $2,044.21 $2,044.21 $2,044.21 $2,044.21 $2,044.21 .................... .................... .................... .................... .................... .................... .................... $655.22 .................... .................... .................... .................... $655.22 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $278.34 .................... $278.34 $433.94 .................... $278.34 $278.34 $278.34 $433.94 .................... .................... .................... $278.34 $278.34 $278.34 .................... .................... .................... $278.34 $362.39 $362.39 .................... .................... .................... $362.39 .................... .................... $278.34 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $408.84 $408.84 $408.84 $408.84 $408.84 $408.84 $408.84 $408.84 $408.84 $408.84 .................... .................... .................... .................... $408.84 $408.84 $408.84 $408.84 $408.84 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00061 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50740 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T 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 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 T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................................. 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 ..................... 0081 0081 0081 0081 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0093 34.4473 34.4473 34.4473 34.4473 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 23.4516 $2,044.21 $2,044.21 $2,044.21 $2,044.21 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,391.69 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $408.84 $408.84 $408.84 $408.84 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $278.34 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00062 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50741 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 36200 36215 36216 36217 36218 36245 36246 36247 36248 36260 36261 36262 36299 36400 36405 36406 36410 36415 36416 36420 36425 36430 36440 36450 36455 36460 36468 36469 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T C C C C C C C C C T C C C T C T T T T C T C C N S N N N N N N N N N N N N N N N N N N N N N T T T N N N N N A N T T S S S S S T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................ 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 ..................... Drawing blood .......................................... 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 .......................... 0093 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0115 .................... .................... .................... 0093 .................... 0088 0088 0088 0088 .................... 0115 .................... .................... .................... 0267 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0623 0623 0622 .................... .................... .................... .................... .................... .................... .................... 0035 0035 0110 0110 0110 0110 0110 0098 0098 23.4516 .................... .................... .................... .................... .................... .................... .................... .................... .................... 31.4727 .................... .................... .................... 23.4516 .................... 36.5617 36.5617 36.5617 36.5617 .................... 31.4727 .................... .................... .................... 2.6327 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 27.1105 27.1105 21.2671 .................... .................... .................... .................... .................... .................... .................... 0.7158 0.7158 3.6594 3.6594 3.6594 3.6594 3.6594 1.1346 1.1346 $1,391.69 .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,867.68 .................... .................... .................... $1,391.69 .................... $2,169.68 $2,169.68 $2,169.68 $2,169.68 .................... $1,867.68 .................... .................... .................... $156.23 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,608.82 $1,608.82 $1,262.05 .................... .................... .................... .................... .................... .................... .................... $42.48 $42.48 $217.16 $217.16 $217.16 $217.16 $217.16 $67.33 $67.33 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $459.35 .................... .................... .................... .................... .................... $655.22 $655.22 $655.22 $655.22 .................... $459.35 .................... .................... .................... $62.18 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $278.34 .................... .................... .................... .................... .................... .................... .................... .................... .................... $373.54 .................... .................... .................... $278.34 .................... $433.94 $433.94 $433.94 $433.94 .................... $373.54 .................... .................... .................... $31.25 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $321.76 $321.76 $252.41 .................... .................... .................... .................... .................... .................... .................... $8.50 $8.50 $43.43 $43.43 $43.43 $43.43 $43.43 $13.47 $13.47 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00063 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50742 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 36625 36640 36660 36680 36800 36810 36815 36818 36819 36820 36821 36822 36823 36825 36830 36831 36832 36833 36834 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T N N N S S S S S S S N T T T T T T T T T T T T T T T T T T T T T T T T T T T T N N N T C T T T T T T T T C C T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Injection therapy of vein .......................... Injection therapy of veins ......................... Endovenous rf, 1st vein ........................... Endovenous rf, vein add-on .................... Endovenous laser, 1st vein ..................... Endovenous laser vein addon ................. 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 tunneled cv cath ............................ Insert tunneled cv cath ............................ Insert tunneled cv cath ............................ Insert tunneled cv cath ............................ Repair tunneled cv cath ........................... Repair tunneled cv cath ........................... Replace tunneled cv cath ........................ Replace tunneled cv cath ........................ Replace tunneled cv cath ........................ Replace tunneled cv cath ........................ Replace tunneled cv cath ........................ Replace tunneled cv cath ........................ Replace tunneled cv 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 .......................... 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 fusion/uppr arm vein ........................... Av fusion/forearm vein ............................. Av fusion direct any site .......................... Insertion of cannula(s) ............................. Insertion of cannula(s) ............................. Artery-vein autograft ................................ Artery-vein graft ....................................... Open thrombect av fistula ....................... Av fistula revision, open .......................... Av fistula revision ..................................... Repair A-V aneurysm .............................. 0098 0098 0092 0092 0092 0092 .................... .................... .................... 0111 0111 0111 0111 0112 0112 0112 .................... 0676 0621 0621 0622 0622 0623 0623 0623 0623 1564 0621 0621 0622 0622 0621 0621 0622 0621 0622 0623 0623 0621 0622 0621 0621 0622 0621 0621 .................... .................... .................... 0623 .................... 0002 0115 0115 0115 0088 0088 0088 0088 .................... .................... 0088 0088 0088 0088 0088 0088 1.1346 1.1346 26.482 26.482 26.482 26.482 .................... .................... .................... 12.3956 12.3956 12.3956 12.3956 26.7948 26.7948 26.7948 .................... 2.4105 8.2986 8.2986 21.2671 21.2671 27.1105 27.1105 27.1105 27.1105 .................... 8.2986 8.2986 21.2671 21.2671 8.2986 8.2986 21.2671 8.2986 21.2671 27.1105 27.1105 8.2986 21.2671 8.2986 8.2986 21.2671 8.2986 8.2986 .................... .................... .................... 27.1105 .................... 0.9559 31.4727 31.4727 31.4727 36.5617 36.5617 36.5617 36.5617 .................... .................... 36.5617 36.5617 36.5617 36.5617 36.5617 36.5617 $67.33 $67.33 $1,571.52 $1,571.52 $1,571.52 $1,571.52 .................... .................... .................... $735.59 $735.59 $735.59 $735.59 $1,590.08 $1,590.08 $1,590.08 .................... $143.05 $492.46 $492.46 $1,262.05 $1,262.05 $1,608.82 $1,608.82 $1,608.82 $1,608.82 $4,750.00 $492.46 $492.46 $1,262.05 $1,262.05 $492.46 $492.46 $1,262.05 $492.46 $1,262.05 $1,608.82 $1,608.82 $492.46 $1,262.05 $492.46 $492.46 $1,262.05 $492.46 $492.46 .................... .................... .................... $1,608.82 .................... $56.73 $1,867.68 $1,867.68 $1,867.68 $2,169.68 $2,169.68 $2,169.68 $2,169.68 .................... .................... $2,169.68 $2,169.68 $2,169.68 $2,169.68 $2,169.68 $2,169.68 .................... .................... $505.37 $505.37 $505.37 $505.37 .................... .................... .................... $200.18 $200.18 $200.18 $200.18 $438.94 $438.94 $438.94 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $459.35 $459.35 $459.35 $655.22 $655.22 $655.22 $655.22 .................... .................... $655.22 $655.22 $655.22 $655.22 $655.22 $655.22 $13.47 $13.47 $314.30 $314.30 $314.30 $314.30 .................... .................... .................... $147.12 $147.12 $147.12 $147.12 $318.02 $318.02 $318.02 .................... $28.61 $98.49 $98.49 $252.41 $252.41 $321.76 $321.76 $321.76 $321.76 $950.00 $98.49 $98.49 $252.41 $252.41 $98.49 $98.49 $252.41 $98.49 $252.41 $321.76 $321.76 $98.49 $252.41 $98.49 $98.49 $252.41 $98.49 $98.49 .................... .................... .................... $321.76 .................... $11.35 $373.54 $373.54 $373.54 $433.94 $433.94 $433.94 $433.94 .................... .................... $433.94 $433.94 $433.94 $433.94 $433.94 $433.94 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00064 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50743 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 38101 38102 38115 38120 38129 38200 38204 38205 38206 38207 38208 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T C C C C C C T T T T T T T T T T T T C C S S T T T T T T T T T C C C T T C T T T T T T T T T C T T C C C C T T N E S S E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................... Transcatheter stent .................................. Transcatheter stent add-on ..................... Transcatheter stent .................................. Transcatheter stent add-on ..................... 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 ..................... Revision of leg veins ............................... 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 .......................... 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 ...................... 0115 0088 0676 0115 0653 .................... .................... .................... .................... .................... .................... 0229 0676 0685 0676 0676 0103 0115 0229 0229 0229 0229 0103 .................... .................... 0416 0416 0092 0092 0093 0093 0091 0091 0092 0021 0091 .................... .................... .................... 0091 0091 .................... 0091 0092 0092 0092 0091 0091 0091 0091 0091 .................... 0181 0103 .................... .................... .................... .................... 0131 0130 .................... .................... 0111 0111 .................... .................... 31.4727 36.5617 2.4105 31.4727 30.5339 .................... .................... .................... .................... .................... .................... 64.4545 2.4105 6.0174 2.4105 2.4105 14.7142 31.4727 64.4545 64.4545 64.4545 64.4545 14.7142 .................... .................... 19.5542 19.5542 26.482 26.482 23.4516 23.4516 28.9999 28.9999 26.482 14.9776 28.9999 .................... .................... .................... 28.9999 28.9999 .................... 28.9999 26.482 26.482 26.482 28.9999 28.9999 28.9999 28.9999 28.9999 .................... 30.8663 14.7142 .................... .................... .................... .................... 43.3389 31.9271 .................... .................... 12.3956 12.3956 .................... .................... $1,867.68 $2,169.68 $143.05 $1,867.68 $1,811.97 .................... .................... .................... .................... .................... .................... $3,824.92 $143.05 $357.09 $143.05 $143.05 $873.18 $1,867.68 $3,824.92 $3,824.92 $3,824.92 $3,824.92 $873.18 .................... .................... $1,160.40 $1,160.40 $1,571.52 $1,571.52 $1,391.69 $1,391.69 $1,720.94 $1,720.94 $1,571.52 $888.82 $1,720.94 .................... .................... .................... $1,720.94 $1,720.94 .................... $1,720.94 $1,571.52 $1,571.52 $1,571.52 $1,720.94 $1,720.94 $1,720.94 $1,720.94 $1,720.94 .................... $1,831.70 $873.18 .................... .................... .................... .................... $2,571.86 $1,894.65 .................... .................... $735.59 $735.59 .................... .................... $459.35 $655.22 .................... $459.35 .................... .................... .................... .................... .................... .................... .................... $771.23 .................... $115.47 .................... .................... $223.63 $459.35 $771.23 $771.23 $771.23 $771.23 $223.63 .................... .................... .................... .................... $505.37 $505.37 .................... .................... $348.23 $348.23 $505.37 $219.48 $348.23 .................... .................... .................... $348.23 $348.23 .................... $348.23 $505.37 $505.37 $505.37 $348.23 $348.23 $348.23 $348.23 $348.23 .................... $621.82 $223.63 .................... .................... .................... .................... $1,001.89 $659.53 .................... .................... $200.18 $200.18 .................... .................... $373.54 $433.94 $28.61 $373.54 $362.39 .................... .................... .................... .................... .................... .................... $764.98 $28.61 $71.42 $28.61 $28.61 $174.64 $373.54 $764.98 $764.98 $764.98 $764.98 $174.64 .................... .................... $232.08 $232.08 $314.30 $314.30 $278.34 $278.34 $344.19 $344.19 $314.30 $177.76 $344.19 .................... .................... .................... $344.19 $344.19 .................... $344.19 $314.30 $314.30 $314.30 $344.19 $344.19 $344.19 $344.19 $344.19 .................... $366.34 $174.64 .................... .................... .................... .................... $514.37 $378.93 .................... .................... $147.12 $147.12 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00065 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50744 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 39545 39560 39561 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI E E E E E E E T T S S S S T T T C C C T T T T T T T T T C C T T T T T T C T T C C T C C C N N N S C C C C T C C C C C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ..................... Revision of diaphragm ............................. Resect diaphragm, simple ....................... Resect diaphragm, complex .................... .................... .................... .................... .................... .................... .................... .................... 0003 0003 0111 0123 0123 0111 0007 0008 0113 .................... .................... .................... 0113 0005 0113 0113 0113 0113 0114 0113 0113 .................... .................... 0131 0132 0131 0130 0113 0113 .................... 0114 0114 .................... .................... 0113 .................... .................... .................... .................... .................... .................... 0110 .................... .................... .................... .................... 0069 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 2.653 2.653 12.3956 22.9902 22.9902 12.3956 11.4501 16.4989 21.4653 .................... .................... .................... 21.4653 3.5994 21.4653 21.4653 21.4653 21.4653 40.7652 21.4653 21.4653 .................... .................... 43.3389 62.9914 43.3389 31.9271 21.4653 21.4653 .................... 40.7652 40.7652 .................... .................... 21.4653 .................... .................... .................... .................... .................... .................... 3.6594 .................... .................... .................... .................... 30.6775 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $157.44 $157.44 $735.59 $1,364.31 $1,364.31 $735.59 $679.48 $979.09 $1,273.82 .................... .................... .................... $1,273.82 $213.60 $1,273.82 $1,273.82 $1,273.82 $1,273.82 $2,419.13 $1,273.82 $1,273.82 .................... .................... $2,571.86 $3,738.10 $2,571.86 $1,894.65 $1,273.82 $1,273.82 .................... $2,419.13 $2,419.13 .................... .................... $1,273.82 .................... .................... .................... .................... .................... .................... $217.16 .................... .................... .................... .................... $1,820.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $200.18 .................... .................... $200.18 .................... .................... .................... .................... .................... .................... .................... $71.59 .................... .................... .................... .................... $485.91 .................... .................... .................... .................... $1,001.89 $1,239.22 $1,001.89 $659.53 .................... .................... .................... $485.91 $485.91 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $591.64 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $31.49 $31.49 $147.12 $272.86 $272.86 $147.12 $135.90 $195.82 $254.76 .................... .................... .................... $254.76 $42.72 $254.76 $254.76 $254.76 $254.76 $483.83 $254.76 $254.76 .................... .................... $514.37 $747.62 $514.37 $378.93 $254.76 $254.76 .................... $483.83 $483.83 .................... .................... $254.76 .................... .................... .................... .................... .................... .................... $43.43 .................... .................... .................... .................... $364.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00066 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50745 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ...... ...... ...... ...... ...... ...... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C E E E E E E T T T T T T T T T T T T T T T T T T X T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................ .................... .................... .................... .................... .................... .................... .................... 0251 0253 0254 0253 0254 0254 0254 0252 0252 0252 0256 0256 0256 0256 0256 0251 0251 0252 0340 0252 0251 0251 0253 0253 0253 0254 0251 0252 0253 0251 0252 0254 0254 0254 0256 0256 0251 0253 0251 0254 0253 0253 0251 0252 0251 0252 0252 0252 0252 0253 0252 0253 0253 0253 0254 0252 0253 0254 .................... .................... .................... .................... .................... .................... .................... .................... 2.0101 16.1357 23.404 16.1357 23.404 23.404 23.404 7.8673 7.8673 7.8673 37.3204 37.3204 37.3204 37.3204 37.3204 2.0101 2.0101 7.8673 0.6384 7.8673 2.0101 2.0101 16.1357 16.1357 16.1357 23.404 2.0101 7.8673 16.1357 2.0101 7.8673 23.404 23.404 23.404 37.3204 37.3204 2.0101 16.1357 2.0101 23.404 16.1357 16.1357 2.0101 7.8673 2.0101 7.8673 7.8673 7.8673 7.8673 16.1357 7.8673 16.1357 16.1357 16.1357 23.404 7.8673 16.1357 23.404 .................... .................... .................... .................... .................... .................... .................... .................... $119.29 $957.54 $1,388.86 $957.54 $1,388.86 $1,388.86 $1,388.86 $466.87 $466.87 $466.87 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $119.29 $119.29 $466.87 $37.88 $466.87 $119.29 $119.29 $957.54 $957.54 $957.54 $1,388.86 $119.29 $466.87 $957.54 $119.29 $466.87 $1,388.86 $1,388.86 $1,388.86 $2,214.70 $2,214.70 $119.29 $957.54 $119.29 $1,388.86 $957.54 $957.54 $119.29 $466.87 $119.29 $466.87 $466.87 $466.87 $466.87 $957.54 $466.87 $957.54 $957.54 $957.54 $1,388.86 $466.87 $957.54 $1,388.86 .................... .................... .................... .................... .................... .................... .................... .................... .................... $282.29 $321.35 $282.29 $321.35 $321.35 $321.35 $113.41 $113.41 $113.41 .................... .................... .................... .................... .................... .................... .................... $113.41 .................... $113.41 .................... .................... $282.29 $282.29 $282.29 $321.35 .................... $113.41 $282.29 .................... $113.41 $321.35 $321.35 $321.35 .................... .................... .................... $282.29 .................... $321.35 $282.29 $282.29 .................... $113.41 .................... $113.41 $113.41 $113.41 $113.41 $282.29 $113.41 $282.29 $282.29 $282.29 $321.35 $113.41 $282.29 $321.35 .................... .................... .................... .................... .................... .................... .................... .................... $23.86 $191.51 $277.77 $191.51 $277.77 $277.77 $277.77 $93.37 $93.37 $93.37 $442.94 $442.94 $442.94 $442.94 $442.94 $23.86 $23.86 $93.37 $7.58 $93.37 $23.86 $23.86 $191.51 $191.51 $191.51 $277.77 $23.86 $93.37 $191.51 $23.86 $93.37 $277.77 $277.77 $277.77 $442.94 $442.94 $23.86 $191.51 $23.86 $277.77 $191.51 $191.51 $23.86 $93.37 $23.86 $93.37 $93.37 $93.37 $93.37 $191.51 $93.37 $191.51 $191.51 $191.51 $277.77 $93.37 $191.51 $277.77 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00067 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50746 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 41135 41140 41145 41150 41153 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Tongue and neck surgery ........................ Removal of tongue .................................. Tongue removal, neck surgery ................ Tongue, mouth, jaw surgery .................... Tongue, mouth, neck surgery .................. 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 .......................... .................... .................... .................... .................... .................... .................... 0251 0251 0252 0254 0253 0252 0251 0251 0254 0253 0252 0252 0253 0254 0253 0253 0254 0253 0253 0253 0254 0253 0254 0251 0251 0252 0253 0253 0254 0256 0252 0254 0253 0251 0256 0256 0256 0256 0256 0256 0256 0256 0256 0253 0254 0251 0253 0251 0253 0253 0251 0251 0251 0252 0253 0253 0253 0005 0253 0253 .................... .................... .................... .................... .................... .................... 2.0101 2.0101 7.8673 23.404 16.1357 7.8673 2.0101 2.0101 23.404 16.1357 7.8673 7.8673 16.1357 23.404 16.1357 16.1357 23.404 16.1357 16.1357 16.1357 23.404 16.1357 23.404 2.0101 2.0101 7.8673 16.1357 16.1357 23.404 37.3204 7.8673 23.404 16.1357 2.0101 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 16.1357 23.404 2.0101 16.1357 2.0101 16.1357 16.1357 2.0101 2.0101 2.0101 7.8673 16.1357 16.1357 16.1357 3.5994 16.1357 16.1357 .................... .................... .................... .................... .................... .................... $119.29 $119.29 $466.87 $1,388.86 $957.54 $466.87 $119.29 $119.29 $1,388.86 $957.54 $466.87 $466.87 $957.54 $1,388.86 $957.54 $957.54 $1,388.86 $957.54 $957.54 $957.54 $1,388.86 $957.54 $1,388.86 $119.29 $119.29 $466.87 $957.54 $957.54 $1,388.86 $2,214.70 $466.87 $1,388.86 $957.54 $119.29 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $957.54 $1,388.86 $119.29 $957.54 $119.29 $957.54 $957.54 $119.29 $119.29 $119.29 $466.87 $957.54 $957.54 $957.54 $213.60 $957.54 $957.54 .................... .................... .................... .................... .................... .................... .................... .................... $113.41 $321.35 $282.29 $113.41 .................... .................... $321.35 $282.29 $113.41 $113.41 $282.29 $321.35 $282.29 $282.29 $321.35 $282.29 $282.29 $282.29 $321.35 $282.29 $321.35 .................... .................... $113.41 $282.29 $282.29 $321.35 .................... $113.41 $321.35 $282.29 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $282.29 $321.35 .................... $282.29 .................... $282.29 $282.29 .................... .................... .................... $113.41 $282.29 $282.29 $282.29 $71.59 $282.29 $282.29 .................... .................... .................... .................... .................... .................... $23.86 $23.86 $93.37 $277.77 $191.51 $93.37 $23.86 $23.86 $277.77 $191.51 $93.37 $93.37 $191.51 $277.77 $191.51 $191.51 $277.77 $191.51 $191.51 $191.51 $277.77 $191.51 $277.77 $23.86 $23.86 $93.37 $191.51 $191.51 $277.77 $442.94 $93.37 $277.77 $191.51 $23.86 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $191.51 $277.77 $23.86 $191.51 $23.86 $191.51 $191.51 $23.86 $23.86 $23.86 $93.37 $191.51 $191.51 $191.51 $42.72 $191.51 $191.51 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00068 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50747 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 42409 42410 42415 42420 42425 42426 42440 42450 42500 42505 42507 42508 42509 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T C T T T T T T T T N T T T T T T T T T T T T T X T T T T T T T T T T T T C T T T T C T T C T T C T T C T T T T C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .............................. 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 ............................ 0253 0256 0256 0256 0256 .................... 0256 0254 0254 0256 0256 0256 0256 0256 .................... 0253 0252 0251 0254 0251 0251 0253 0256 0253 0253 0253 0254 0253 0340 0254 0256 0258 0258 0258 0258 0258 0258 0258 0258 0254 0256 .................... 0258 0258 0256 0256 .................... 0252 0254 .................... 0254 0250 .................... 0256 0250 .................... 0253 0251 0252 0253 .................... .................... .................... .................... .................... .................... 16.1357 37.3204 37.3204 37.3204 37.3204 .................... 37.3204 23.404 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 .................... 16.1357 7.8673 2.0101 23.404 2.0101 2.0101 16.1357 37.3204 16.1357 16.1357 16.1357 23.404 16.1357 0.6384 23.404 37.3204 22.2466 22.2466 22.2466 22.2466 22.2466 22.2466 22.2466 22.2466 23.404 37.3204 .................... 22.2466 22.2466 37.3204 37.3204 .................... 7.8673 23.404 .................... 23.404 1.2896 .................... 37.3204 1.2896 .................... 16.1357 2.0101 7.8673 16.1357 .................... .................... .................... .................... .................... .................... $957.54 $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... $2,214.70 $1,388.86 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... $957.54 $466.87 $119.29 $1,388.86 $119.29 $119.29 $957.54 $2,214.70 $957.54 $957.54 $957.54 $1,388.86 $957.54 $37.88 $1,388.86 $2,214.70 $1,320.18 $1,320.18 $1,320.18 $1,320.18 $1,320.18 $1,320.18 $1,320.18 $1,320.18 $1,388.86 $2,214.70 .................... $1,320.18 $1,320.18 $2,214.70 $2,214.70 .................... $466.87 $1,388.86 .................... $1,388.86 $76.53 .................... $2,214.70 $76.53 .................... $957.54 $119.29 $466.87 $957.54 .................... .................... .................... .................... .................... .................... $282.29 .................... .................... .................... .................... .................... .................... $321.35 $321.35 .................... .................... .................... .................... .................... .................... $282.29 $113.41 .................... $321.35 .................... .................... $282.29 .................... $282.29 $282.29 $282.29 $321.35 $282.29 .................... $321.35 .................... $437.25 $437.25 $437.25 $437.25 $437.25 $437.25 $437.25 $437.25 $321.35 .................... .................... $437.25 $437.25 .................... .................... .................... $113.41 $321.35 .................... $321.35 $26.79 .................... .................... $26.79 .................... $282.29 .................... $113.41 $282.29 .................... .................... .................... .................... .................... .................... $191.51 $442.94 $442.94 $442.94 $442.94 .................... $442.94 $277.77 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 .................... $191.51 $93.37 $23.86 $277.77 $23.86 $23.86 $191.51 $442.94 $191.51 $191.51 $191.51 $277.77 $191.51 $7.58 $277.77 $442.94 $264.04 $264.04 $264.04 $264.04 $264.04 $264.04 $264.04 $264.04 $277.77 $442.94 .................... $264.04 $264.04 $442.94 $442.94 .................... $93.37 $277.77 .................... $277.77 $15.31 .................... $442.94 $15.31 .................... $191.51 $23.86 $93.37 $191.51 .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00069 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50748 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 43113 43116 43117 43118 43121 43122 43123 43124 43130 43135 43200 43201 43202 43204 43205 43215 43216 43217 43219 43220 43226 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... 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 ...................... .................... .................... .................... .................... .................... .................... .................... .................... 0254 .................... 0141 0141 0141 0141 0141 0141 0141 0141 0384 0141 0141 0141 0422 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0384 0422 0141 0141 0151 0151 0151 0151 0151 0151 0151 0384 0384 0151 0151 0132 0130 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 23.404 .................... 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 22.3392 8.1835 8.1835 8.1835 22.9647 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 8.1835 22.3392 22.9647 8.1835 8.1835 18.7338 18.7338 18.7338 18.7338 18.7338 18.7338 18.7338 22.3392 22.3392 18.7338 18.7338 62.9914 31.9271 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,388.86 .................... $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $1,325.68 $485.63 $485.63 $485.63 $1,362.79 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $485.63 $1,325.68 $1,362.79 $485.63 $485.63 $1,111.72 $1,111.72 $1,111.72 $1,111.72 $1,111.72 $1,111.72 $1,111.72 $1,325.68 $1,325.68 $1,111.72 $1,111.72 $3,738.10 $1,894.65 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $321.35 .................... $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $287.93 $143.38 $143.38 $143.38 $448.81 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $287.93 $448.81 $143.38 $143.38 $245.46 $245.46 $245.46 $245.46 $245.46 $245.46 $245.46 $287.93 $287.93 $245.46 $245.46 $1,239.22 $659.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $277.77 .................... $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $265.14 $97.13 $97.13 $97.13 $272.56 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $97.13 $265.14 $272.56 $97.13 $97.13 $222.34 $222.34 $222.34 $222.34 $222.34 $222.34 $222.34 $265.14 $265.14 $222.34 $222.34 $747.62 $378.93 .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00070 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50749 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C C C C C C C C C C C C C T T T T C C T C C C T C T C C C C C C C C C C C C C C C C C T T T T T X T T C C C C T T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... 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 ........................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0140 0140 0140 0140 .................... .................... 0141 .................... .................... .................... 0141 .................... 0141 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0132 0132 0131 0130 0141 0272 0121 0122 .................... .................... .................... .................... 0422 0141 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 5.4737 5.4737 5.4737 5.4737 .................... .................... 8.1835 .................... .................... .................... 8.1835 .................... 8.1835 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 62.9914 62.9914 43.3389 31.9271 8.1835 1.3801 2.2766 6.9721 .................... .................... .................... .................... 22.9647 8.1835 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $324.83 $324.83 $324.83 $324.83 .................... .................... $485.63 .................... .................... .................... $485.63 .................... $485.63 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3,738.10 $3,738.10 $2,571.86 $1,894.65 $485.63 $81.90 $135.10 $413.75 .................... .................... .................... .................... $1,362.79 $485.63 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $94.18 $94.18 $94.18 $94.18 .................... .................... $143.38 .................... .................... .................... $143.38 .................... $143.38 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,239.22 $1,239.22 $1,001.89 $659.53 $143.38 $32.76 $43.80 $84.85 .................... .................... .................... .................... $448.81 $143.38 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $64.97 $64.97 $64.97 $64.97 .................... .................... $97.13 .................... .................... .................... $97.13 .................... $97.13 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $747.62 $747.62 $514.37 $378.93 $97.13 $16.38 $27.02 $82.75 .................... .................... .................... .................... $272.56 $97.13 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00071 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50750 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C C C T C T C C C C C C C C T 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 T T C C C C T T T C C C T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Repair of stomach lesion ......................... Gastroplasty for obesity ........................... Gastroplasty for obesity ........................... Gastroplasty duodenal switch .................. Gastric bypass for obesity ....................... Gastric bypass for obesity ....................... 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 ...................... 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 ....................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0141 .................... 0141 .................... .................... .................... .................... .................... .................... .................... .................... 0141 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0131 0131 .................... .................... .................... .................... 0132 0132 0132 .................... .................... .................... 0130 0130 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 8.1835 .................... 8.1835 .................... .................... .................... .................... .................... .................... .................... .................... 8.1835 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 43.3389 43.3389 .................... .................... .................... .................... 62.9914 62.9914 62.9914 .................... .................... .................... 31.9271 31.9271 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $485.63 .................... $485.63 .................... .................... .................... .................... .................... .................... .................... .................... $485.63 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,571.86 $2,571.86 .................... .................... .................... .................... $3,738.10 $3,738.10 $3,738.10 .................... .................... .................... $1,894.65 $1,894.65 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $143.38 .................... $143.38 .................... .................... .................... .................... .................... .................... .................... .................... $143.38 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,001.89 $1,001.89 .................... .................... .................... .................... $1,239.22 $1,239.22 $1,239.22 .................... .................... .................... $659.53 $659.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $97.13 .................... $97.13 .................... .................... .................... .................... .................... .................... .................... .................... $97.13 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $514.37 $514.37 .................... .................... .................... .................... $747.62 $747.62 $747.62 .................... .................... .................... $378.93 $378.93 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00072 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50751 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 44626 44640 44650 44660 44661 44680 44700 44701 44715 44720 44721 44799 44800 44820 44850 44899 44900 44901 44950 44955 44960 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C T C C C C T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C C C C C C C C C C N C C C T C C C C C T C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .............................. 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 ......................................... .................... .................... 0027 .................... .................... .................... .................... 0027 .................... .................... 0142 0142 0142 0142 0142 0142 0142 0384 0142 0142 0142 0142 0142 0384 0142 0142 0384 0143 0143 0143 0143 0143 0143 0143 0143 0143 0384 0121 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0142 .................... .................... .................... .................... .................... 0037 .................... .................... .................... .................... .................... 18.4182 .................... .................... .................... .................... 18.4182 .................... .................... 9.3487 9.3487 9.3487 9.3487 9.3487 9.3487 9.3487 22.3392 9.3487 9.3487 9.3487 9.3487 9.3487 22.3392 9.3487 9.3487 22.3392 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 22.3392 2.2766 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 9.3487 .................... .................... .................... .................... .................... 9.4751 .................... .................... .................... .................... .................... $1,092.99 .................... .................... .................... .................... $1,092.99 .................... .................... $554.78 $554.78 $554.78 $554.78 $554.78 $554.78 $554.78 $1,325.68 $554.78 $554.78 $554.78 $554.78 $554.78 $1,325.68 $554.78 $554.78 $1,325.68 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $1,325.68 $135.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $554.78 .................... .................... .................... .................... .................... $562.28 .................... .................... .................... .................... .................... $329.72 .................... .................... .................... .................... $329.72 .................... .................... $152.78 $152.78 $152.78 $152.78 $152.78 $152.78 $152.78 $287.93 $152.78 $152.78 $152.78 $152.78 $152.78 $287.93 $152.78 $152.78 $287.93 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $287.93 $43.80 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $152.78 .................... .................... .................... .................... .................... $224.91 .................... .................... .................... .................... .................... $218.60 .................... .................... .................... .................... $218.60 .................... .................... $110.96 $110.96 $110.96 $110.96 $110.96 $110.96 $110.96 $265.14 $110.96 $110.96 $110.96 $110.96 $110.96 $265.14 $110.96 $110.96 $265.14 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $265.14 $27.02 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $110.96 .................... .................... .................... .................... .................... $112.46 .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00073 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50752 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 45379 45380 45381 45382 45383 45384 45385 45386 45387 45391 45392 45500 45505 45520 45540 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T C C C C C C C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................... Colonoscopy w/fb removal ...................... 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 ............................ 0131 0130 0148 0155 0155 0149 0150 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0149 0150 0150 0150 0146 0147 0147 0428 0147 0147 0147 0147 0428 0428 0384 0146 0146 0146 0147 0147 0146 0146 0147 0147 0147 0147 0147 0384 0143 0143 0143 0143 0143 0143 0143 0143 0143 0143 0384 0143 0143 0149 0150 0098 .................... 43.3389 31.9271 3.7383 16.2546 16.2546 18.0726 23.8654 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 18.0726 23.8654 23.8654 23.8654 4.6374 7.9679 7.9679 19.9022 7.9679 7.9679 7.9679 7.9679 19.9022 19.9022 22.3392 4.6374 4.6374 4.6374 7.9679 7.9679 4.6374 4.6374 7.9679 7.9679 7.9679 7.9679 7.9679 22.3392 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 8.6869 22.3392 8.6869 8.6869 18.0726 23.8654 1.1346 .................... $2,571.86 $1,894.65 $221.84 $964.60 $964.60 $1,072.48 $1,416.24 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,072.48 $1,416.24 $1,416.24 $1,416.24 $275.20 $472.84 $472.84 $1,181.06 $472.84 $472.84 $472.84 $472.84 $1,181.06 $1,181.06 $1,325.68 $275.20 $275.20 $275.20 $472.84 $472.84 $275.20 $275.20 $472.84 $472.84 $472.84 $472.84 $472.84 $1,325.68 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $515.51 $1,325.68 $515.51 $515.51 $1,072.48 $1,416.24 $67.33 .................... $1,001.89 $659.53 $57.21 .................... .................... $293.06 $437.12 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $293.06 $437.12 $437.12 $437.12 $64.40 .................... .................... .................... .................... .................... .................... .................... .................... .................... $287.93 $64.40 $64.40 $64.40 .................... .................... $64.40 $64.40 .................... .................... .................... .................... .................... $287.93 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $186.06 $287.93 $186.06 $186.06 $293.06 $437.12 .................... .................... $514.37 $378.93 $44.37 $192.92 $192.92 $214.50 $283.25 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $214.50 $283.25 $283.25 $283.25 $55.04 $94.57 $94.57 $236.21 $94.57 $94.57 $94.57 $94.57 $236.21 $236.21 $265.14 $55.04 $55.04 $55.04 $94.57 $94.57 $55.04 $55.04 $94.57 $94.57 $94.57 $94.57 $94.57 $265.14 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $103.10 $265.14 $103.10 $103.10 $214.50 $283.25 $13.47 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00074 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50753 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 46742 46744 46746 46748 46750 46751 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T C T C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T X T T T T T T T T T C T C C C C C C C C C T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Repair of anovaginal fistula ..................... Repair of anovaginal fistula ..................... Construction of absent anus .................... Construction of absent anus .................... Construction of absent anus .................... Repair of imperforated anus .................... Repair of cloacal anomaly ....................... Repair of cloacal anomaly ....................... Repair of cloacal anomaly ....................... Repair of anal sphincter .......................... Repair of anal sphincter .......................... 0150 .................... 0150 .................... .................... .................... .................... .................... .................... 0148 0149 0149 0148 0148 0150 0148 0149 0150 0148 0150 0155 0149 0148 0150 0149 0150 0149 0148 0149 0150 0150 0150 0150 0150 0150 0150 0150 0150 0150 0150 0150 0148 0155 0340 0147 0146 0147 0428 0147 0428 0146 0428 0150 .................... 0150 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0150 .................... 23.8654 .................... 23.8654 .................... .................... .................... .................... .................... .................... 3.7383 18.0726 18.0726 3.7383 3.7383 23.8654 3.7383 18.0726 23.8654 3.7383 23.8654 16.2546 18.0726 3.7383 23.8654 18.0726 23.8654 18.0726 3.7383 18.0726 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 23.8654 3.7383 16.2546 0.6384 7.9679 4.6374 7.9679 19.9022 7.9679 19.9022 4.6374 19.9022 23.8654 .................... 23.8654 .................... .................... .................... .................... .................... .................... .................... .................... .................... 23.8654 .................... $1,416.24 .................... $1,416.24 .................... .................... .................... .................... .................... .................... $221.84 $1,072.48 $1,072.48 $221.84 $221.84 $1,416.24 $221.84 $1,072.48 $1,416.24 $221.84 $1,416.24 $964.60 $1,072.48 $221.84 $1,416.24 $1,072.48 $1,416.24 $1,072.48 $221.84 $1,072.48 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $1,416.24 $221.84 $964.60 $37.88 $472.84 $275.20 $472.84 $1,181.06 $472.84 $1,181.06 $275.20 $1,181.06 $1,416.24 .................... $1,416.24 .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,416.24 .................... $437.12 .................... $437.12 .................... .................... .................... .................... .................... .................... $57.21 $293.06 $293.06 $57.21 $57.21 $437.12 $57.21 $293.06 $437.12 $57.21 $437.12 .................... $293.06 $57.21 $437.12 $293.06 $437.12 $293.06 $57.21 $293.06 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $437.12 $57.21 .................... .................... .................... $64.40 .................... .................... .................... .................... $64.40 .................... $437.12 .................... $437.12 .................... .................... .................... .................... .................... .................... .................... .................... .................... $437.12 .................... $283.25 .................... $283.25 .................... .................... .................... .................... .................... .................... $44.37 $214.50 $214.50 $44.37 $44.37 $283.25 $44.37 $214.50 $283.25 $44.37 $283.25 $192.92 $214.50 $44.37 $283.25 $214.50 $283.25 $214.50 $44.37 $214.50 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $283.25 $44.37 $192.92 $7.58 $94.57 $55.04 $94.57 $236.21 $94.57 $236.21 $55.04 $236.21 $283.25 .................... $283.25 .................... .................... .................... .................... .................... .................... .................... .................... .................... $283.25 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00075 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50754 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 47133 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T N C T C C C C C C C C C C C C C C C C C C C C C C T T T C C T T C C C C C T N N T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............................. Removal of donor 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 ....................... 0150 0149 0150 0150 0150 0016 0017 0013 0695 0695 0695 0155 0155 0149 0149 0150 0149 0148 0155 0155 0150 0148 0685 .................... .................... 0037 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0131 0131 0130 .................... .................... 0423 0002 .................... .................... .................... .................... .................... 0152 .................... .................... 0152 0152 0427 23.8654 18.0726 23.8654 23.8654 23.8654 2.5834 18.4211 1.1078 20.3164 20.3164 20.3164 16.2546 16.2546 18.0726 18.0726 23.8654 18.0726 3.7383 16.2546 16.2546 23.8654 3.7383 6.0174 .................... .................... 9.4751 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 43.3389 43.3389 31.9271 .................... .................... 40.2866 0.9559 .................... .................... .................... .................... .................... 12.2833 .................... .................... 12.2833 12.2833 10.1977 $1,416.24 $1,072.48 $1,416.24 $1,416.24 $1,416.24 $153.31 $1,093.16 $65.74 $1,205.64 $1,205.64 $1,205.64 $964.60 $964.60 $1,072.48 $1,072.48 $1,416.24 $1,072.48 $221.84 $964.60 $964.60 $1,416.24 $221.84 $357.09 .................... .................... $562.28 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,571.86 $2,571.86 $1,894.65 .................... .................... $2,390.73 $56.73 .................... .................... .................... .................... .................... $728.93 .................... .................... $728.93 $728.93 $605.16 $437.12 $293.06 $437.12 $437.12 $437.12 $33.57 $227.84 $14.20 $266.59 $266.59 $266.59 .................... .................... $293.06 $293.06 $437.12 $293.06 $57.21 .................... .................... $437.12 $57.21 $115.47 .................... .................... $224.91 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,001.89 $1,001.89 $659.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $124.11 $283.25 $214.50 $283.25 $283.25 $283.25 $30.66 $218.63 $13.15 $241.13 $241.13 $241.13 $192.92 $192.92 $214.50 $214.50 $283.25 $214.50 $44.37 $192.92 $192.92 $283.25 $44.37 $71.42 .................... .................... $112.46 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $514.37 $514.37 $378.93 .................... .................... $478.15 $11.35 .................... .................... .................... .................... .................... $145.79 .................... .................... $145.79 $145.79 $121.03 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00076 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50755 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 47530 47550 47552 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 48550 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T C T T T T T T T T T T C T C C C C C T C C C C C C C C C C C C C C C C C C T C C C C C T C C C C C C C C C C E C C C C T C C C C E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Revise/reinsert bile tube .......................... Bile duct endoscopy add-on .................... Biliary endoscopy thru skin ...................... 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 ................................. Donor pancreatectomy ............................ 0427 .................... 0152 0152 0152 0152 0152 0130 0130 0131 0131 0131 .................... 0130 .................... .................... .................... .................... .................... 0152 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0152 .................... .................... .................... .................... .................... 0685 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0037 .................... .................... .................... .................... .................... 10.1977 .................... 12.2833 12.2833 12.2833 12.2833 12.2833 31.9271 31.9271 43.3389 43.3389 43.3389 .................... 31.9271 .................... .................... .................... .................... .................... 12.2833 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 12.2833 .................... .................... .................... .................... .................... 6.0174 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 9.4751 .................... .................... .................... .................... .................... $605.16 .................... $728.93 $728.93 $728.93 $728.93 $728.93 $1,894.65 $1,894.65 $2,571.86 $2,571.86 $2,571.86 .................... $1,894.65 .................... .................... .................... .................... .................... $728.93 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $728.93 .................... .................... .................... .................... .................... $357.09 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $562.28 .................... .................... .................... .................... .................... $124.11 .................... .................... .................... .................... .................... .................... $659.53 $659.53 $1,001.89 $1,001.89 $1,001.89 .................... $659.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $115.47 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $224.91 .................... .................... .................... .................... .................... $121.03 .................... $145.79 $145.79 $145.79 $145.79 $145.79 $378.93 $378.93 $514.37 $514.37 $514.37 .................... $378.93 .................... .................... .................... .................... .................... $145.79 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $145.79 .................... .................... .................... .................... .................... $71.42 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $112.46 .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00077 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50756 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 48551 48552 48554 48556 48999 49000 49002 49010 49020 49021 49040 49041 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C E C T C C C C T C T C T C T T T T T C C C T C T T T T T N T T T T T N C T N C T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................. 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 ................... .................... .................... .................... .................... 0004 .................... .................... .................... .................... 0037 .................... 0037 .................... 0037 .................... 0070 0070 0153 0685 0130 .................... .................... .................... 0153 .................... 0130 0130 0130 0130 0130 .................... 0115 0652 0652 0105 0152 .................... .................... 0153 .................... .................... 0105 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 .................... .................... .................... .................... 1.7646 .................... .................... .................... .................... 9.4751 .................... 9.4751 .................... 9.4751 .................... 3.2101 3.2101 21.6961 6.0174 31.9271 .................... .................... .................... 21.6961 .................... 31.9271 31.9271 31.9271 31.9271 31.9271 .................... 31.4727 28.8948 28.8948 22.3685 12.2833 .................... .................... 21.6961 .................... .................... 22.3685 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 28.7847 .................... .................... .................... .................... $104.72 .................... .................... .................... .................... $562.28 .................... $562.28 .................... $562.28 .................... $190.50 $190.50 $1,287.51 $357.09 $1,894.65 .................... .................... .................... $1,287.51 .................... $1,894.65 $1,894.65 $1,894.65 $1,894.65 $1,894.65 .................... $1,867.68 $1,714.70 $1,714.70 $1,327.41 $728.93 .................... .................... $1,287.51 .................... .................... $1,327.41 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 .................... .................... .................... .................... $22.36 .................... .................... .................... .................... $224.91 .................... $224.91 .................... $224.91 .................... .................... .................... $382.75 $115.47 $659.53 .................... .................... .................... $382.75 .................... $659.53 $659.53 $659.53 $659.53 $659.53 .................... $459.35 .................... .................... $370.40 .................... .................... .................... $382.75 .................... .................... $370.40 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 $464.85 .................... .................... .................... .................... $20.94 .................... .................... .................... .................... $112.46 .................... $112.46 .................... $112.46 .................... $38.10 $38.10 $257.50 $71.42 $378.93 .................... .................... .................... $257.50 .................... $378.93 $378.93 $378.93 $378.93 $378.93 .................... $373.54 $342.94 $342.94 $265.48 $145.79 .................... .................... $257.50 .................... .................... $265.48 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 $341.63 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00078 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50757 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 49582 49585 49587 49590 49600 49605 49606 49610 49611 49650 49651 49659 49900 49904 49905 49906 49999 50010 50020 50021 50040 50045 50060 50065 50070 50075 50080 50081 50100 50120 50125 50130 50135 50200 50205 50220 50225 50230 50234 50236 50240 50280 50290 50300 50320 50323 50325 50327 50328 50329 50340 50360 50365 50370 50380 50390 50391 50392 50393 50394 50395 50396 50398 50400 50405 50500 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T C C C C T T T C C C C T C T T C C C C C C T T C C C C C T C C C C C C C C C C C C C C C C C C C C C T T T T N T T T C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Rpr umbil hern, block < 5 yr .................... Rpr umbil hern, reduc > 5 yr ................... Rpr umbil hern, block > 5 yr .................... Repair spigilian 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 ............................................ Free omental flap, microvasc .................. Abdomen surgery procedure ................... Exploration of kidney ............................... Renal abscess, open drain ...................... Renal abscess, percut drain .................... 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 ........................ Removal of donor kidney ......................... Removal of donor kidney ......................... 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 ........................... 0154 0154 0154 0154 0154 .................... .................... .................... .................... 0131 0131 0130 .................... .................... .................... .................... 0153 .................... 0162 0037 .................... .................... .................... .................... .................... .................... 0429 0429 .................... .................... .................... .................... .................... 0685 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0685 0156 0161 0161 .................... 0161 0164 0122 .................... .................... .................... 28.7847 28.7847 28.7847 28.7847 28.7847 .................... .................... .................... .................... 43.3389 43.3389 31.9271 .................... .................... .................... .................... 21.6961 .................... 23.3918 9.4751 .................... .................... .................... .................... .................... .................... 42.3147 42.3147 .................... .................... .................... .................... .................... 6.0174 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 6.0174 2.5751 18.5576 18.5576 .................... 18.5576 1.1855 6.9721 .................... .................... .................... $1,708.17 $1,708.17 $1,708.17 $1,708.17 $1,708.17 .................... .................... .................... .................... $2,571.86 $2,571.86 $1,894.65 .................... .................... .................... .................... $1,287.51 .................... $1,388.14 $562.28 .................... .................... .................... .................... .................... .................... $2,511.08 $2,511.08 .................... .................... .................... .................... .................... $357.09 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $357.09 $152.81 $1,101.26 $1,101.26 .................... $1,101.26 $70.35 $413.75 .................... .................... .................... $464.85 $464.85 $464.85 $464.85 $464.85 .................... .................... .................... .................... $1,001.89 $1,001.89 $659.53 .................... .................... .................... .................... $382.75 .................... .................... $224.91 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $115.47 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $115.47 $40.52 $249.36 $249.36 .................... $249.36 $17.29 $84.85 .................... .................... .................... $341.63 $341.63 $341.63 $341.63 $341.63 .................... .................... .................... .................... $514.37 $514.37 $378.93 .................... .................... .................... .................... $257.50 .................... $277.63 $112.46 .................... .................... .................... .................... .................... .................... $502.22 $502.22 .................... .................... .................... .................... .................... $71.42 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $71.42 $30.56 $220.25 $220.25 .................... $220.25 $14.07 $82.75 .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00079 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50758 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C T T T T C C C C T T T T T T T T T T T T C T C C C C C C C N T T N 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 T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .......................... 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 ...................... .................... .................... .................... .................... 0130 0131 0131 0130 .................... .................... .................... .................... 0130 0160 0161 0160 0162 0161 0160 0160 0160 0160 0163 0161 .................... 0169 .................... .................... .................... .................... .................... .................... .................... .................... 0164 0122 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0131 0131 .................... .................... .................... .................... 31.9271 43.3389 43.3389 31.9271 .................... .................... .................... .................... 31.9271 6.6753 18.5576 6.6753 23.3918 18.5576 6.6753 6.6753 6.6753 6.6753 33.7354 18.5576 .................... 43.0133 .................... .................... .................... .................... .................... .................... .................... .................... 1.1855 6.9721 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 43.3389 43.3389 .................... .................... .................... .................... $1,894.65 $2,571.86 $2,571.86 $1,894.65 .................... .................... .................... .................... $1,894.65 $396.13 $1,101.26 $396.13 $1,388.14 $1,101.26 $396.13 $396.13 $396.13 $396.13 $2,001.96 $1,101.26 .................... $2,552.54 .................... .................... .................... .................... .................... .................... .................... .................... $70.35 $413.75 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,571.86 $2,571.86 .................... .................... .................... .................... $659.53 $1,001.89 $1,001.89 $659.53 .................... .................... .................... .................... $659.53 $105.06 $249.36 $105.06 .................... $249.36 $105.06 $105.06 $105.06 $105.06 .................... $249.36 .................... $1,021.01 .................... .................... .................... .................... .................... .................... .................... .................... $17.29 $84.85 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,001.89 $1,001.89 .................... .................... .................... .................... $378.93 $514.37 $514.37 $378.93 .................... .................... .................... .................... $378.93 $79.23 $220.25 $79.23 $277.63 $220.25 $79.23 $79.23 $79.23 $79.23 $400.39 $220.25 .................... $510.51 .................... .................... .................... .................... .................... .................... .................... .................... $14.07 $82.75 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $514.37 $514.37 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00080 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50759 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 51596 51597 51600 51605 51610 51700 51701 51702 51703 51705 51710 51715 51720 51725 51726 51736 51741 51772 51784 51785 51792 51795 51797 51798 51800 51820 51840 51841 51845 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T C T T T T C C C C C C C C C C C C C C N N N T X X T T T T T T T T T T T T T T T X C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................... 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 ........................... Complex cystometrogram ........................ Urine flow measurement .......................... Electro-uroflowmetry, first ........................ Urethra pressure profile ........................... Anal/urinary muscle study ....................... Anal/urinary muscle study ....................... Urinary reflex study .................................. Urine voiding pressure study ................... Intraabdominal pressure test ................... Us urine capacity measure ...................... Revision of bladder/urethra ..................... Revision of urinary tract ........................... Attach bladder/urethra ............................. Attach bladder/urethra ............................. Repair bladder neck ................................ 0131 0130 0160 0160 0161 0161 0161 0160 0160 0161 0161 0161 0164 0164 0165 0162 0162 0162 0160 0162 .................... 0162 0008 0154 0162 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0164 0340 0340 0164 0121 0122 0168 0156 0156 0156 0164 0164 0156 0164 0164 0164 0164 0164 0340 .................... .................... .................... .................... .................... 43.3389 31.9271 6.6753 6.6753 18.5576 18.5576 18.5576 6.6753 6.6753 18.5576 18.5576 18.5576 1.1855 1.1855 16.6689 23.3918 23.3918 23.3918 6.6753 23.3918 .................... 23.3918 16.4989 28.7847 23.3918 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.1855 0.6384 0.6384 1.1855 2.2766 6.9721 28.2685 2.5751 2.5751 2.5751 1.1855 1.1855 2.5751 1.1855 1.1855 1.1855 1.1855 1.1855 0.6384 .................... .................... .................... .................... .................... $2,571.86 $1,894.65 $396.13 $396.13 $1,101.26 $1,101.26 $1,101.26 $396.13 $396.13 $1,101.26 $1,101.26 $1,101.26 $70.35 $70.35 $989.18 $1,388.14 $1,388.14 $1,388.14 $396.13 $1,388.14 .................... $1,388.14 $979.09 $1,708.17 $1,388.14 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $70.35 $37.88 $37.88 $70.35 $135.10 $413.75 $1,677.54 $152.81 $152.81 $152.81 $70.35 $70.35 $152.81 $70.35 $70.35 $70.35 $70.35 $70.35 $37.88 .................... .................... .................... .................... .................... $1,001.89 $659.53 $105.06 $105.06 $249.36 $249.36 $249.36 $105.06 $105.06 $249.36 $249.36 $249.36 $17.29 $17.29 .................... .................... .................... .................... $105.06 .................... .................... .................... .................... $464.85 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $17.29 .................... .................... $17.29 $43.80 $84.85 $388.03 $40.52 $40.52 $40.52 $17.29 $17.29 $40.52 $17.29 $17.29 $17.29 $17.29 $17.29 .................... .................... .................... .................... .................... .................... $514.37 $378.93 $79.23 $79.23 $220.25 $220.25 $220.25 $79.23 $79.23 $220.25 $220.25 $220.25 $14.07 $14.07 $197.84 $277.63 $277.63 $277.63 $79.23 $277.63 .................... $277.63 $195.82 $341.63 $277.63 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.07 $7.58 $7.58 $14.07 $27.02 $82.75 $335.51 $30.56 $30.56 $30.56 $14.07 $14.07 $30.56 $14.07 $14.07 $14.07 $14.07 $14.07 $7.58 .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00081 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50760 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C T C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... 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, stone remove ................... 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 ........................ .................... .................... 0162 .................... .................... .................... .................... .................... .................... 0131 0132 0160 0160 0161 0161 0160 0161 0162 0162 0162 0162 0162 0162 0161 0160 0161 0161 0161 0162 0161 0163 0161 0161 0161 0161 0161 0161 0160 0161 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0161 0162 0163 0162 0162 0162 0162 0162 0162 0161 0163 0162 0163 .................... .................... 23.3918 .................... .................... .................... .................... .................... .................... 43.3389 62.9914 6.6753 6.6753 18.5576 18.5576 6.6753 18.5576 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 18.5576 6.6753 18.5576 18.5576 18.5576 23.3918 18.5576 33.7354 18.5576 18.5576 18.5576 18.5576 18.5576 18.5576 6.6753 18.5576 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 18.5576 23.3918 33.7354 23.3918 23.3918 23.3918 23.3918 23.3918 23.3918 18.5576 33.7354 23.3918 33.7354 .................... .................... $1,388.14 .................... .................... .................... .................... .................... .................... $2,571.86 $3,738.10 $396.13 $396.13 $1,101.26 $1,101.26 $396.13 $1,101.26 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,101.26 $396.13 $1,101.26 $1,101.26 $1,101.26 $1,388.14 $1,101.26 $2,001.96 $1,101.26 $1,101.26 $1,101.26 $1,101.26 $1,101.26 $1,101.26 $396.13 $1,101.26 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,101.26 $1,388.14 $2,001.96 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,388.14 $1,101.26 $2,001.96 $1,388.14 $2,001.96 .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,001.89 $1,239.22 $105.06 $105.06 $249.36 $249.36 $105.06 $249.36 .................... .................... .................... .................... .................... .................... $249.36 $105.06 $249.36 $249.36 $249.36 .................... $249.36 .................... $249.36 $249.36 $249.36 $249.36 $249.36 $249.36 $105.06 $249.36 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $249.36 .................... .................... .................... .................... .................... .................... .................... .................... $249.36 .................... .................... .................... .................... .................... $277.63 .................... .................... .................... .................... .................... .................... $514.37 $747.62 $79.23 $79.23 $220.25 $220.25 $79.23 $220.25 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $220.25 $79.23 $220.25 $220.25 $220.25 $277.63 $220.25 $400.39 $220.25 $220.25 $220.25 $220.25 $220.25 $220.25 $79.23 $220.25 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $220.25 $277.63 $400.39 $277.63 $277.63 $277.63 $277.63 $277.63 $277.63 $220.25 $400.39 $277.63 $400.39 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00082 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50761 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C T T T T S T S S T S C T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... Reconstruction of urethra ........................ Reconstruct urethra/bladder .................... Correct bladder function .......................... Remove perineal prosthesis .................... 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 .................................... 0163 0163 0163 0162 0429 0429 0162 0166 0166 0166 0166 0166 0166 0166 0166 0166 0168 0166 0168 0168 0166 0168 0166 0166 0166 0166 0166 0168 0168 0168 .................... 0168 0168 0168 0168 0385 0168 0385 0386 0168 0386 .................... 0168 0168 0166 0168 0166 0168 0166 0168 0168 0156 0164 0161 0165 0164 0164 0164 0166 0675 0675 0162 0164 0166 0166 0008 33.7354 33.7354 33.7354 23.3918 42.3147 42.3147 23.3918 17.6743 17.6743 17.6743 17.6743 17.6743 17.6743 17.6743 17.6743 17.6743 28.2685 17.6743 28.2685 28.2685 17.6743 28.2685 17.6743 17.6743 17.6743 17.6743 17.6743 28.2685 128.2685 28.2685 .................... 28.2685 28.2685 28.2685 28.2685 75.6446 28.2685 75.6446 120.1694 28.2685 120.1694 .................... 28.2685 28.2685 17.6743 28.2685 17.6743 28.2685 17.6743 28.2685 28.2685 2.5751 1.1855 18.5576 16.6689 1.1855 1.1855 1.1855 17.6743 43.7329 43.7329 23.3918 1.1855 17.6743 17.6743 16.4989 $2,001.96 $2,001.96 $2,001.96 $1,388.14 $2,511.08 $2,511.08 $1,388.14 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,677.54 $1,048.85 $1,677.54 $1,677.54 $1,048.85 $1,677.54 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,048.85 $1,677.54 $1,677.54 $1,677.54 .................... $1,677.54 $1,677.54 $1,677.54 $1,677.54 $4,488.98 $1,677.54 $4,488.98 $7,131.21 $1,677.54 $7,131.21 .................... $1,677.54 $1,677.54 $1,048.85 $1,677.54 $1,048.85 $1,677.54 $1,048.85 $1,677.54 $1,677.54 $152.81 $70.35 $1,101.26 $989.18 $70.35 $70.35 $70.35 $1,048.85 $2,595.24 $2,595.24 $1,388.14 $70.35 $1,048.85 $1,048.85 $979.09 .................... .................... .................... .................... .................... .................... .................... $218.73 $218.73 $218.73 $218.73 $218.73 $218.73 $218.73 $218.73 $218.73 $388.03 $218.73 $388.03 $388.03 $218.73 $388.03 $218.73 $218.73 $218.73 $218.73 $218.73 $388.03 $388.03 $388.03 .................... $388.03 $388.03 $388.03 $388.03 .................... $388.03 .................... .................... $388.03 .................... .................... $388.03 $388.03 $218.73 $388.03 $218.73 $388.03 $218.73 $388.03 $388.03 $40.52 $17.29 $249.36 .................... $17.29 $17.29 $17.29 $218.73 .................... .................... .................... $17.29 $218.73 $218.73 .................... $400.39 $400.39 $400.39 $277.63 $502.22 $502.22 $277.63 $209.77 $209.77 $209.77 $209.77 $209.77 $209.77 $209.77 $209.77 $209.77 $335.51 $209.77 $335.51 $335.51 $209.77 $335.51 $209.77 $209.77 $209.77 $209.77 $209.77 $335.51 $335.51 $335.51 .................... $335.51 $335.51 $335.51 $335.51 $897.80 $335.51 $897.80 $1,426.24 $335.51 $1,426.24 .................... $335.51 $335.51 $209.77 $335.51 $209.77 $335.51 $209.77 $335.51 $335.51 $30.56 $14.07 $220.25 $197.84 $14.07 $14.07 $14.07 $209.77 $519.05 $519.05 $277.63 $14.07 $209.77 $209.77 $195.82 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00083 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50762 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 54250 54300 54304 54308 54312 54316 54318 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T C C C T T T T T T T T T T N T T T T T T T T T T T T T T C C T T T T T T T C S S S T T S C T S C T C T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .............................................. Revision of penis ..................................... Revision of penis ..................................... Reconstruction of urethra ........................ Reconstruction of urethra ........................ Reconstruction of urethra ........................ Reconstruction of urethra ........................ 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 .................................. 0013 0017 0012 0017 0017 0695 0021 0022 0181 0181 0181 0008 0181 .................... .................... .................... 0180 0180 0180 0180 0180 0180 0180 0156 0181 0156 .................... 0165 0164 0164 0164 0181 0181 0181 0181 0181 0181 0181 0181 0181 0181 .................... .................... 0181 0181 0181 0181 0181 0181 0181 .................... 0385 0386 0386 0181 0181 0386 .................... 0181 0386 .................... 0181 .................... 0181 0181 0156 1.1078 18.4211 0.8497 18.4211 18.4211 20.3164 14.9776 19.6472 30.8663 30.8663 30.8663 16.4989 30.8663 .................... .................... .................... 19.8827 19.8827 19.8827 19.8827 19.8827 19.8827 19.8827 2.5751 30.8663 2.5751 .................... 16.6689 1.1855 1.1855 1.1855 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 .................... .................... 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 30.8663 .................... 75.6446 120.1694 120.1694 30.8663 30.8663 120.1694 .................... 30.8663 120.1694 .................... 30.8663 .................... 30.8663 30.8663 2.5751 $65.74 $1,093.16 $50.42 $1,093.16 $1,093.16 $1,205.64 $888.82 $1,165.92 $1,831.70 $1,831.70 $1,831.70 $979.09 $1,831.70 .................... .................... .................... $1,179.90 $1,179.90 $1,179.90 $1,179.90 $1,179.90 $1,179.90 $1,179.90 $152.81 $1,831.70 $152.81 .................... $989.18 $70.35 $70.35 $70.35 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 .................... .................... $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 $1,831.70 .................... $4,488.98 $7,131.21 $7,131.21 $1,831.70 $1,831.70 $7,131.21 .................... $1,831.70 $7,131.21 .................... $1,831.70 .................... $1,831.70 $1,831.70 $152.81 $14.20 $227.84 $11.18 $227.84 $227.84 $266.59 $219.48 $354.45 $621.82 $621.82 $621.82 .................... $621.82 .................... .................... .................... $304.87 $304.87 $304.87 $304.87 $304.87 $304.87 $304.87 $40.52 $621.82 $40.52 .................... .................... $17.29 $17.29 $17.29 $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 .................... .................... $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 $621.82 .................... .................... .................... .................... $621.82 $621.82 .................... .................... $621.82 .................... .................... $621.82 .................... $621.82 $621.82 $40.52 $13.15 $218.63 $10.08 $218.63 $218.63 $241.13 $177.76 $233.18 $366.34 $366.34 $366.34 $195.82 $366.34 .................... .................... .................... $235.98 $235.98 $235.98 $235.98 $235.98 $235.98 $235.98 $30.56 $366.34 $30.56 .................... $197.84 $14.07 $14.07 $14.07 $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 .................... .................... $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 $366.34 .................... $897.80 $1,426.24 $1,426.24 $366.34 $366.34 $1,426.24 .................... $366.34 $1,426.24 .................... $366.34 .................... $366.34 $366.34 $30.56 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00084 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50763 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 55530 55535 55540 55550 55559 55600 55605 55650 55680 55700 55705 55720 55725 55801 55810 55812 55815 55821 55831 55840 55842 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T C T T T T T C T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T C C T T T T T C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................. 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 ...................... 0037 0183 0183 0183 0183 0154 .................... 0154 0183 0183 0183 0154 .................... 0183 0183 0183 0131 0132 0130 0183 0004 0183 0183 0183 0183 0183 0183 0183 0004 0154 0154 0183 0008 0183 0183 0183 0183 0183 0183 0183 .................... 0183 0183 0183 0183 0183 0154 0154 0131 0130 0183 .................... .................... 0183 0184 0184 0162 0162 .................... .................... .................... .................... .................... .................... .................... .................... 9.4751 23.6415 23.6415 23.6415 23.6415 28.7847 .................... 28.7847 23.6415 23.6415 23.6415 28.7847 .................... 23.6415 23.6415 23.6415 43.3389 62.9914 31.9271 23.6415 1.7646 23.6415 23.6415 23.6415 23.6415 23.6415 23.6415 23.6415 1.7646 28.7847 28.7847 23.6415 16.4989 23.6415 23.6415 23.6415 23.6415 23.6415 23.6415 23.6415 .................... 23.6415 23.6415 23.6415 23.6415 23.6415 28.7847 28.7847 43.3389 31.9271 23.6415 .................... .................... 23.6415 4.3566 4.3566 23.3918 23.3918 .................... .................... .................... .................... .................... .................... .................... .................... $562.28 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,708.17 .................... $1,708.17 $1,402.96 $1,402.96 $1,402.96 $1,708.17 .................... $1,402.96 $1,402.96 $1,402.96 $2,571.86 $3,738.10 $1,894.65 $1,402.96 $104.72 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $104.72 $1,708.17 $1,708.17 $1,402.96 $979.09 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 .................... $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,402.96 $1,708.17 $1,708.17 $2,571.86 $1,894.65 $1,402.96 .................... .................... $1,402.96 $258.53 $258.53 $1,388.14 $1,388.14 .................... .................... .................... .................... .................... .................... .................... .................... $224.91 .................... .................... .................... .................... $464.85 .................... $464.85 .................... .................... .................... $464.85 .................... .................... .................... .................... $1,001.89 $1,239.22 $659.53 .................... $22.36 .................... .................... .................... .................... .................... .................... .................... $22.36 $464.85 $464.85 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $464.85 $464.85 $1,001.89 $659.53 .................... .................... .................... .................... $96.27 $96.27 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $112.46 $280.59 $280.59 $280.59 $280.59 $341.63 .................... $341.63 $280.59 $280.59 $280.59 $341.63 .................... $280.59 $280.59 $280.59 $514.37 $747.62 $378.93 $280.59 $20.94 $280.59 $280.59 $280.59 $280.59 $280.59 $280.59 $280.59 $20.94 $341.63 $341.63 $280.59 $195.82 $280.59 $280.59 $280.59 $280.59 $280.59 $280.59 $280.59 .................... $280.59 $280.59 $280.59 $280.59 $280.59 $341.63 $341.63 $514.37 $378.93 $280.59 .................... .................... $280.59 $51.71 $51.71 $277.63 $277.63 .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00085 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50764 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 57135 57150 57155 57160 57170 57180 57200 57210 57220 57230 57240 57250 57260 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C T T C C C T T T E E T T T T T T T T T T C C C C C C C T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............................. 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 ...................................... .................... 0163 0165 .................... .................... .................... 0197 0674 0164 .................... .................... 0189 0189 0194 0193 0017 0695 0019 0019 0195 0195 .................... .................... .................... .................... .................... .................... .................... 0194 0193 0194 0194 0193 0194 0188 0189 0193 0193 0192 0007 0008 0194 0194 0192 0194 0194 0195 0195 .................... .................... .................... 0195 0194 0194 0191 0192 0188 0191 0189 0194 0194 0202 0195 0195 0195 0195 .................... 33.7354 16.6689 .................... .................... .................... 2.3572 95.7856 1.1855 .................... .................... 2.371 2.371 20.7525 14.5843 18.4211 20.3164 4.0547 4.0547 26.6791 26.6791 .................... .................... .................... .................... .................... .................... .................... 20.7525 14.5843 20.7525 20.7525 14.5843 20.7525 1.14 2.371 14.5843 14.5843 4.3082 11.4501 16.4989 20.7525 20.7525 4.3082 20.7525 20.7525 26.6791 26.6791 .................... .................... .................... 26.6791 20.7525 20.7525 0.167 4.3082 1.14 0.167 2.371 20.7525 20.7525 40.3866 26.6791 26.6791 26.6791 26.6791 .................... $2,001.96 $989.18 .................... .................... .................... $139.88 $5,684.20 $70.35 .................... .................... $140.70 $140.70 $1,231.52 $865.48 $1,093.16 $1,205.64 $240.62 $240.62 $1,583.22 $1,583.22 .................... .................... .................... .................... .................... .................... .................... $1,231.52 $865.48 $1,231.52 $1,231.52 $865.48 $1,231.52 $67.65 $140.70 $865.48 $865.48 $255.66 $679.48 $979.09 $1,231.52 $1,231.52 $255.66 $1,231.52 $1,231.52 $1,583.22 $1,583.22 .................... .................... .................... $1,583.22 $1,231.52 $1,231.52 $9.91 $255.66 $67.65 $9.91 $140.70 $1,231.52 $1,231.52 $2,396.66 $1,583.22 $1,583.22 $1,583.22 $1,583.22 .................... .................... .................... .................... .................... .................... .................... .................... $17.29 .................... .................... .................... .................... $397.84 .................... $227.84 $266.59 $71.87 $71.87 $483.80 $483.80 .................... .................... .................... .................... .................... .................... .................... $397.84 .................... $397.84 $397.84 .................... $397.84 .................... .................... .................... .................... .................... .................... .................... $397.84 $397.84 .................... $397.84 $397.84 $483.80 $483.80 .................... .................... .................... $483.80 $397.84 $397.84 $2.78 .................... .................... $2.78 .................... $397.84 $397.84 $958.66 $483.80 $483.80 $483.80 $483.80 .................... $400.39 $197.84 .................... .................... .................... $27.98 $1,136.84 $14.07 .................... .................... $28.14 $28.14 $246.30 $173.10 $218.63 $241.13 $48.12 $48.12 $316.64 $316.64 .................... .................... .................... .................... .................... .................... .................... $246.30 $173.10 $246.30 $246.30 $173.10 $246.30 $13.53 $28.14 $173.10 $173.10 $51.13 $135.90 $195.82 $246.30 $246.30 $51.13 $246.30 $246.30 $316.64 $316.64 .................... .................... .................... $316.64 $246.30 $246.30 $1.98 $51.13 $13.53 $1.98 $28.14 $246.30 $246.30 $479.33 $316.64 $316.64 $316.64 $316.64 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00086 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50765 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 58210 58240 58260 58262 58263 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T C C C C T T T T T C T C C C T C T T C T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T C T C C C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Extensive repair of vagina ....................... Insert mesh/pelvic flr addon .................... Repair of bowel bulge .............................. Repair of bowel pouch ............................. Suspension of vagina .............................. Repair of vaginal prolapse ....................... 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 ................. Examination of vagina ............................. Vagina examination & biopsy .................. Biopsy of cervix w/scope ......................... Endocerv curettage w/scope ................... Cervix excision ......................................... 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 .............................. Removal of uterus lesion ......................... Myomectomy vag method ....................... Myomectomy abdom complex ................. Total hysterectomy .................................. Total hysterectomy .................................. Partial hysterectomy ................................ Extensive hysterectomy ........................... Extensive hysterectomy ........................... Removal of pelvis contents ..................... Vaginal hysterectomy .............................. Vag hyst including t/o .............................. Vag hyst w/t/o & vag repair ..................... 0202 0154 0195 .................... .................... .................... .................... 0202 0202 0202 0195 0195 .................... 0195 .................... .................... .................... 0202 .................... 0195 0195 .................... 0194 0193 0194 0189 0189 0130 0189 0189 0189 0189 0193 0194 0192 0189 0193 0189 0193 0194 0195 0195 .................... .................... .................... 0195 0195 0202 0194 0194 0193 0196 0188 0196 .................... 0195 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 40.3866 28.7847 26.6791 .................... .................... .................... .................... 40.3866 40.3866 40.3866 26.6791 26.6791 .................... 26.6791 .................... .................... .................... 40.3866 .................... 26.6791 26.6791 .................... 20.7525 14.5843 20.7525 2.371 2.371 31.9271 2.371 2.371 2.371 2.371 14.5843 20.7525 4.3082 2.371 14.5843 2.371 14.5843 20.7525 26.6791 26.6791 .................... .................... .................... 26.6791 26.6791 40.3866 20.7525 20.7525 14.5843 17.0974 1.14 17.0974 .................... 26.6791 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,396.66 $1,708.17 $1,583.22 .................... .................... .................... .................... $2,396.66 $2,396.66 $2,396.66 $1,583.22 $1,583.22 .................... $1,583.22 .................... .................... .................... $2,396.66 .................... $1,583.22 $1,583.22 .................... $1,231.52 $865.48 $1,231.52 $140.70 $140.70 $1,894.65 $140.70 $140.70 $140.70 $140.70 $865.48 $1,231.52 $255.66 $140.70 $865.48 $140.70 $865.48 $1,231.52 $1,583.22 $1,583.22 .................... .................... .................... $1,583.22 $1,583.22 $2,396.66 $1,231.52 $1,231.52 $865.48 $1,014.61 $67.65 $1,014.61 .................... $1,583.22 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $958.66 $464.85 $483.80 .................... .................... .................... .................... $958.66 $958.66 $958.66 $483.80 $483.80 .................... $483.80 .................... .................... .................... $958.66 .................... $483.80 $483.80 .................... $397.84 .................... $397.84 .................... .................... $659.53 .................... .................... .................... .................... .................... $397.84 .................... .................... .................... .................... .................... $397.84 $483.80 $483.80 .................... .................... .................... $483.80 $483.80 $958.66 $397.84 $397.84 .................... $338.23 .................... $338.23 .................... $483.80 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $479.33 $341.63 $316.64 .................... .................... .................... .................... $479.33 $479.33 $479.33 $316.64 $316.64 .................... $316.64 .................... .................... .................... $479.33 .................... $316.64 $316.64 .................... $246.30 $173.10 $246.30 $28.14 $28.14 $378.93 $28.14 $28.14 $28.14 $28.14 $173.10 $246.30 $51.13 $28.14 $173.10 $28.14 $173.10 $246.30 $316.64 $316.64 .................... .................... .................... $316.64 $316.64 $479.33 $246.30 $246.30 $173.10 $202.92 $13.53 $202.92 .................... $316.64 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00087 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50766 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C C E T T T T N T T T T T C C C C T T T T T T T T T T T T T T T T T C C T T T T T T T T T C C C C C C T T C T C T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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) ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0189 0197 0197 0197 .................... 0193 0193 0195 0195 0202 .................... .................... .................... .................... 0130 0131 0132 0131 0131 0131 0190 0190 0190 0387 0387 0190 0387 0202 0130 0190 0195 .................... .................... 0194 0131 0131 0131 0131 0131 0131 0131 0130 .................... .................... .................... .................... .................... .................... 0195 0193 .................... 0195 .................... 0193 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 2.371 2.3572 2.3572 2.3572 .................... 14.5843 14.5843 26.6791 26.6791 40.3866 .................... .................... .................... .................... 31.9271 43.3389 62.9914 43.3389 43.3389 43.3389 21.0653 21.0653 21.0653 32.5445 32.5445 21.0653 32.5445 40.3866 31.9271 21.0653 26.6791 .................... .................... 20.7525 43.3389 43.3389 43.3389 43.3389 43.3389 43.3389 43.3389 31.9271 .................... .................... .................... .................... .................... .................... 26.6791 14.5843 .................... 26.6791 .................... 14.5843 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $140.70 $139.88 $139.88 $139.88 .................... $865.48 $865.48 $1,583.22 $1,583.22 $2,396.66 .................... .................... .................... .................... $1,894.65 $2,571.86 $3,738.10 $2,571.86 $2,571.86 $2,571.86 $1,250.08 $1,250.08 $1,250.08 $1,931.29 $1,931.29 $1,250.08 $1,931.29 $2,396.66 $1,894.65 $1,250.08 $1,583.22 .................... .................... $1,231.52 $2,571.86 $2,571.86 $2,571.86 $2,571.86 $2,571.86 $2,571.86 $2,571.86 $1,894.65 .................... .................... .................... .................... .................... .................... $1,583.22 $865.48 .................... $1,583.22 .................... $865.48 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $483.80 $483.80 $958.66 .................... .................... .................... .................... $659.53 $1,001.89 $1,239.22 $1,001.89 $1,001.89 $1,001.89 $424.28 $424.28 $424.28 $655.55 $655.55 $424.28 $655.55 $958.66 $659.53 $424.28 $483.80 .................... .................... $397.84 $1,001.89 $1,001.89 $1,001.89 $1,001.89 $1,001.89 $1,001.89 $1,001.89 $659.53 .................... .................... .................... .................... .................... .................... $483.80 .................... .................... $483.80 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $28.14 $27.98 $27.98 $27.98 .................... $173.10 $173.10 $316.64 $316.64 $479.33 .................... .................... .................... .................... $378.93 $514.37 $747.62 $514.37 $514.37 $514.37 $250.02 $250.02 $250.02 $386.26 $386.26 $250.02 $386.26 $479.33 $378.93 $250.02 $316.64 .................... .................... $246.30 $514.37 $514.37 $514.37 $514.37 $514.37 $514.37 $514.37 $378.93 .................... .................... .................... .................... .................... .................... $316.64 $173.10 .................... $316.64 .................... $173.10 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00088 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50767 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 58900 58920 58925 58940 58943 58950 58951 58952 58953 58954 58956 58960 58970 58974 58976 58999 59000 59001 59012 59015 59020 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T C C C C C C C C C T T T T T T T T T T T E B T T T T T C C C C C C T T T T T T C C B T B T T B B B E C E C E T E E C E T T T C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Biopsy of ovary(s) .................................... Partial removal of ovary(s) ...................... Removal of ovarian cyst(s) ...................... 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 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 ............................... 0193 0195 0195 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0197 0197 0197 0191 0198 0192 0198 0198 0192 0198 0198 .................... .................... 0198 0198 0198 0198 0195 .................... .................... .................... .................... .................... .................... 0131 0131 0196 0189 0193 0194 .................... .................... .................... 0194 .................... 0700 0193 .................... .................... .................... .................... .................... .................... .................... .................... 0194 .................... .................... .................... .................... 0201 0201 0201 .................... 14.5843 26.6791 26.6791 .................... .................... .................... .................... .................... .................... .................... .................... .................... 2.3572 2.3572 2.3572 0.167 1.3683 4.3082 1.3683 1.3683 4.3082 1.3683 1.3683 .................... .................... 1.3683 1.3683 1.3683 1.3683 26.6791 .................... .................... .................... .................... .................... .................... 43.3389 43.3389 17.0974 2.371 14.5843 20.7525 .................... .................... .................... 20.7525 .................... 5.3614 14.5843 .................... .................... .................... .................... .................... .................... .................... .................... 20.7525 .................... .................... .................... .................... 17.6047 17.6047 17.6047 .................... $865.48 $1,583.22 $1,583.22 .................... .................... .................... .................... .................... .................... .................... .................... .................... $139.88 $139.88 $139.88 $9.91 $81.20 $255.66 $81.20 $81.20 $255.66 $81.20 $81.20 .................... .................... $81.20 $81.20 $81.20 $81.20 $1,583.22 .................... .................... .................... .................... .................... .................... $2,571.86 $2,571.86 $1,014.61 $140.70 $865.48 $1,231.52 .................... .................... .................... $1,231.52 .................... $318.16 $865.48 .................... .................... .................... .................... .................... .................... .................... .................... $1,231.52 .................... .................... .................... .................... $1,044.72 $1,044.72 $1,044.72 .................... .................... $483.80 $483.80 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2.78 $32.19 .................... $32.19 $32.19 .................... $32.19 $32.19 .................... .................... $32.19 $32.19 $32.19 $32.19 $483.80 .................... .................... .................... .................... .................... .................... $1,001.89 $1,001.89 $338.23 .................... .................... $397.84 .................... .................... .................... $397.84 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $397.84 .................... .................... .................... .................... $329.65 $329.65 $329.65 .................... $173.10 $316.64 $316.64 .................... .................... .................... .................... .................... .................... .................... .................... .................... $27.98 $27.98 $27.98 $1.98 $16.24 $51.13 $16.24 $16.24 $51.13 $16.24 $16.24 .................... .................... $16.24 $16.24 $16.24 $16.24 $316.64 .................... .................... .................... .................... .................... .................... $514.37 $514.37 $202.92 $28.14 $173.10 $246.30 .................... .................... .................... $246.30 .................... $63.63 $173.10 .................... .................... .................... .................... .................... .................... .................... .................... $246.30 .................... .................... .................... .................... $208.94 $208.94 $208.94 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00089 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50768 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 59840 59841 59850 59851 59852 59855 59856 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T C C C C C C T T T T T T T T T T T T T T T T C T C C T T T C C T C C C C C C C C T T T T T T T T T C C C C C C C C C C T C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Abortion .................................................... Abortion .................................................... Abortion .................................................... Abortion .................................................... Abortion .................................................... Abortion .................................................... Abortion .................................................... 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 ........................ 0200 0200 .................... .................... .................... .................... .................... .................... 0198 0201 0194 0198 0130 0198 0252 0004 0004 0114 0114 0114 0114 0114 0114 0256 .................... 0256 .................... .................... 0114 0114 0256 .................... .................... 0022 .................... .................... .................... .................... .................... .................... .................... .................... 0130 0114 0212 0212 0212 0212 0212 0212 0212 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0224 .................... .................... .................... .................... 17.8728 17.8728 .................... .................... .................... .................... .................... .................... 1.3683 17.6047 20.7525 1.3683 31.9271 1.3683 7.8673 1.7646 1.7646 40.7652 40.7652 40.7652 40.7652 40.7652 40.7652 37.3204 .................... 37.3204 .................... .................... 40.7652 40.7652 37.3204 .................... .................... 19.6472 .................... .................... .................... .................... .................... .................... .................... .................... 31.9271 40.7652 2.974 2.974 2.974 2.974 2.974 2.974 2.974 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 40.6455 .................... .................... .................... .................... $1,060.63 $1,060.63 .................... .................... .................... .................... .................... .................... $81.20 $1,044.72 $1,231.52 $81.20 $1,894.65 $81.20 $466.87 $104.72 $104.72 $2,419.13 $2,419.13 $2,419.13 $2,419.13 $2,419.13 $2,419.13 $2,214.70 .................... $2,214.70 .................... .................... $2,419.13 $2,419.13 $2,214.70 .................... .................... $1,165.92 .................... .................... .................... .................... .................... .................... .................... .................... $1,894.65 $2,419.13 $176.49 $176.49 $176.49 $176.49 $176.49 $176.49 $176.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,412.03 .................... .................... .................... .................... $263.69 $263.69 .................... .................... .................... .................... .................... .................... $32.19 $329.65 $397.84 $32.19 $659.53 $32.19 $113.41 $22.36 $22.36 $485.91 $485.91 $485.91 $485.91 $485.91 $485.91 .................... .................... .................... .................... .................... $485.91 $485.91 .................... .................... .................... $354.45 .................... .................... .................... .................... .................... .................... .................... .................... $659.53 $485.91 $70.59 $70.59 $70.59 $70.59 $70.59 $70.59 $70.59 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $212.13 $212.13 .................... .................... .................... .................... .................... .................... $16.24 $208.94 $246.30 $16.24 $378.93 $16.24 $93.37 $20.94 $20.94 $483.83 $483.83 $483.83 $483.83 $483.83 $483.83 $442.94 .................... $442.94 .................... .................... $483.83 $483.83 $442.94 .................... .................... $233.18 .................... .................... .................... .................... .................... .................... .................... .................... $378.93 $483.83 $35.30 $35.30 $35.30 $35.30 $35.30 $35.30 $35.30 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $482.41 .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00090 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50769 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 61312 61313 61314 61315 61316 61320 61321 61322 61323 61330 61332 61333 61334 61340 61343 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C C C C T C C T 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 C C C C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ..................... Relieve cranial pressure .......................... Incise skull (press relief) .......................... 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 ..................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0256 .................... .................... 0256 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 37.3204 .................... .................... 37.3204 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,214.70 .................... .................... $2,214.70 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $442.94 .................... .................... $442.94 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00091 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50770 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 61575 61576 61580 61581 61582 61583 61584 61585 61586 61590 61591 61592 61595 61596 61597 61598 61600 61601 61605 61606 61607 61608 61609 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI 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 T C T C C C C C C C C C C C C C C C C C C C C C T T E S C C C C C C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .............................. 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 ................ Occlusion/embolization cath .................... 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 .......................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0081 .................... 0081 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0220 0206 .................... 0302 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 34.4473 .................... 34.4473 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 17.3586 5.492 .................... 4.6145 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2,044.21 .................... $2,044.21 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,030.11 $325.91 .................... $273.84 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $75.55 .................... $103.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $408.84 .................... $408.84 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $206.02 $65.18 .................... $54.77 .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00092 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50771 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 62194 62200 62201 62220 62223 62225 62230 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C T S T T C C C C C C C C C C C C C C C C C T C C C C C C C C T C C C C T T S C C T T T T T T T T T T N T N N T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Implant neuroelectrodes .......................... Revise/remove neuroelectrode ................ Implant neurostim one 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 ..................... Replace/irrigate catheter .......................... Establish brain cavity shunt ..................... Establish brain cavity shunt ..................... Establish brain cavity shunt ..................... Establish brain cavity shunt ..................... Replace/irrigate catheter .......................... Replace/revise brain shunt ...................... Csf shunt reprogram ................................ Remove brain cavity shunt ...................... Replace brain cavity shunt ...................... Lysis epidural adhesions ......................... Epidural lysis on single day ..................... Drain spinal cord cyst .............................. Needle biopsy, spinal cord ...................... Spinal fluid tap, diagnostic ....................... Drain cerebro spinal fluid ......................... Treat epidural spine lesion ...................... 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 .................... .................... 0687 0039 0315 0688 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0122 .................... .................... .................... .................... .................... .................... .................... .................... 0427 .................... .................... .................... .................... 0427 0224 0691 .................... .................... 0203 0203 0212 0685 0204 0204 0206 0207 0207 0207 .................... 0221 .................... .................... 0212 0212 0207 0207 0207 0207 0223 0208 0203 0226 0227 .................... 19.2347 181.4 290.647 43.0444 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 6.9721 .................... .................... .................... .................... .................... .................... .................... .................... 10.1977 .................... .................... .................... .................... 10.1977 40.6455 2.5252 .................... .................... 10.4015 10.4015 2.974 6.0174 2.191 2.191 5.492 6.0109 6.0109 6.0109 .................... 29.9209 .................... .................... 2.974 2.974 6.0109 6.0109 6.0109 6.0109 28.123 42.3409 10.4015 138.8695 136.4922 .................... $1,141.44 $10,764.82 $17,247.86 $2,554.38 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $413.75 .................... .................... .................... .................... .................... .................... .................... .................... $605.16 .................... .................... .................... .................... $605.16 $2,412.03 $149.85 .................... .................... $617.26 $617.26 $176.49 $357.09 $130.02 $130.02 $325.91 $356.70 $356.70 $356.70 .................... $1,775.60 .................... .................... $176.49 $176.49 $356.70 $356.70 $356.70 $356.70 $1,668.90 $2,512.64 $617.26 $8,240.93 $8,099.86 .................... $456.57 .................... .................... $1,021.75 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $84.85 .................... .................... .................... .................... .................... .................... .................... .................... $124.11 .................... .................... .................... .................... $124.11 .................... $59.94 .................... .................... $246.90 $246.90 $70.59 $115.47 $40.13 $40.13 $75.55 $86.92 $86.92 $86.92 .................... $463.62 .................... .................... $70.59 $70.59 $86.92 $86.92 $86.92 $86.92 .................... .................... $246.90 .................... .................... .................... $228.29 $2,152.96 $3,449.57 $510.88 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $82.75 .................... .................... .................... .................... .................... .................... .................... .................... $121.03 .................... .................... .................... .................... $121.03 $482.41 $29.97 .................... .................... $123.45 $123.45 $35.30 $71.42 $26.00 $26.00 $65.18 $71.34 $71.34 $71.34 .................... $355.12 .................... .................... $35.30 $35.30 $71.34 $71.34 $71.34 $71.34 $333.78 $502.53 $123.45 $1,648.19 $1,619.97 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00093 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50772 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T S S T T T T T T T T T T T T T C C T T T T C C T T T T T 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 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ...................... 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 .......................... 0227 0221 0691 0691 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 .................... .................... 0208 0208 0208 0208 .................... .................... 0208 0208 0208 0208 0208 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 136.4922 29.9209 2.5252 2.5252 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 42.3409 .................... .................... 42.3409 42.3409 42.3409 42.3409 .................... .................... 42.3409 42.3409 42.3409 42.3409 42.3409 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $8,099.86 $1,775.60 $149.85 $149.85 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 .................... .................... $2,512.64 $2,512.64 $2,512.64 $2,512.64 .................... .................... $2,512.64 $2,512.64 $2,512.64 $2,512.64 $2,512.64 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $463.62 $59.94 $59.94 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,619.97 $355.12 $29.97 $29.97 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 $502.53 .................... .................... $502.53 $502.53 $502.53 $502.53 .................... .................... $502.53 $502.53 $502.53 $502.53 $502.53 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00094 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50773 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 63746 64400 64402 64405 64408 64410 64412 64413 64415 64416 64417 64418 64420 64421 64425 64430 64435 64445 64446 64447 64448 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI 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 T T T S S T T T C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................ Implant neuroreceiver .............................. 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 .......................... 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 ...................... Injection for nerve block .......................... 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 .......................... Injection for nerve block .......................... N blk inj, sciatic, cont inf .......................... N block inj fem, single ............................. N block inj fem, cont inf ........................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0220 0220 0220 0040 0040 0687 0222 0688 .................... .................... .................... .................... .................... .................... .................... .................... 0228 0228 0109 0204 0204 0204 0204 0206 0206 0204 0204 0204 0204 0204 0204 0206 0204 0204 0204 0204 0206 0204 0204 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 17.3586 17.3586 17.3586 55.3297 55.3297 19.2347 179.0982 43.0444 .................... .................... .................... .................... .................... .................... .................... .................... 51.7258 51.7258 11.0433 2.191 2.191 2.191 2.191 5.492 5.492 2.191 2.191 2.191 2.191 2.191 2.191 5.492 2.191 2.191 2.191 2.191 5.492 2.191 2.191 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,030.11 $1,030.11 $1,030.11 $3,283.43 $3,283.43 $1,141.44 $10,628.22 $2,554.38 .................... .................... .................... .................... .................... .................... .................... .................... $3,069.56 $3,069.56 $655.34 $130.02 $130.02 $130.02 $130.02 $325.91 $325.91 $130.02 $130.02 $130.02 $130.02 $130.02 $130.02 $325.91 $130.02 $130.02 $130.02 $130.02 $325.91 $130.02 $130.02 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $456.57 .................... $1,021.75 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $131.49 $40.13 $40.13 $40.13 $40.13 $75.55 $75.55 $40.13 $40.13 $40.13 $40.13 $40.13 $40.13 $75.55 $40.13 $40.13 $40.13 $40.13 $75.55 $40.13 $40.13 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $206.02 $206.02 $206.02 $656.69 $656.69 $228.29 $2,125.64 $510.88 .................... .................... .................... .................... .................... .................... .................... .................... $613.91 $613.91 $131.07 $26.00 $26.00 $26.00 $26.00 $65.18 $65.18 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $65.18 $26.00 $26.00 $26.00 $26.00 $65.18 $26.00 $26.00 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00095 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50774 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 64719 64721 64722 64726 64727 64732 64734 64736 64738 64740 64742 64744 64746 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T A S S S S S S S S S S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................ Implant neuroreceiver .............................. 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 .................... 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 ........................... 0204 0204 0207 0206 0207 0206 0207 0207 0207 0207 0204 0204 0207 0204 0207 0207 .................... 0225 0040 0040 0040 0040 0225 0040 0225 0040 0040 0687 0222 0688 0203 0203 0203 0204 0204 0204 0203 0203 0207 0203 0207 0206 0206 0207 0203 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 2.191 2.191 6.0109 5.492 6.0109 5.492 6.0109 6.0109 6.0109 6.0109 2.191 2.191 6.0109 2.191 6.0109 6.0109 .................... 234.6925 55.3297 55.3297 55.3297 55.3297 234.6925 55.3297 234.6925 55.3297 55.3297 19.2347 179.0982 43.0444 10.4015 10.4015 10.4015 2.191 2.191 2.191 10.4015 10.4015 6.0109 10.4015 6.0109 5.492 5.492 6.0109 10.4015 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 $130.02 $130.02 $356.70 $325.91 $356.70 $325.91 $356.70 $356.70 $356.70 $356.70 $130.02 $130.02 $356.70 $130.02 $356.70 $356.70 .................... $13,927.36 $3,283.43 $3,283.43 $3,283.43 $3,283.43 $13,927.36 $3,283.43 $13,927.36 $3,283.43 $3,283.43 $1,141.44 $10,628.22 $2,554.38 $617.26 $617.26 $617.26 $130.02 $130.02 $130.02 $617.26 $617.26 $356.70 $617.26 $356.70 $325.91 $325.91 $356.70 $617.26 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $40.13 $40.13 $86.92 $75.55 $86.92 $75.55 $86.92 $86.92 $86.92 $86.92 $40.13 $40.13 $86.92 $40.13 $86.92 $86.92 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $456.57 .................... $1,021.75 $246.90 $246.90 $246.90 $40.13 $40.13 $40.13 $246.90 $246.90 $86.92 $246.90 $86.92 $75.55 $75.55 $86.92 $246.90 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $26.00 $26.00 $71.34 $65.18 $71.34 $65.18 $71.34 $71.34 $71.34 $71.34 $26.00 $26.00 $71.34 $26.00 $71.34 $71.34 .................... $2,785.47 $656.69 $656.69 $656.69 $656.69 $2,785.47 $656.69 $2,785.47 $656.69 $656.69 $228.29 $2,125.64 $510.88 $123.45 $123.45 $123.45 $26.00 $26.00 $26.00 $123.45 $123.45 $71.34 $123.45 $71.34 $65.18 $65.18 $71.34 $123.45 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00096 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50775 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 64905 64907 64999 65091 65093 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................................... Nerve pedicle transfer ............................. Nerve pedicle transfer ............................. Nervous system surgery .......................... Revise eye ............................................... Revise eye with implant ........................... .................... .................... .................... 0220 0220 0221 0220 0220 0220 0220 0220 0220 0220 0220 0221 0220 0220 0220 0221 0220 0220 .................... .................... .................... 0220 0054 0054 0054 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 .................... .................... 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0204 0242 0241 .................... .................... .................... 17.3586 17.3586 29.9209 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 17.3586 29.9209 17.3586 17.3586 17.3586 29.9209 17.3586 17.3586 .................... .................... .................... 17.3586 25.3711 25.3711 25.3711 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 .................... .................... 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 29.9209 2.191 30.5464 23.3036 .................... .................... .................... $1,030.11 $1,030.11 $1,775.60 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,030.11 $1,775.60 $1,030.11 $1,030.11 $1,030.11 $1,775.60 $1,030.11 $1,030.11 .................... .................... .................... $1,030.11 $1,505.60 $1,505.60 $1,505.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 .................... .................... $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $1,775.60 $130.02 $1,812.72 $1,382.91 .................... .................... .................... .................... .................... $463.62 .................... .................... .................... .................... .................... .................... .................... .................... $463.62 .................... .................... .................... $463.62 .................... .................... .................... .................... .................... .................... .................... .................... .................... $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 .................... .................... $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $463.62 $40.13 $597.36 $384.47 .................... .................... .................... $206.02 $206.02 $355.12 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $206.02 $355.12 $206.02 $206.02 $206.02 $355.12 $206.02 $206.02 .................... .................... .................... $206.02 $301.12 $301.12 $301.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 .................... .................... $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $355.12 $26.00 $362.54 $276.58 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00097 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50776 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T S S S S T T T T T C T T T T T T T T T S T T S T T T T T E E E T E T T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... 0242 0242 0242 0242 0242 0242 0240 0241 0241 0242 0241 0242 0240 0698 0698 0698 0698 0233 0236 0237 0240 0234 .................... 0234 0236 0672 0232 0243 0233 0233 0233 0234 0698 0239 0233 0231 0240 0244 0244 0244 0244 .................... .................... .................... 0244 .................... 0233 0233 0244 0244 0244 0233 0233 0234 0234 0232 0234 0247 0247 0233 0234 0234 0233 0233 0234 0234 30.5464 30.5464 30.5464 30.5464 30.5464 30.5464 18.1508 23.3036 23.3036 30.5464 23.3036 30.5464 18.1508 1.2438 1.2438 1.2438 1.2438 14.9673 17.0229 28.9401 18.1508 21.9741 .................... 21.9741 17.0229 36.9284 6.6732 22.1671 14.9673 14.9673 14.9673 21.9741 1.2438 6.9097 14.9673 1.9278 18.1508 38.3723 38.3723 38.3723 38.3723 .................... .................... .................... 38.3723 .................... 14.9673 14.9673 38.3723 38.3723 38.3723 14.9673 14.9673 21.9741 21.9741 6.6732 21.9741 5.033 5.033 14.9673 21.9741 21.9741 14.9673 14.9673 21.9741 21.9741 $1,812.72 $1,812.72 $1,812.72 $1,812.72 $1,812.72 $1,812.72 $1,077.12 $1,382.91 $1,382.91 $1,812.72 $1,382.91 $1,812.72 $1,077.12 $73.81 $73.81 $73.81 $73.81 $888.20 $1,010.19 $1,717.39 $1,077.12 $1,304.01 .................... $1,304.01 $1,010.19 $2,191.44 $396.01 $1,315.46 $888.20 $888.20 $888.20 $1,304.01 $73.81 $410.04 $888.20 $114.40 $1,077.12 $2,277.13 $2,277.13 $2,277.13 $2,277.13 .................... .................... .................... $2,277.13 .................... $888.20 $888.20 $2,277.13 $2,277.13 $2,277.13 $888.20 $888.20 $1,304.01 $1,304.01 $396.01 $1,304.01 $298.67 $298.67 $888.20 $1,304.01 $1,304.01 $888.20 $888.20 $1,304.01 $1,304.01 $597.36 $597.36 $597.36 $597.36 $597.36 $597.36 $315.31 $384.47 $384.47 $597.36 $384.47 $597.36 $315.31 $16.55 $16.55 $16.55 $16.55 $266.33 .................... .................... $315.31 $511.31 .................... $511.31 .................... .................... $103.17 $431.39 $266.33 $266.33 $266.33 $511.31 $16.55 .................... $266.33 $44.61 $315.31 $803.26 $803.26 $803.26 $803.26 .................... .................... .................... $803.26 .................... $266.33 $266.33 $803.26 $803.26 $803.26 $266.33 $266.33 $511.31 $511.31 $103.17 $511.31 $104.31 $104.31 $266.33 $511.31 $511.31 $266.33 $266.33 $511.31 $511.31 $362.54 $362.54 $362.54 $362.54 $362.54 $362.54 $215.42 $276.58 $276.58 $362.54 $276.58 $362.54 $215.42 $14.76 $14.76 $14.76 $14.76 $177.64 $202.04 $343.48 $215.42 $260.80 .................... $260.80 $202.04 $438.29 $79.20 $263.09 $177.64 $177.64 $177.64 $260.80 $14.76 $82.01 $177.64 $22.88 $215.42 $455.43 $455.43 $455.43 $455.43 .................... .................... .................... $455.43 .................... $177.64 $177.64 $455.43 $455.43 $455.43 $177.64 $177.64 $260.80 $260.80 $79.20 $260.80 $59.73 $59.73 $177.64 $260.80 $260.80 $177.64 $177.64 $260.80 $260.80 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00098 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50777 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 66020 66030 66130 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 66761 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Injection treatment of eye ........................ Injection treatment of eye ........................ Remove eye lesion .................................. 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 .......................... Destruction, ciliary body .......................... 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 ......................... 0233 0232 0234 0234 0234 0234 0234 0234 0673 0673 0673 0672 0673 0233 0232 0232 0234 0234 0232 0234 0234 0234 0234 0233 0233 0233 0233 0234 0247 0247 0247 0232 0247 0234 0232 0245 0249 0249 0249 0249 0245 0246 0246 0246 0246 0246 .................... 0232 0237 0237 0237 0237 0672 0235 0236 0247 0672 0672 0672 0672 0236 0248 0672 0672 0236 0672 14.9673 6.6732 21.9741 21.9741 21.9741 21.9741 21.9741 21.9741 29.2582 29.2582 29.2582 36.9284 29.2582 14.9673 6.6732 6.6732 21.9741 21.9741 6.6732 21.9741 21.9741 21.9741 21.9741 14.9673 14.9673 14.9673 14.9673 21.9741 5.033 5.033 5.033 6.6732 5.033 21.9741 6.6732 13.3625 27.9369 27.9369 27.9369 27.9369 13.3625 23.4597 23.4597 23.4597 23.4597 23.4597 .................... 6.6732 28.9401 28.9401 28.9401 28.9401 36.9284 4.6593 17.0229 5.033 36.9284 36.9284 36.9284 36.9284 17.0229 4.6769 36.9284 36.9284 17.0229 36.9284 $888.20 $396.01 $1,304.01 $1,304.01 $1,304.01 $1,304.01 $1,304.01 $1,304.01 $1,736.27 $1,736.27 $1,736.27 $2,191.44 $1,736.27 $888.20 $396.01 $396.01 $1,304.01 $1,304.01 $396.01 $1,304.01 $1,304.01 $1,304.01 $1,304.01 $888.20 $888.20 $888.20 $888.20 $1,304.01 $298.67 $298.67 $298.67 $396.01 $298.67 $1,304.01 $396.01 $792.97 $1,657.86 $1,657.86 $1,657.86 $1,657.86 $792.97 $1,392.17 $1,392.17 $1,392.17 $1,392.17 $1,392.17 .................... $396.01 $1,717.39 $1,717.39 $1,717.39 $1,717.39 $2,191.44 $276.50 $1,010.19 $298.67 $2,191.44 $2,191.44 $2,191.44 $2,191.44 $1,010.19 $277.54 $2,191.44 $2,191.44 $1,010.19 $2,191.44 $266.33 $103.17 $511.31 $511.31 $511.31 $511.31 $511.31 $511.31 $649.56 $649.56 $649.56 .................... $649.56 $266.33 $103.17 $103.17 $511.31 $511.31 $103.17 $511.31 $511.31 $511.31 $511.31 $266.33 $266.33 $266.33 $266.33 $511.31 $104.31 $104.31 $104.31 $103.17 $104.31 $511.31 $103.17 $221.89 $524.67 $524.67 $524.67 $524.67 $221.89 $495.96 $495.96 $495.96 $495.96 $495.96 .................... $103.17 .................... .................... .................... .................... .................... $67.40 .................... $104.31 .................... .................... .................... .................... .................... $93.98 .................... .................... .................... .................... $177.64 $79.20 $260.80 $260.80 $260.80 $260.80 $260.80 $260.80 $347.25 $347.25 $347.25 $438.29 $347.25 $177.64 $79.20 $79.20 $260.80 $260.80 $79.20 $260.80 $260.80 $260.80 $260.80 $177.64 $177.64 $177.64 $177.64 $260.80 $59.73 $59.73 $59.73 $79.20 $59.73 $260.80 $79.20 $158.59 $331.57 $331.57 $331.57 $331.57 $158.59 $278.43 $278.43 $278.43 $278.43 $278.43 .................... $79.20 $343.48 $343.48 $343.48 $343.48 $438.29 $55.30 $202.04 $59.73 $438.29 $438.29 $438.29 $438.29 $202.04 $55.51 $438.29 $438.29 $202.04 $438.29 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00099 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50778 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 67115 67120 67121 67141 67145 67208 67210 67218 67220 67221 67225 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T S T T T T T T T T T T T T T T S T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............... 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 .................................... Relative weight APC 0236 0236 0237 0235 0248 0236 0248 0236 0235 0235 0235 0236 0248 0240 0237 0235 0243 0243 0243 0243 0243 0243 0243 0243 0243 0243 0243 0243 0238 0699 0243 0241 0241 0241 0241 0242 0240 0242 0242 0242 0242 0242 0231 0238 0238 0242 0241 0242 0238 0238 0239 0240 0238 0239 0238 0240 0238 0698 0238 0239 0240 0239 0239 0239 0233 0240 17.0229 17.0229 28.9401 4.6593 4.6769 17.0229 4.6769 17.0229 4.6593 4.6593 4.6593 17.0229 4.6769 18.1508 28.9401 4.6593 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 22.1671 2.5933 10.0177 22.1671 23.3036 23.3036 23.3036 23.3036 30.5464 18.1508 30.5464 30.5464 30.5464 30.5464 30.5464 1.9278 2.5933 2.5933 30.5464 23.3036 30.5464 2.5933 2.5933 6.9097 18.1508 2.5933 6.9097 2.5933 18.1508 2.5933 1.2438 2.5933 6.9097 18.1508 6.9097 6.9097 6.9097 14.9673 18.1508 Payment rate National unadjusted copayment Minimum unadjusted copayment $1,010.19 $1,010.19 $1,717.39 $276.50 $277.54 $1,010.19 $277.54 $1,010.19 $276.50 $276.50 $276.50 $1,010.19 $277.54 $1,077.12 $1,717.39 $276.50 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $1,315.46 $153.89 $594.48 $1,315.46 $1,382.91 $1,382.91 $1,382.91 $1,382.91 $1,812.72 $1,077.12 $1,812.72 $1,812.72 $1,812.72 $1,812.72 $1,812.72 $114.40 $153.89 $153.89 $1,812.72 $1,382.91 $1,812.72 $153.89 $153.89 $410.04 $1,077.12 $153.89 $410.04 $153.89 $1,077.12 $153.89 $73.81 $153.89 $410.04 $1,077.12 $410.04 $410.04 $410.04 $888.20 $1,077.12 .................... .................... .................... $67.40 $93.98 .................... $93.98 .................... $67.40 $67.40 $67.40 .................... $93.98 $315.31 .................... $67.40 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 $431.39 .................... .................... $431.39 $384.47 $384.47 $384.47 $384.47 $597.36 $315.31 $597.36 $597.36 $597.36 $597.36 $597.36 $44.61 .................... .................... $597.36 $384.47 $597.36 .................... .................... .................... $315.31 .................... .................... .................... $315.31 .................... $16.55 .................... .................... $315.31 .................... .................... .................... $266.33 $315.31 $202.04 $202.04 $343.48 $55.30 $55.51 $202.04 $55.51 $202.04 $55.30 $55.30 $55.30 $202.04 $55.51 $215.42 $343.48 $55.30 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $263.09 $30.78 $118.90 $263.09 $276.58 $276.58 $276.58 $276.58 $362.54 $215.42 $362.54 $362.54 $362.54 $362.54 $362.54 $22.88 $30.78 $30.78 $362.54 $276.58 $362.54 $30.78 $30.78 $82.01 $215.42 $30.78 $82.01 $30.78 $215.42 $30.78 $14.76 $30.78 $82.01 $215.42 $82.01 $82.01 $82.01 $177.64 $215.42 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00100 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50779 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 67900 67901 67902 67903 67904 67906 67908 67909 67911 67912 67914 67915 67916 67917 67921 67922 67923 67924 67930 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T T T T T T T T T S T T T T T T T T T S T T T T T S T T T T T T T T T T T T T T T T T T T T T T T T T T T S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................................ 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 .......................... Relative weight APC 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0698 0240 0240 0240 0241 0241 0241 0240 0238 0240 0698 0232 0699 0240 0233 0239 0230 0240 0242 0241 0241 0234 0241 0240 0234 0234 0233 0238 0238 0240 0238 0241 0241 0240 0241 0240 0240 0241 0242 0241 0238 0242 0241 0242 0698 0231 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 18.1508 1.2438 18.1508 18.1508 18.1508 23.3036 23.3036 23.3036 18.1508 2.5933 18.1508 1.2438 6.6732 10.0177 18.1508 14.9673 6.9097 0.7858 18.1508 30.5464 23.3036 23.3036 21.9741 23.3036 18.1508 21.9741 21.9741 14.9673 2.5933 2.5933 18.1508 2.5933 23.3036 23.3036 18.1508 23.3036 18.1508 18.1508 23.3036 30.5464 23.3036 2.5933 30.5464 23.3036 30.5464 1.2438 1.9278 Payment rate National unadjusted copayment Minimum unadjusted copayment $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $1,077.12 $73.81 $1,077.12 $1,077.12 $1,077.12 $1,382.91 $1,382.91 $1,382.91 $1,077.12 $153.89 $1,077.12 $73.81 $396.01 $594.48 $1,077.12 $888.20 $410.04 $46.63 $1,077.12 $1,812.72 $1,382.91 $1,382.91 $1,304.01 $1,382.91 $1,077.12 $1,304.01 $1,304.01 $888.20 $153.89 $153.89 $1,077.12 $153.89 $1,382.91 $1,382.91 $1,077.12 $1,382.91 $1,077.12 $1,077.12 $1,382.91 $1,812.72 $1,382.91 $153.89 $1,812.72 $1,382.91 $1,812.72 $73.81 $114.40 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $315.31 $16.55 $315.31 $315.31 $315.31 $384.47 $384.47 $384.47 $315.31 .................... $315.31 $16.55 $103.17 .................... $315.31 $266.33 .................... $14.97 $315.31 $597.36 $384.47 $384.47 $511.31 $384.47 $315.31 $511.31 $511.31 $266.33 .................... .................... $315.31 .................... $384.47 $384.47 $315.31 $384.47 $315.31 $315.31 $384.47 $597.36 $384.47 .................... $597.36 $384.47 $597.36 $16.55 $44.61 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $215.42 $14.76 $215.42 $215.42 $215.42 $276.58 $276.58 $276.58 $215.42 $30.78 $215.42 $14.76 $79.20 $118.90 $215.42 $177.64 $82.01 $9.33 $215.42 $362.54 $276.58 $276.58 $260.80 $276.58 $215.42 $260.80 $260.80 $177.64 $30.78 $30.78 $215.42 $30.78 $276.58 $276.58 $215.42 $276.58 $215.42 $215.42 $276.58 $362.54 $276.58 $30.78 $362.54 $276.58 $362.54 $14.76 $22.88 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00101 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50780 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T S S T T S N S T T T E T T T T T T T C X T X T T T T T T T T T T T T T T T T T T T T T T C T T T C T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ........................... 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 .................. 0240 0698 0231 0240 0240 0231 .................... 0230 0006 0008 0006 .................... 0019 0253 0021 0254 0254 0021 0252 .................... 0340 0022 0340 0012 0253 0254 0256 0256 0251 0251 0251 0252 0251 0251 0253 0252 0252 0253 0254 0256 0256 0254 0256 0256 0256 .................... 0253 0256 0256 .................... 0256 0256 0256 0256 0256 0254 0254 0256 0256 0256 0256 0256 0256 0256 0256 0256 18.1508 1.2438 1.9278 18.1508 18.1508 1.9278 .................... 0.7858 1.55 16.4989 1.55 .................... 4.0547 16.1357 14.9776 23.404 23.404 14.9776 7.8673 .................... 0.6384 19.6472 0.6384 0.8497 16.1357 23.404 37.3204 37.3204 2.0101 2.0101 2.0101 7.8673 2.0101 2.0101 16.1357 7.8673 7.8673 16.1357 23.404 37.3204 37.3204 23.404 37.3204 37.3204 37.3204 .................... 16.1357 37.3204 37.3204 .................... 37.3204 37.3204 37.3204 37.3204 37.3204 23.404 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 $1,077.12 $73.81 $114.40 $1,077.12 $1,077.12 $114.40 .................... $46.63 $91.98 $979.09 $91.98 .................... $240.62 $957.54 $888.82 $1,388.86 $1,388.86 $888.82 $466.87 .................... $37.88 $1,165.92 $37.88 $50.42 $957.54 $1,388.86 $2,214.70 $2,214.70 $119.29 $119.29 $119.29 $466.87 $119.29 $119.29 $957.54 $466.87 $466.87 $957.54 $1,388.86 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 .................... $957.54 $2,214.70 $2,214.70 .................... $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $315.31 $16.55 $44.61 $315.31 $315.31 $44.61 .................... $14.97 $22.28 .................... $22.28 .................... $71.87 $282.29 $219.48 $321.35 $321.35 $219.48 $113.41 .................... .................... $354.45 .................... $11.18 $282.29 $321.35 .................... .................... .................... .................... .................... $113.41 .................... .................... $282.29 $113.41 $113.41 $282.29 $321.35 .................... .................... $321.35 .................... .................... .................... .................... $282.29 .................... .................... .................... .................... .................... .................... .................... .................... $321.35 $321.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... $215.42 $14.76 $22.88 $215.42 $215.42 $22.88 .................... $9.33 $18.40 $195.82 $18.40 .................... $48.12 $191.51 $177.76 $277.77 $277.77 $177.76 $93.37 .................... $7.58 $233.18 $7.58 $10.08 $191.51 $277.77 $442.94 $442.94 $23.86 $23.86 $23.86 $93.37 $23.86 $23.86 $191.51 $93.37 $93.37 $191.51 $277.77 $442.94 $442.94 $277.77 $442.94 $442.94 $442.94 .................... $191.51 $442.94 $442.94 .................... $442.94 $442.94 $442.94 $442.94 $442.94 $277.77 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00102 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50781 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 69955 69960 69970 69979 69990 70010 70015 70030 70100 70110 70120 70130 70134 70140 70150 70160 70170 70190 70200 70210 70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70336 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T T T T T T T T T T T T E T T T T T T T T T T T T T T T T T T T T T C T T C T N S S X X X X X X X X X X X X X X X X X X X X X X S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .............................. 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 ............................. X-ray eye for foreign body ....................... X-ray exam of jaw .................................... X-ray exam of jaw .................................... X-ray exam of mastoids ........................... X-ray exam of mastoids ........................... X-ray exam of middle ear ........................ X-ray exam of facial bones ...................... X-ray exam of facial bones ...................... X-ray exam of nasal bones ..................... X-ray exam of tear duct ........................... 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, pituitary saddle .................... X-ray exam of skull .................................. X-ray exam of skull .................................. X-ray exam of teeth ................................. X-ray exam of teeth ................................. Full mouth x-ray of teeth ......................... X-ray exam of jaw joint ............................ X-ray exam of jaw joints .......................... X-ray exam of jaw joint ............................ Magnetic image, jaw joint ........................ 0256 0256 0256 0254 0256 0256 0256 0256 0256 0256 0256 0256 .................... 0256 0256 0256 0256 0256 0256 0256 0256 0256 0251 0256 0256 0256 0256 0256 0256 0256 0256 0256 0259 0251 .................... 0256 0256 .................... 0251 .................... 0274 0274 0260 0260 0260 0260 0260 0261 0260 0260 0260 0264 0260 0260 0260 0260 0260 0260 0261 0262 0262 0262 0260 0260 0275 0335 37.3204 37.3204 37.3204 23.404 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 .................... 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 2.0101 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 37.3204 366.3317 2.0101 .................... 37.3204 37.3204 .................... 2.0101 .................... 3.0413 3.0413 0.7555 0.7555 0.7555 0.7555 0.7555 1.2901 0.7555 0.7555 0.7555 3.524 0.7555 0.7555 0.7555 0.7555 0.7555 0.7555 1.2901 0.9228 0.9228 0.9228 0.7555 0.7555 3.5779 5.1581 $2,214.70 $2,214.70 $2,214.70 $1,388.86 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 .................... $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $119.29 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $2,214.70 $21,739.22 $119.29 .................... $2,214.70 $2,214.70 .................... $119.29 .................... $180.48 $180.48 $44.83 $44.83 $44.83 $44.83 $44.83 $76.56 $44.83 $44.83 $44.83 $209.12 $44.83 $44.83 $44.83 $44.83 $44.83 $44.83 $76.56 $54.76 $54.76 $54.76 $44.83 $44.83 $212.32 $306.10 .................... .................... .................... $321.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $8,070.21 .................... .................... .................... .................... .................... .................... .................... $72.19 $72.19 $17.93 $17.93 $17.93 $17.93 $17.93 .................... $17.93 $17.93 $17.93 $79.41 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 .................... .................... .................... .................... $17.93 $17.93 $69.09 $122.43 $442.94 $442.94 $442.94 $277.77 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 .................... $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $23.86 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $442.94 $4,347.84 $23.86 .................... $442.94 $442.94 .................... $23.86 .................... $36.10 $36.10 $8.97 $8.97 $8.97 $8.97 $8.97 $15.31 $8.97 $8.97 $8.97 $41.82 $8.97 $8.97 $8.97 $8.97 $8.97 $8.97 $15.31 $10.95 $10.95 $10.95 $8.97 $8.97 $42.46 $61.22 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00103 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50782 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 70350 ....... 70355 ....... 70360 ....... 70370 ....... 70371 ....... 70373 ....... 70380 ....... 70390 ....... 70450* ..... 70460* ..... 70470* ..... 70480* ..... 70481* ..... 70482* ..... 70486* ..... 70487* ..... 70488* ..... 70490* ..... 70491* ..... 70492* ..... 70496* ..... 70498* ..... 70540* ..... 70542* ..... 70543* ..... 70544* ..... 70545* ..... 70546* ..... 70547* ..... 70548* ..... 70549* ..... 70551* ..... 70552* ..... 70553* ..... 70557 ....... 70558 ....... 70559 ....... 71010 ....... 71015 ....... 71020 ....... 71021 ....... 71022 ....... 71023 ....... 71030 ....... 71034 ....... 71035 ....... 71040 ....... 71060 ....... 71090 ....... 71100 ....... 71101 ....... 71110 ....... 71111 ....... 71120 ....... 71130 ....... 71250* ..... 71260* ..... 71270* ..... 71275* ..... 71550* ..... 71551* ..... 71552* ..... 71555 ....... 72010 ....... 72020 ....... 72040 ....... SI X X X X X X X X S S S S S S S S S S S S S S S S S S S S S S S S S S S S S X X X X X X X X X X X X X X X X X X S S S S S S S B X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... X-ray head for orthodontia ....................... Panoramic x-ray of jaws .......................... X-ray exam of neck ................................. Throat x-ray & fluoroscopy ...................... Speech evaluation, complex .................... Contrast x-ray of larynx ........................... X-ray exam of salivary gland ................... X-ray exam of salivary duct ..................... 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 sft tsue nck w/o & w/dye ..................... Ct angiography, head .............................. Ct angiography, neck ............................... Mri orbit/face/neck w/o dye ...................... Mri orbit/face/neck w/dye ......................... Mri orbt/fac/nck w/o & w dye ................... Mr angiography head w/o dye ................. Mr angiography head w/dye .................... Mr angiograph head w/o&w dye .............. Mr angiography neck w/o dye ................. Mr angiography neck w/dye .................... Mr angiograph neck w/o&w dye .............. Mri brain w/o dye ..................................... Mri brain w/ dye ....................................... Mri brain w/o & w/ dye ............................. Mri brain w/o dye ..................................... Mri brain 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 and fluoroscopy .................... Chest x-ray .............................................. Chest x-ray and fluoroscopy .................... Chest x-ray .............................................. Contrast x-ray of bronchi ......................... Contrast x-ray of bronchi ......................... X-ray & pacemaker insertion ................... X-ray exam of ribs ................................... X-ray exam of ribs/chest .......................... X-ray exam of ribs ................................... X-ray exam of ribs/ chest ........................ X-ray exam of breastbone ....................... X-ray exam of breastbone ....................... Ct thorax w/o dye .................................... Ct thorax w/dye ........................................ Ct thorax w/o & w/ dye ............................ Ct angiography, chest .............................. Mri chest w/o dye .................................... Mri chest w/dye ........................................ Mri chest w/o & w/dye ............................. Mri angio chest w or w/o dye .................. X-ray exam of spine ................................ X-ray exam of spine ................................ X-ray exam of neck spine ........................ 0260 0260 0260 0272 0272 0263 0260 0263 0332 0283 0333 0332 0283 0333 0332 0283 0333 0332 0283 0333 0662 0662 0336 0284 0337 0336 0284 0337 0336 0284 0337 0336 0284 0337 0336 0284 0337 0260 0260 0260 0260 0260 0272 0260 0272 0260 0263 0263 0272 0260 0260 0260 0261 0260 0260 0332 0283 0333 0662 0336 0284 0337 .................... 0260 0260 0260 0.7555 0.7555 0.7555 1.3801 1.3801 1.7476 0.7555 1.7476 3.2694 4.4253 5.2836 3.2694 4.4253 5.2836 3.2694 4.4253 5.2836 3.2694 4.4253 5.2836 5.1621 5.1621 6.0742 6.4201 8.7945 6.0742 6.4201 8.7945 6.0742 6.4201 8.7945 6.0742 6.4201 8.7945 6.0742 6.4201 8.7945 0.7555 0.7555 0.7555 0.7555 0.7555 1.3801 0.7555 1.3801 0.7555 1.7476 1.7476 1.3801 0.7555 0.7555 0.7555 1.2901 0.7555 0.7555 3.2694 4.4253 5.2836 5.1621 6.0742 6.4201 8.7945 .................... 0.7555 0.7555 0.7555 $44.83 $44.83 $44.83 $81.90 $81.90 $103.71 $44.83 $103.71 $194.02 $262.61 $313.54 $194.02 $262.61 $313.54 $194.02 $262.61 $313.54 $194.02 $262.61 $313.54 $306.33 $306.33 $360.46 $380.99 $521.89 $360.46 $380.99 $521.89 $360.46 $380.99 $521.89 $360.46 $380.99 $521.89 $360.46 $380.99 $521.89 $44.83 $44.83 $44.83 $44.83 $44.83 $81.90 $44.83 $81.90 $44.83 $103.71 $103.71 $81.90 $44.83 $44.83 $44.83 $76.56 $44.83 $44.83 $194.02 $262.61 $313.54 $306.33 $360.46 $380.99 $521.89 .................... $44.83 $44.83 $44.83 $17.93 $17.93 $17.93 $32.76 $32.76 $24.40 $17.93 $24.40 $77.60 $105.04 $125.41 $77.60 $105.04 $125.41 $77.60 $105.04 $125.41 $77.60 $105.04 $125.41 $122.53 $122.53 $144.18 $152.39 $208.75 $144.18 $152.39 $208.75 $144.18 $152.39 $208.75 $144.18 $152.39 $208.75 $144.18 $152.39 $208.75 $17.93 $17.93 $17.93 $17.93 $17.93 $32.76 $17.93 $32.76 $17.93 $24.40 $24.40 $32.76 $17.93 $17.93 $17.93 .................... $17.93 $17.93 $77.60 $105.04 $125.41 $122.53 $144.18 $152.39 $208.75 .................... $17.93 $17.93 $17.93 $8.97 $8.97 $8.97 $16.38 $16.38 $20.74 $8.97 $20.74 $38.80 $52.52 $62.71 $38.80 $52.52 $62.71 $38.80 $52.52 $62.71 $38.80 $52.52 $62.71 $61.27 $61.27 $72.09 $76.20 $104.38 $72.09 $76.20 $104.38 $72.09 $76.20 $104.38 $72.09 $76.20 $104.38 $72.09 $76.20 $104.38 $8.97 $8.97 $8.97 $8.97 $8.97 $16.38 $8.97 $16.38 $8.97 $20.74 $20.74 $16.38 $8.97 $8.97 $8.97 $15.31 $8.97 $8.97 $38.80 $52.52 $62.71 $61.27 $72.09 $76.20 $104.38 .................... $8.97 $8.97 $8.97 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00104 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50783 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 72050 ....... 72052 ....... 72069 ....... 72070 ....... 72072 ....... 72074 ....... 72080 ....... 72090 ....... 72100 ....... 72110 ....... 72114 ....... 72120 ....... 72125* ..... 72126* ..... 72127* ..... 72128* ..... 72129* ..... 72130* ..... 72131* ..... 72132* ..... 72133* ..... 72141* ..... 72142* ..... 72146* ..... 72147* ..... 72148* ..... 72149* ..... 72156* ..... 72157* ..... 72158* ..... 72159 ....... 72170 ....... 72190 ....... 72191* ..... 72192* ..... 72193* ..... 72194* ..... 72195* ..... 72196* ..... 72197* ..... 72198 ....... 72200 ....... 72202 ....... 72220 ....... 72240 ....... 72255 ....... 72265 ....... 72270 ....... 72275 ....... 72285 ....... 72295 ....... 73000 ....... 73010 ....... 73020 ....... 73030 ....... 73040 ....... 73050 ....... 73060 ....... 73070 ....... 73080 ....... 73085 ....... 73090 ....... 73092 ....... 73100 ....... 73110 ....... 73115 ....... SI X X X X X X X X X X X X S S S S S S S S S S S S S S S S S S E X X S S S S S S S B X X X S S S S S S S X X X X S X X X X S X X X X S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... X-ray exam of neck spine ........................ X-ray exam of neck 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 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 ....................... 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 .................. 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 ................... Mri lumbar spine w/o & w/dye ................. Mr angio spine w/o&w/dye ...................... X-ray exam of pelvis ................................ X-ray exam of pelvis ................................ Ct angiograph pelv w/o&w/dye ................ Ct pelvis w/o dye ..................................... Ct pelvis w/dye ........................................ Ct pelvis w/o & w/dye .............................. Mri pelvis w/o dye .................................... Mri pelvis w/dye ....................................... Mri 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 of tailbone ............................ Contrast x-ray of neck spine ................... Contrast x-ray, thorax spine .................... Contrast x-ray, lower spine ...................... Contrast x-ray, spine ............................... Epidurography .......................................... X-ray c/t spine disk .................................. X-ray of lower spine disk ......................... X-ray exam of collar bone ....................... X-ray exam of shoulder blade ................. X-ray exam of shoulder ........................... X-ray exam of shoulder ........................... Contrast x-ray of shoulder ....................... X-ray exam of shoulders ......................... X-ray exam of humerus ........................... X-ray exam of elbow ................................ X-ray exam of elbow ................................ Contrast x-ray of elbow ........................... X-ray exam of forearm ............................. X-ray exam of arm, infant ........................ X-ray exam of wrist .................................. X-ray exam of wrist .................................. Contrast x-ray of wrist ............................. 0261 0261 0260 0260 0260 0260 0260 0261 0260 0261 0261 0261 0332 0283 0333 0332 0283 0333 0332 0283 0333 0336 0284 0336 0284 0336 0284 0337 0337 0337 .................... 0260 0260 0662 0332 0283 0333 0336 0284 0337 .................... 0260 0260 0260 0274 0274 0274 0274 0274 0388 0388 0260 0260 0260 0260 0275 0260 0260 0260 0260 0275 0260 0260 0260 0260 0275 1.2901 1.2901 0.7555 0.7555 0.7555 0.7555 0.7555 1.2901 0.7555 1.2901 1.2901 1.2901 3.2694 4.4253 5.2836 3.2694 4.4253 5.2836 3.2694 4.4253 5.2836 6.0742 6.4201 6.0742 6.4201 6.0742 6.4201 8.7945 8.7945 8.7945 .................... 0.7555 0.7555 5.1621 3.2694 4.4253 5.2836 6.0742 6.4201 8.7945 .................... 0.7555 0.7555 0.7555 3.0413 3.0413 3.0413 3.0413 3.0413 12.3294 12.3294 0.7555 0.7555 0.7555 0.7555 3.5779 0.7555 0.7555 0.7555 0.7555 3.5779 0.7555 0.7555 0.7555 0.7555 3.5779 $76.56 $76.56 $44.83 $44.83 $44.83 $44.83 $44.83 $76.56 $44.83 $76.56 $76.56 $76.56 $194.02 $262.61 $313.54 $194.02 $262.61 $313.54 $194.02 $262.61 $313.54 $360.46 $380.99 $360.46 $380.99 $360.46 $380.99 $521.89 $521.89 $521.89 .................... $44.83 $44.83 $306.33 $194.02 $262.61 $313.54 $360.46 $380.99 $521.89 .................... $44.83 $44.83 $44.83 $180.48 $180.48 $180.48 $180.48 $180.48 $731.66 $731.66 $44.83 $44.83 $44.83 $44.83 $212.32 $44.83 $44.83 $44.83 $44.83 $212.32 $44.83 $44.83 $44.83 $44.83 $212.32 .................... .................... $17.93 $17.93 $17.93 $17.93 $17.93 .................... $17.93 .................... .................... .................... $77.60 $105.04 $125.41 $77.60 $105.04 $125.41 $77.60 $105.04 $125.41 $144.18 $152.39 $144.18 $152.39 $144.18 $152.39 $208.75 $208.75 $208.75 .................... $17.93 $17.93 $122.53 $77.60 $105.04 $125.41 $144.18 $152.39 $208.75 .................... $17.93 $17.93 $17.93 $72.19 $72.19 $72.19 $72.19 $72.19 $292.66 $292.66 $17.93 $17.93 $17.93 $17.93 $69.09 $17.93 $17.93 $17.93 $17.93 $69.09 $17.93 $17.93 $17.93 $17.93 $69.09 $15.31 $15.31 $8.97 $8.97 $8.97 $8.97 $8.97 $15.31 $8.97 $15.31 $15.31 $15.31 $38.80 $52.52 $62.71 $38.80 $52.52 $62.71 $38.80 $52.52 $62.71 $72.09 $76.20 $72.09 $76.20 $72.09 $76.20 $104.38 $104.38 $104.38 .................... $8.97 $8.97 $61.27 $38.80 $52.52 $62.71 $72.09 $76.20 $104.38 .................... $8.97 $8.97 $8.97 $36.10 $36.10 $36.10 $36.10 $36.10 $146.33 $146.33 $8.97 $8.97 $8.97 $8.97 $42.46 $8.97 $8.97 $8.97 $8.97 $42.46 $8.97 $8.97 $8.97 $8.97 $42.46 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00105 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50784 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 73120 ....... 73130 ....... 73140 ....... 73200* ..... 73201* ..... 73202* ..... 73206* ..... 73218* ..... 73219* ..... 73220* ..... 73221* ..... 73222* ..... 73223* ..... 73225 ....... 73500 ....... 73510 ....... 73520 ....... 73525 ....... 73530 ....... 73540 ....... 73542 ....... 73550 ....... 73560 ....... 73562 ....... 73564 ....... 73565 ....... 73580 ....... 73590 ....... 73592 ....... 73600 ....... 73610 ....... 73615 ....... 73620 ....... 73630 ....... 73650 ....... 73660 ....... 73700* ..... 73701* ..... 73702* ..... 73706* ..... 73718* ..... 73719* ..... 73720* ..... 73721* ..... 73722* ..... 73723* ..... 73725 ....... 74000 ....... 74010 ....... 74020 ....... 74022 ....... 74150* ..... 74160* ..... 74170* ..... 74175* ..... 74181* ..... 74182* ..... 74183* ..... 74185 ....... 74190 ....... 74210 ....... 74220 ....... 74230 ....... 74235 ....... 74240 ....... 74241 ....... SI X X X S S S S S S S S S S E X X X S X X S X X X X X S X X X X S X X X X S S S S S S S S S S B X X X X S S S S S S S B X S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... X-ray exam of hand ................................. X-ray exam of hand ................................. X-ray exam of finger(s) ............................ Ct upper extremity w/o dye ..................... Ct upper extremity w/dye ......................... Ct uppr extremity w/o&w/dye ................... Ct angio upr extrm w/o&w/dye ................ Mri upper extremity w/o dye .................... Mri upper extremity w/dye ....................... Mri uppr extremity w/o&w/dye ................. Mri joint upr extrem w/o dye .................... Mri joint upr extrem w/dye ....................... Mri joint 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 hips .................................. Contrast x-ray of hip ................................ X-ray exam of hip .................................... X-ray exam of pelvis & hips .................... X-ray exam, sacroiliac joint ..................... X-ray exam of thigh ................................. X-ray exam of knee, 1 or 2 ..................... X-ray exam of knee, 3 ............................. X-ray exam, knee, 4 or more .................. X-ray exam of knees ............................... Contrast x-ray of knee joint ..................... X-ray exam of lower leg .......................... X-ray exam of leg, infant ......................... X-ray exam of ankle ................................ X-ray exam of ankle ................................ Contrast x-ray of ankle ............................ X-ray exam of foot ................................... X-ray exam of foot ................................... X-ray exam of heel .................................. X-ray exam of toe(s) ................................ Ct lower extremity w/o dye ...................... Ct lower extremity w/dye ......................... Ct lwr extremity w/o&w/dye ..................... Ct angio lwr extr w/o&w/dye .................... Mri lower extremity w/o dye ..................... Mri lower extremity w/dye ........................ Mri lwr extremity w/o&w/dye .................... Mri jnt of lwr extre w/o dye ...................... Mri joint of lwr extr w/dye ........................ Mri joint lwr extr w/o&w/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 series, abdomen .................. Ct abdomen w/o dye ............................... Ct abdomen w/dye ................................... Ct abdomen w/o &w /dye ........................ Ct angio abdom w/o & w/dye .................. Mri abdomen w/o dye .............................. Mri abdomen w/dye ................................. Mri abdomen w/o & w/dye ....................... Mri angio, abdom w orw/o dye ................ X-ray exam of peritoneum ....................... Contrst x-ray exam of throat .................... Contrast x-ray, esophagus ...................... Cine/vid x-ray, throat/esoph ..................... Remove esophagus obstruction .............. X-ray exam, upper gi tract ....................... X-ray exam, upper gi tract ....................... 0260 0260 0260 0332 0283 0333 0662 0336 0284 0337 0336 0284 0337 .................... 0260 0260 0261 0275 0261 0260 0275 0260 0260 0260 0260 0260 0275 0260 0260 0260 0260 0275 0260 0260 0260 0260 0332 0283 0333 0662 0336 0284 0337 0336 0284 0337 .................... 0260 0260 0260 0261 0332 0283 0333 0662 0336 0284 0337 .................... 0264 0276 0276 0276 0296 0276 0276 0.7555 0.7555 0.7555 3.2694 4.4253 5.2836 5.1621 6.0742 6.4201 8.7945 6.0742 6.4201 8.7945 .................... 0.7555 0.7555 1.2901 3.5779 1.2901 0.7555 3.5779 0.7555 0.7555 0.7555 0.7555 0.7555 3.5779 0.7555 0.7555 0.7555 0.7555 3.5779 0.7555 0.7555 0.7555 0.7555 3.2694 4.4253 5.2836 5.1621 6.0742 6.4201 8.7945 6.0742 6.4201 8.7945 .................... 0.7555 0.7555 0.7555 1.2901 3.2694 4.4253 5.2836 5.1621 6.0742 6.4201 8.7945 .................... 3.524 1.5319 1.5319 1.5319 2.2452 1.5319 1.5319 $44.83 $44.83 $44.83 $194.02 $262.61 $313.54 $306.33 $360.46 $380.99 $521.89 $360.46 $380.99 $521.89 .................... $44.83 $44.83 $76.56 $212.32 $76.56 $44.83 $212.32 $44.83 $44.83 $44.83 $44.83 $44.83 $212.32 $44.83 $44.83 $44.83 $44.83 $212.32 $44.83 $44.83 $44.83 $44.83 $194.02 $262.61 $313.54 $306.33 $360.46 $380.99 $521.89 $360.46 $380.99 $521.89 .................... $44.83 $44.83 $44.83 $76.56 $194.02 $262.61 $313.54 $306.33 $360.46 $380.99 $521.89 .................... $209.12 $90.91 $90.91 $90.91 $133.24 $90.91 $90.91 $17.93 $17.93 $17.93 $77.60 $105.04 $125.41 $122.53 $144.18 $152.39 $208.75 $144.18 $152.39 $208.75 .................... $17.93 $17.93 .................... $69.09 .................... $17.93 $69.09 $17.93 $17.93 $17.93 $17.93 $17.93 $69.09 $17.93 $17.93 $17.93 $17.93 $69.09 $17.93 $17.93 $17.93 $17.93 $77.60 $105.04 $125.41 $122.53 $144.18 $152.39 $208.75 $144.18 $152.39 $208.75 .................... $17.93 $17.93 $17.93 .................... $77.60 $105.04 $125.41 $122.53 $144.18 $152.39 $208.75 .................... $79.41 $36.36 $36.36 $36.36 $53.29 $36.36 $36.36 $8.97 $8.97 $8.97 $38.80 $52.52 $62.71 $61.27 $72.09 $76.20 $104.38 $72.09 $76.20 $104.38 .................... $8.97 $8.97 $15.31 $42.46 $15.31 $8.97 $42.46 $8.97 $8.97 $8.97 $8.97 $8.97 $42.46 $8.97 $8.97 $8.97 $8.97 $42.46 $8.97 $8.97 $8.97 $8.97 $38.80 $52.52 $62.71 $61.27 $72.09 $76.20 $104.38 $72.09 $76.20 $104.38 .................... $8.97 $8.97 $8.97 $15.31 $38.80 $52.52 $62.71 $61.27 $72.09 $76.20 $104.38 .................... $41.82 $18.18 $18.18 $18.18 $26.65 $18.18 $18.18 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00106 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50785 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 74245 ....... 74246 ....... 74247 ....... 74249 ....... 74250 ....... 74251 ....... 74260 ....... 74270 ....... 74280 ....... 74283 ....... 74290 ....... 74291 ....... 74300 ....... 74301 ....... 74305 ....... 74320 ....... 74327 ....... 74328 ....... 74329 ....... 74330 ....... 74340 ....... 74350 ....... 74355 ....... 74360 ....... 74363 ....... 74400 ....... 74410 ....... 74415 ....... 74420 ....... 74425 ....... 74430 ....... 74440 ....... 74445 ....... 74450 ....... 74455 ....... 74470 ....... 74475 ....... 74480 ....... 74485 ....... 74710 ....... 74740 ....... 74742 ....... 74775 ....... 75552 ....... 75553 ....... 75554 ....... 75555 ....... 75556 ....... 75600 ....... 75605 ....... 75625 ....... 75630 ....... 75635* ..... 75650 ....... 75658 ....... 75660 ....... 75662 ....... 75665 ....... 75671 ....... 75676 ....... 75680 ....... 75685 ....... 75705 ....... 75710 ....... 75716 ....... 75722 ....... SI S S S S S S S S S S S S X X X X S N N N X X X S S S S S S S S S S S S X S S S X X X S S S S S E S S S S S S S S S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... X-ray exam, upper 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 ...................... Contrast x-ray exam of colon .................. Contrast x-ray exam of colon .................. Contrast x-ray exam of colon .................. Contrast x-ray, gallbladder ...................... Contrast x-rays, gallbladder ..................... X-ray bile ducts/pancreas ........................ X-rays at surgery add-on ......................... X-ray bile ducts/pancreas ........................ Contrast x-ray of bile ducts ..................... X-ray bile stone removal .......................... X-ray bile duct endoscopy ....................... X-ray for pancreas endoscopy ................ X-ray bile/panc endoscopy ...................... X-ray guide for GI tube ............................ X-ray guide, stomach tube ...................... X-ray guide, intestinal tube ...................... X-ray guide, GI 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 ....................... Contrast x-ray, bladder ............................ X-ray, male genital tract .......................... X-ray exam of penis ................................ X-ray, urethra/bladder .............................. X-ray, urethra/bladder .............................. X-ray exam of kidney lesion .................... X-ray control, cath insert ......................... X-ray control, cath insert ......................... X-ray guide, GU dilation .......................... X-ray measurement of pelvis ................... X-ray, female genital tract ....................... X-ray, fallopian tube ................................. X-ray exam of perineum .......................... Heart mri for morph w/o dye ................... Heart mri for morph w/dye ....................... Cardiac MRI/function ............................... 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 ................... X-ray aorta, leg arteries ........................... Ct angio abdominal arteries .................... Artery x-rays, head & neck ...................... 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, neck ................................... Artery x-rays, neck ................................... Artery x-rays, spine .................................. Artery x-rays, spine .................................. Artery x-rays, arm/leg .............................. Artery x-rays, arms/legs ........................... Artery x-rays, kidney ................................ 0277 0276 0276 0277 0276 0277 0277 0276 0277 0276 0276 0276 0263 0263 0263 0264 0296 .................... .................... .................... 0272 0263 0263 0296 0297 0278 0278 0278 0278 0278 0278 0278 0278 0278 0278 0263 0297 0296 0296 0261 0264 0264 0278 0336 0284 0336 0336 .................... 0280 0280 0280 0280 0662 0280 0279 0668 0280 0280 0280 0280 0280 0280 0668 0280 0280 0280 2.3852 1.5319 1.5319 2.3852 1.5319 2.3852 2.3852 1.5319 2.3852 1.5319 1.5319 1.5319 1.7476 1.7476 1.7476 3.524 2.2452 .................... .................... .................... 1.3801 1.7476 1.7476 2.2452 5.253 2.6434 2.6434 2.6434 2.6434 2.6434 2.6434 2.6434 2.6434 2.6434 2.6434 1.7476 5.253 2.2452 2.2452 1.2901 3.524 3.524 2.6434 6.0742 6.4201 6.0742 6.0742 .................... 20.7902 20.7902 20.7902 20.7902 5.1621 20.7902 8.9319 6.5024 20.7902 20.7902 20.7902 20.7902 20.7902 20.7902 6.5024 20.7902 20.7902 20.7902 $141.54 $90.91 $90.91 $141.54 $90.91 $141.54 $141.54 $90.91 $141.54 $90.91 $90.91 $90.91 $103.71 $103.71 $103.71 $209.12 $133.24 .................... .................... .................... $81.90 $103.71 $103.71 $133.24 $311.73 $156.87 $156.87 $156.87 $156.87 $156.87 $156.87 $156.87 $156.87 $156.87 $156.87 $103.71 $311.73 $133.24 $133.24 $76.56 $209.12 $209.12 $156.87 $360.46 $380.99 $360.46 $360.46 .................... $1,233.75 $1,233.75 $1,233.75 $1,233.75 $306.33 $1,233.75 $530.05 $385.87 $1,233.75 $1,233.75 $1,233.75 $1,233.75 $1,233.75 $1,233.75 $385.87 $1,233.75 $1,233.75 $1,233.75 $56.61 $36.36 $36.36 $56.61 $36.36 $56.61 $56.61 $36.36 $56.61 $36.36 $36.36 $36.36 $24.40 $24.40 $24.40 $79.41 $53.29 .................... .................... .................... $32.76 $24.40 $24.40 $53.29 $122.13 $62.74 $62.74 $62.74 $62.74 $62.74 $62.74 $62.74 $62.74 $62.74 $62.74 $24.40 $122.13 $53.29 $53.29 .................... $79.41 $79.41 $62.74 $144.18 $152.39 $144.18 $144.18 .................... $353.85 $353.85 $353.85 $353.85 $122.53 $353.85 $150.03 $114.67 $353.85 $353.85 $353.85 $353.85 $353.85 $353.85 $114.67 $353.85 $353.85 $353.85 $28.31 $18.18 $18.18 $28.31 $18.18 $28.31 $28.31 $18.18 $28.31 $18.18 $18.18 $18.18 $20.74 $20.74 $20.74 $41.82 $26.65 .................... .................... .................... $16.38 $20.74 $20.74 $26.65 $62.35 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $20.74 $62.35 $26.65 $26.65 $15.31 $41.82 $41.82 $31.37 $72.09 $76.20 $72.09 $72.09 .................... $246.75 $246.75 $246.75 $246.75 $61.27 $246.75 $106.01 $77.17 $246.75 $246.75 $246.75 $246.75 $246.75 $246.75 $77.17 $246.75 $246.75 $246.75 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00107 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50786 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 75724 75726 75731 75733 75736 75741 75743 75746 75756 75774 75790 75801 75803 75805 75807 75809 75810 75820 75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 75891 75893 75894 75896 75898 75900 75901 75902 75940 75945 75946 75952 75953 75954 75960 75961 75962 75964 75966 75968 75970 75978 75980 75982 75984 75989 75992 75993 75994 75995 75996 75998 76000 76001 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI S S S S S S S S S S S X X X X X S S S S S S S S S S S S S S S S S N S S X C X X S S S C C C S S S S S S S S S S X N S S S S S N X N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Artery x-rays, kidneys .............................. Artery x-rays, abdomen ........................... Artery x-rays, adrenal gland .................... Artery x-rays, adrenals ............................ Artery x-rays, pelvis ................................. Artery x-rays, lung ................................... Artery x-rays, lungs .................................. Artery x-rays, lung ................................... Artery x-rays, chest .................................. Artery x-ray, each vessel ......................... Visualize A-V shunt ................................. Lymph vessel x-ray, arm/leg ................... Lymph vessel x-ray,arms/legs ................. Lymph vessel x-ray, trunk ....................... Lymph vessel x-ray, trunk ....................... Nonvascular shunt, x-ray ......................... Vein x-ray, spleen/liver ............................ Vein x-ray, arm/leg .................................. Vein x-ray, arms/legs ............................... Vein x-ray, trunk ...................................... Vein x-ray, chest ...................................... Vein x-ray, kidney .................................... Vein x-ray, kidneys .................................. Vein x-ray, adrenal gland ........................ Vein x-ray, adrenal glands ....................... Vein x-ray, neck ....................................... Vein x-ray, skull ....................................... Vein x-ray, skull ....................................... Vein x-ray, eye socket ............................. Vein x-ray, liver ........................................ Vein x-ray, liver ........................................ Vein x-ray, liver ........................................ Vein x-ray, liver ........................................ Venous sampling by catheter .................. X-rays, transcath therapy ........................ X-rays, transcath therapy ........................ Follow-up angiography ............................ Arterial catheter exchange ....................... Remove cva device obstruct ................... Remove cva lumen obstruct .................... X-ray placement, vein filter ...................... Intravascular us ....................................... Intravascular us add-on ........................... Endovasc repair abdom aorta ................. Abdom aneurysm endovas rpr ................ Iliac aneurysm endovas rpr ..................... Transcatheter intro, stent ......................... Retrieval, broken catheter ....................... Repair arterial blockage ........................... Repair artery blockage, each .................. Repair arterial blockage ........................... Repair artery blockage, each .................. Vascular biopsy ....................................... Repair venous blockage .......................... Contrast xray exam bile duct ................... Contrast xray exam bile duct ................... Xray control catheter change .................. 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 ......................... Fluoroguide for vein device ..................... Fluoroscope examination ......................... Fluoroscope exam, extensive .................. 0280 0280 0280 0668 0280 0279 0280 0279 0279 0279 0279 0264 0264 0264 0264 0263 0279 0668 0668 0279 0279 0279 0279 0280 0280 0668 0668 0279 0668 0280 0279 0280 0279 .................... 0297 0297 0263 .................... 0263 0263 0297 0267 0266 .................... .................... .................... 0668 0668 0668 0668 0668 0668 0668 0668 0297 0297 0263 .................... 0279 0279 0279 0279 0279 .................... 0272 .................... 20.7902 20.7902 20.7902 6.5024 20.7902 8.9319 20.7902 8.9319 8.9319 8.9319 8.9319 3.524 3.524 3.524 3.524 1.7476 8.9319 6.5024 6.5024 8.9319 8.9319 8.9319 8.9319 20.7902 20.7902 6.5024 6.5024 8.9319 6.5024 20.7902 8.9319 20.7902 8.9319 .................... 5.253 5.253 1.7476 .................... 1.7476 1.7476 5.253 2.6327 1.6393 .................... .................... .................... 6.5024 6.5024 6.5024 6.5024 6.5024 6.5024 6.5024 6.5024 5.253 5.253 1.7476 .................... 8.9319 8.9319 8.9319 8.9319 8.9319 .................... 1.3801 .................... $1,233.75 $1,233.75 $1,233.75 $385.87 $1,233.75 $530.05 $1,233.75 $530.05 $530.05 $530.05 $530.05 $209.12 $209.12 $209.12 $209.12 $103.71 $530.05 $385.87 $385.87 $530.05 $530.05 $530.05 $530.05 $1,233.75 $1,233.75 $385.87 $385.87 $530.05 $385.87 $1,233.75 $530.05 $1,233.75 $530.05 .................... $311.73 $311.73 $103.71 .................... $103.71 $103.71 $311.73 $156.23 $97.28 .................... .................... .................... $385.87 $385.87 $385.87 $385.87 $385.87 $385.87 $385.87 $385.87 $311.73 $311.73 $103.71 .................... $530.05 $530.05 $530.05 $530.05 $530.05 .................... $81.90 .................... $353.85 $353.85 $353.85 $114.67 $353.85 $150.03 $353.85 $150.03 $150.03 $150.03 $150.03 $79.41 $79.41 $79.41 $79.41 $24.40 $150.03 $114.67 $114.67 $150.03 $150.03 $150.03 $150.03 $353.85 $353.85 $114.67 $114.67 $150.03 $114.67 $353.85 $150.03 $353.85 $150.03 .................... $122.13 $122.13 $24.40 .................... $24.40 $24.40 $122.13 $62.18 $38.91 .................... .................... .................... $114.67 $114.67 $114.67 $114.67 $114.67 $114.67 $114.67 $114.67 $122.13 $122.13 $24.40 .................... $150.03 $150.03 $150.03 $150.03 $150.03 .................... $32.76 .................... $246.75 $246.75 $246.75 $77.17 $246.75 $106.01 $246.75 $106.01 $106.01 $106.01 $106.01 $41.82 $41.82 $41.82 $41.82 $20.74 $106.01 $77.17 $77.17 $106.01 $106.01 $106.01 $106.01 $246.75 $246.75 $77.17 $77.17 $106.01 $77.17 $246.75 $106.01 $246.75 $106.01 .................... $62.35 $62.35 $20.74 .................... $20.74 $20.74 $62.35 $31.25 $19.46 .................... .................... .................... $77.17 $77.17 $77.17 $77.17 $77.17 $77.17 $77.17 $77.17 $62.35 $62.35 $20.74 .................... $106.01 $106.01 $106.01 $106.01 $106.01 .................... $16.38 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00108 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50787 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 76003 ....... 76005 ....... 76006 ....... 76010 ....... 76012 ....... 76013 ....... 76020 ....... 76040 ....... 76061 ....... 76062 ....... 76065 ....... 76066 ....... 76070 ....... 76071 ....... 76075 ....... 76076 ....... 76077 ....... 76078 ....... 76080 ....... 76082 ....... 76083 ....... 76086 ....... 76088 ....... 76090 ....... 76091 ....... 76092 ....... 76093 ....... 76094 ....... 76095 ....... 76096 ....... 76098 ....... 76100 ....... 76101 ....... 76102 ....... 76120 ....... 76125 ....... 76140 ....... 76150 ....... 76350 ....... 76355 ....... 76360 ....... 76362 ....... 76370 ....... 76375 ....... 76380 ....... 76390 ....... 76393 ....... 76394 ....... 76400 ....... 76496 ....... 76497 ....... 76498 ....... 76499 ....... 76506 ....... 76510 ....... 76511 ....... 76512 ....... 76513 ....... 76514 ....... 76516 ....... 76519 ....... 76529 ....... 76536 ....... 76604* ..... 76645* ..... 76700* ..... SI N N X X S S X X X X X X S S S S X X X A A X X A A A E E X X X X X X X X E X N S S S S S S E S S S X S S X S S S S S X S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Needle localization by x-ray .................... Fluoroguide for spine inject ..................... X-ray stress view ..................................... X-ray, nose to rectum .............................. Percut vertebroplasty fluor ....................... Percut vertebroplasty, ct .......................... X-rays for bone age ................................. X-rays, bone evaluation ........................... X-rays, bone survey ................................. X-rays, bone survey ................................. X-rays, bone evaluation ........................... Joint survey, single view .......................... CT scan, bone density study ................... Ct bone density, peripheral ..................... Dexa, axial skeleton study ....................... Dexa, peripheral study ............................. Dxa bone density/v-fracture ..................... Radiographic absorptiometry ................... X-ray exam of fistula ................................ Computer mammogram add-on .............. Computer mammogram add-on .............. X-ray of mammary duct ........................... X-ray of mammary ducts ......................... Mammogram, one breast ........................ Mammogram, both breasts ...................... Mammogram, screening .......................... Magnetic image, breast ........................... Magnetic image, both breasts ................. Stereotactic breast biopsy ....................... X-ray of needle wire, breast .................... X-ray exam, breast specimen .................. X-ray exam of body section ..................... Complex body section x-ray .................... Complex body section x-rays .................. Cine/video x-rays ..................................... 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 needle biopsy ........................ Ct guide for tissue ablation ...................... Ct scan for therapy guide ........................ 3d/holograph reconstr add-on ................. CAT scan follow-up study ........................ Mr spectroscopy ...................................... Mr guidance for needle place .................. Mri for tissue ablation .............................. Magnetic image, bone marrow ................ Fluoroscopic procedure ........................... Ct procedure ............................................ Mri procedure ........................................... Radiographic procedure .......................... Echo exam of head ................................. Ophth us, b & quant a ............................. Echo exam of eye .................................... Echo exam of eye .................................... Echo exam of eye, water bath ................ Echo exam of eye, thickness .................. Echo exam of eye .................................... Echo exam of eye .................................... Echo exam of eye .................................... Us exam of head and neck ..................... Us exam, chest, b-scan ........................... Us exam, breast(s) .................................. Us exam, abdom, complete ..................... .................... .................... 0260 0260 0274 0274 0260 0261 0261 0261 0261 0260 0288 0282 0288 0665 0260 0260 0263 .................... .................... 0263 0263 .................... .................... .................... .................... .................... 0264 0263 0260 0261 0263 0264 0272 0260 .................... 0260 .................... 0283 0283 0332 0282 0282 0282 .................... 0335 0335 0335 0272 0282 0335 0260 0265 0266 0266 0266 0266 0340 0265 0266 0265 0266 0266 0265 0266 .................... .................... 0.7555 0.7555 3.0413 3.0413 0.7555 1.2901 1.2901 1.2901 1.2901 0.7555 1.2568 1.6542 1.2568 0.6464 0.7555 0.7555 1.7476 .................... .................... 1.7476 1.7476 .................... .................... .................... .................... .................... 3.524 1.7476 0.7555 1.2901 1.7476 3.524 1.3801 0.7555 .................... 0.7555 .................... 4.4253 4.4253 3.2694 1.6542 1.6542 1.6542 .................... 5.1581 5.1581 5.1581 1.3801 1.6542 5.1581 0.7555 1.0213 1.6393 1.6393 1.6393 1.6393 0.6384 1.0213 1.6393 1.0213 1.6393 1.6393 1.0213 1.6393 .................... .................... $44.83 $44.83 $180.48 $180.48 $44.83 $76.56 $76.56 $76.56 $76.56 $44.83 $74.58 $98.17 $74.58 $38.36 $44.83 $44.83 $103.71 .................... .................... $103.71 $103.71 .................... .................... .................... .................... .................... $209.12 $103.71 $44.83 $76.56 $103.71 $209.12 $81.90 $44.83 .................... $44.83 .................... $262.61 $262.61 $194.02 $98.17 $98.17 $98.17 .................... $306.10 $306.10 $306.10 $81.90 $98.17 $306.10 $44.83 $60.61 $97.28 $97.28 $97.28 $97.28 $37.88 $60.61 $97.28 $60.61 $97.28 $97.28 $60.61 $97.28 .................... .................... $17.93 $17.93 $72.19 $72.19 $17.93 .................... .................... .................... .................... $17.93 .................... $39.26 .................... .................... $17.93 $17.93 $24.40 .................... .................... $24.40 $24.40 .................... .................... .................... .................... .................... $79.41 $24.40 $17.93 .................... $24.40 $79.41 $32.76 $17.93 .................... $17.93 .................... $105.04 $105.04 $77.60 $39.26 $39.26 $39.26 .................... $122.43 $122.43 $122.43 $32.76 $39.26 $122.43 $17.93 $24.24 $38.91 $38.91 $38.91 $38.91 .................... $24.24 $38.91 $24.24 $38.91 $38.91 $24.24 $38.91 .................... .................... $8.97 $8.97 $36.10 $36.10 $8.97 $15.31 $15.31 $15.31 $15.31 $8.97 $14.92 $19.63 $14.92 $7.67 $8.97 $8.97 $20.74 .................... .................... $20.74 $20.74 .................... .................... .................... .................... .................... $41.82 $20.74 $8.97 $15.31 $20.74 $41.82 $16.38 $8.97 .................... $8.97 .................... $52.52 $52.52 $38.80 $19.63 $19.63 $19.63 .................... $61.22 $61.22 $61.22 $16.38 $19.63 $61.22 $8.97 $12.12 $19.46 $19.46 $19.46 $19.46 $7.58 $12.12 $19.46 $12.12 $19.46 $19.46 $12.12 $19.46 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00109 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50788 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 76705* ..... 76770* ..... 76775* ..... 76778* ..... 76800 ....... 76801 ....... 76802 ....... 76805 ....... 76810 ....... 76811 ....... 76812 ....... 76815 ....... 76816 ....... 76817 ....... 76818 ....... 76819 ....... 76820 ....... 76821 ....... 76825 ....... 76826 ....... 76827 ....... 76828 ....... 76830* ..... 76831* ..... 76856* ..... 76857* ..... 76870 ....... 76872 ....... 76873 ....... 76880 ....... 76885 ....... 76886 ....... 76930 ....... 76932 ....... 76936 ....... 76937 ....... 76940 ....... 76941 ....... 76942 ....... 76945 ....... 76946 ....... 76948 ....... 76950 ....... 76965 ....... 76970 ....... 76975 ....... 76977 ....... 76986 ....... 76999 ....... 77261 ....... 77262 ....... 77263 ....... 77280 ....... 77285 ....... 77290 ....... 77295 ....... 77299 ....... 77300 ....... 77301 ....... 77305 ....... 77310 ....... 77315 ....... 77321 ....... 77326 ....... 77327 ....... 77328 ....... SI S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S N S S S S S S S S S S X S S E E E X X X X E X X X X X X X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Echo exam of abdomen .......................... Us exam abdo back wall, comp .............. Us exam abdo back wall, lim .................. Us exam kidney transplant ...................... Us exam, spinal canal ............................. Ob us < 14 wks, single fetus ................... Ob us < 14 wks, add’l fetus ..................... Us exam, pg uterus, compl ..................... Us exam, pg uterus, mult ........................ Ob us, detailed, sngl fetus ....................... Ob us, detailed, addl fetus ...................... Us exam, pg uterus limit .......................... Us exam pg uterus repeat ....................... Transvaginal us, obstetric ........................ Fetal biophys profile w/nst ....................... Fetal biophys profil w/o nst ...................... Umbilical 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 ......................... Transvaginal us, non-ob .......................... Echo exam, uterus ................................... Us exam, pelvic, complete ...................... Us exam, pelvic, limited ........................... Us exam, scrotum .................................... Us, transrectal .......................................... Echograp trans r, pros study ................... Us exam, extremity .................................. Us exam infant hips, dynamic ................. Us exam infant hips, static ...................... Echo guide, cardiocentesis ...................... Echo guide for heart biopsy .................... Echo guide for artery repair ..................... Us guide, vascular access ....................... Us guide, tissue ablation ......................... Echo guide for transfusion ....................... Echo guide for biopsy .............................. Echo guide, villus sampling ..................... Echo guide for amniocentesis ................. Echo guide, ova aspiration ...................... Echo guidance radiotherapy .................... Echo guidance radiotherapy .................... Ultrasound exam follow-up ...................... GI endoscopic ultrasound ........................ Us bone density measure ........................ Ultrasound guide intraoper ...................... 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 ........................ Radiation therapy planning ...................... Radiation therapy dose plan .................... Radiotherapy dose plan, imrt .................. Teletx isodose plan simple ...................... Teletx isodose plan intermed .................. Teletx isodose plan complex ................... Special teletx port plan ............................ Radiation therapy dose plan .................... Brachytx isodose calc interm ................... Brachytx isodose plan compl ................... 0266 0266 0266 0266 0266 0266 0265 0266 0266 0267 0266 0265 0265 0266 0266 0266 0096 0096 0671 0697 0671 0697 0266 0267 0266 0265 0266 0266 0266 0266 0265 0266 0268 0268 0268 .................... 0268 0268 0268 0268 0268 0268 0268 0268 0265 0266 0340 0266 0265 .................... .................... .................... 0304 0305 0305 0310 .................... 0304 0310 0304 0305 0305 0305 0304 0305 0305 1.6393 1.6393 1.6393 1.6393 1.6393 1.6393 1.0213 1.6393 1.6393 2.6327 1.6393 1.0213 1.0213 1.6393 1.6393 1.6393 1.6307 1.6307 1.7028 1.5357 1.7028 1.5357 1.6393 2.6327 1.6393 1.0213 1.6393 1.6393 1.6393 1.6393 1.0213 1.6393 1.061 1.061 1.061 .................... 1.061 1.061 1.061 1.061 1.061 1.061 1.061 1.061 1.0213 1.6393 0.6384 1.6393 1.0213 .................... .................... .................... 1.7738 4.0036 4.0036 13.949 .................... 1.7738 13.949 1.7738 4.0036 4.0036 4.0036 1.7738 4.0036 4.0036 $97.28 $97.28 $97.28 $97.28 $97.28 $97.28 $60.61 $97.28 $97.28 $156.23 $97.28 $60.61 $60.61 $97.28 $97.28 $97.28 $96.77 $96.77 $101.05 $91.13 $101.05 $91.13 $97.28 $156.23 $97.28 $60.61 $97.28 $97.28 $97.28 $97.28 $60.61 $97.28 $62.96 $62.96 $62.96 .................... $62.96 $62.96 $62.96 $62.96 $62.96 $62.96 $62.96 $62.96 $60.61 $97.28 $37.88 $97.28 $60.61 .................... .................... .................... $105.26 $237.59 $237.59 $827.78 .................... $105.26 $827.78 $105.26 $237.59 $237.59 $237.59 $105.26 $237.59 $237.59 $38.91 $38.91 $38.91 $38.91 $38.91 $38.91 $24.24 $38.91 $38.91 $62.18 $38.91 $24.24 $24.24 $38.91 $38.91 $38.91 $38.70 $38.70 $40.42 $36.45 $40.42 $36.45 $38.91 $62.18 $38.91 $24.24 $38.91 $38.91 $38.91 $38.91 $24.24 $38.91 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $24.24 $38.91 .................... $38.91 $24.24 .................... .................... .................... $41.52 $91.38 $91.38 $325.27 .................... $41.52 $325.27 $41.52 $91.38 $91.38 $91.38 $41.52 $91.38 $91.38 $19.46 $19.46 $19.46 $19.46 $19.46 $19.46 $12.12 $19.46 $19.46 $31.25 $19.46 $12.12 $12.12 $19.46 $19.46 $19.46 $19.35 $19.35 $20.21 $18.23 $20.21 $18.23 $19.46 $31.25 $19.46 $12.12 $19.46 $19.46 $19.46 $19.46 $12.12 $19.46 $12.59 $12.59 $12.59 .................... $12.59 $12.59 $12.59 $12.59 $12.59 $12.59 $12.59 $12.59 $12.12 $19.46 $7.58 $19.46 $12.12 .................... .................... .................... $21.05 $47.52 $47.52 $165.56 .................... $21.05 $165.56 $21.05 $47.52 $47.52 $47.52 $21.05 $47.52 $47.52 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00110 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50789 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 77331 77332 77333 77334 77336 77370 77399 77401 77402 77403 77404 77406 77407 77408 77409 77411 77412 77413 77414 77416 77417 77418 77427 77431 77432 77470 77499 77520 77522 77523 77525 77600 77605 77610 77615 77620 77750 77761 77762 77763 77776 77777 77778 77781 77782 77783 77784 77789 77790 77799 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075 78099 78102 78103 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI X X X X X X X S S S S S S S S S S S S S X S E E E S E S S S S S S S S S S S S S S S S S S S S S N S S S S S S S S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Special radiation dosimetry ..................... Radiation treatment aid(s) ....................... Radiation treatment aid(s) ....................... Radiation treatment aid(s) ....................... Radiation physics consult ........................ Radiation physics consult ........................ 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 .................... 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 ...................... 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 ........................... Infuse radioactive materials ..................... Apply intrcav radiat simple ...................... Apply intrcav radiat interm ....................... Apply intrcav radiat compl ....................... Apply interstit radiat simpl ....................... Apply interstit radiat inter ......................... Apply interstit radiat compl ...................... High intensity brachytherapy ................... High intensity brachytherapy ................... High intensity brachytherapy ................... High intensity brachytherapy ................... Apply surface radiation ............................ Radiation handling ................................... Radium/radioisotope therapy ................... Thyroid, single uptake ............................. Thyroid, multiple uptakes ......................... Thyroid suppress/stimul ........................... Thyroid imaging with uptake .................... Thyroid image, mult uptakes ................... Thyroid imaging ....................................... Thyroid imaging with flow ........................ Thyroid met imaging ................................ Thyroid met imaging/studies .................... Thyroid met imaging, body ...................... Thyroid met uptake .................................. Parathyroid nuclear imaging .................... Adrenal nuclear imaging .......................... Endocrine nuclear procedure .................. Bone marrow imaging, ltd ........................ Bone marrow imaging, mult ..................... 0304 0303 0303 0303 0304 0304 0304 0300 0300 0300 0300 0300 0300 0300 0300 0301 0301 0301 0301 0301 0260 0412 .................... .................... .................... 0299 .................... 0664 0664 0667 0667 0314 0314 0314 0314 0314 0301 0312 0312 0312 0312 0312 0651 0313 0313 0313 0313 0300 .................... 0313 0389 0389 0389 0390 0391 0390 0390 0406 0406 0406 0399 0391 0391 0390 0400 0400 1.7738 2.8356 2.8356 2.8356 1.7738 1.7738 1.7738 1.5198 1.5198 1.5198 1.5198 1.5198 1.5198 1.5198 1.5198 2.2195 2.2195 2.2195 2.2195 2.2195 0.7555 5.3643 .................... .................... .................... 5.8482 .................... 12.9439 12.9439 15.4857 15.4857 5.9945 5.9945 5.9945 5.9945 5.9945 2.2195 5.0032 5.0032 5.0032 5.0032 5.0032 12.1448 12.8655 12.8655 12.8655 12.8655 1.5198 .................... 12.8655 1.4976 1.4976 1.4976 2.5562 2.8774 2.5562 2.5562 4.3035 4.3035 4.3035 1.5192 2.8774 2.8774 2.5562 4.1335 4.1335 $105.26 $168.27 $168.27 $168.27 $105.26 $105.26 $105.26 $90.19 $90.19 $90.19 $90.19 $90.19 $90.19 $90.19 $90.19 $131.71 $131.71 $131.71 $131.71 $131.71 $44.83 $318.33 .................... .................... .................... $347.05 .................... $768.13 $768.13 $918.97 $918.97 $355.73 $355.73 $355.73 $355.73 $355.73 $131.71 $296.90 $296.90 $296.90 $296.90 $296.90 $720.71 $763.48 $763.48 $763.48 $763.48 $90.19 .................... $763.48 $88.87 $88.87 $88.87 $151.69 $170.75 $151.69 $151.69 $255.38 $255.38 $255.38 $90.15 $170.75 $170.75 $151.69 $245.29 $245.29 $41.52 $66.95 $66.95 $66.95 $41.52 $41.52 $41.52 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $17.93 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $98.36 $98.36 $98.36 $98.36 $98.36 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $35.54 $35.54 $35.54 $60.67 $68.30 $60.67 $60.67 $102.15 $102.15 $102.15 $36.06 $68.30 $68.30 $60.67 $98.11 $98.11 $21.05 $33.65 $33.65 $33.65 $21.05 $21.05 $21.05 $18.04 $18.04 $18.04 $18.04 $18.04 $18.04 $18.04 $18.04 $26.34 $26.34 $26.34 $26.34 $26.34 $8.97 $63.67 .................... .................... .................... $69.41 .................... $153.63 $153.63 $183.79 $183.79 $71.15 $71.15 $71.15 $71.15 $71.15 $26.34 $59.38 $59.38 $59.38 $59.38 $59.38 $144.14 $152.70 $152.70 $152.70 $152.70 $18.04 .................... $152.70 $17.77 $17.77 $17.77 $30.34 $34.15 $30.34 $30.34 $51.08 $51.08 $51.08 $18.03 $34.15 $34.15 $30.34 $49.06 $49.06 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00111 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50790 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 78104 78110 78111 78120 78121 78122 78130 78135 78140 78160 78162 78170 78172 78185 78190 78191 78195 78199 78201 78202 78205 78206 78215 78216 78220 78223 78230 78231 78232 78258 78261 78262 78264 78267 78268 78270 78271 78272 78278 78282 78290 78291 78299 78300 78305 78306 78315 78320 78350 78351 78399 78414 78428 78445 78455 78456 78457 78458 78459 78460 78461 78464 78465 78466 78468 78469 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S A A S S S S S S S S S S S S S X E S S S S S S S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Bone marrow imaging, body .................... Plasma volume, single ............................. Plasma volume, multiple .......................... Red cell mass, single .............................. Red cell mass, multiple ........................... Blood volume ........................................... Red cell survival study ............................. Red cell survival kinetics ......................... Red cell sequestration ............................. Plasma iron turnover ............................... Radioiron absorption exam ...................... Red cell iron utilization ............................ Total body iron estimation ....................... Spleen imaging ........................................ Platelet survival, kinetics ......................... Platelet survival ........................................ Lymph system imaging ............................ Blood/lymph nuclear exam ...................... Liver imaging ........................................... Liver imaging with flow ............................ Liver imaging (3D) ................................... Liver image (3d) with flow ....................... Liver and spleen imaging ........................ Liver & spleen image/flow ....................... Liver function study .................................. Hepatobiliary imaging .............................. Salivary gland imaging ............................ Serial salivary imaging ............................. Salivary gland function exam .................. Esophageal motility study ........................ Gastric mucosa imaging .......................... Gastroesophageal reflux exam ................ Gastric emptying study ............................ Breath tst attain/anal c-14 ....................... Breath test analysis, c-14 ........................ Vit B-12 absorption exam ........................ Vit b-12 absrp exam, int fac .................... Vit B-12 absorp, combined ...................... Acute GI blood loss imaging ................... GI protein loss exam ............................... Meckel’s divert exam ............................... Leveen/shunt patency exam .................... GI nuclear procedure ............................... Bone imaging, limited area ...................... Bone imaging, multiple areas .................. Bone imaging, whole body ...................... Bone imaging, 3 phase ............................ Bone imaging (3D) ................................... Bone mineral, single photon .................... Bone mineral, dual photon ...................... Musculoskeletal nuclear exam ................ Non-imaging heart function ..................... Cardiac shunt imaging ............................. Vascular flow imaging .............................. Venous thrombosis study ........................ Acute venous thrombus image ................ Venous thrombosis imaging .................... Ven thrombosis images, bilat .................. Heart muscle imaging (PET) ................... Heart muscle blood, single ...................... Heart muscle blood, multiple ................... Heart image (3d), single .......................... Heart image (3d), multiple ....................... Heart infarct image .................................. Heart infarct image (ef) ............................ Heart infarct image (3D) .......................... 0400 0393 0393 0393 0393 0393 0393 0393 0393 0393 0393 0393 0393 0400 0389 0389 0400 0400 0394 0394 0394 0394 0394 0394 0394 0394 0395 0395 0395 0395 0395 0395 0395 .................... .................... 0389 0389 0389 0395 0395 0395 0395 0395 0396 0396 0396 0396 0396 0260 .................... 0396 0398 0398 0397 0397 0397 0397 0397 0285 0398 0377 0398 0377 0398 0398 0398 4.1335 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 3.4438 4.1335 1.4976 1.4976 4.1335 4.1335 4.463 4.463 4.463 4.463 4.463 4.463 4.463 4.463 3.8699 3.8699 3.8699 3.8699 3.8699 3.8699 3.8699 .................... .................... 1.4976 1.4976 1.4976 3.8699 3.8699 3.8699 3.8699 3.8699 4.1426 4.1426 4.1426 4.1426 4.1426 0.7555 .................... 4.1426 4.3093 4.3093 2.2646 2.2646 2.2646 2.2646 2.2646 17.1798 4.3093 6.8344 4.3093 6.8344 4.3093 4.3093 4.3093 $245.29 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $204.37 $245.29 $88.87 $88.87 $245.29 $245.29 $264.85 $264.85 $264.85 $264.85 $264.85 $264.85 $264.85 $264.85 $229.65 $229.65 $229.65 $229.65 $229.65 $229.65 $229.65 .................... .................... $88.87 $88.87 $88.87 $229.65 $229.65 $229.65 $229.65 $229.65 $245.83 $245.83 $245.83 $245.83 $245.83 $44.83 .................... $245.83 $255.73 $255.73 $134.39 $134.39 $134.39 $134.39 $134.39 $1,019.50 $255.73 $405.57 $255.73 $405.57 $255.73 $255.73 $255.73 $98.11 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $81.74 $98.11 $35.54 $35.54 $98.11 $98.11 $105.93 $105.93 $105.93 $105.93 $105.93 $105.93 $105.93 $105.93 $91.86 $91.86 $91.86 $91.86 $91.86 $91.86 $91.86 .................... .................... $35.54 $35.54 $35.54 $91.86 $91.86 $91.86 $91.86 $91.86 $98.33 $98.33 $98.33 $98.33 $98.33 $17.93 .................... $98.33 $102.29 $102.29 $53.75 $53.75 $53.75 $53.75 $53.75 $318.72 $102.29 $162.22 $102.29 $162.22 $102.29 $102.29 $102.29 $49.06 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $40.87 $49.06 $17.77 $17.77 $49.06 $49.06 $52.97 $52.97 $52.97 $52.97 $52.97 $52.97 $52.97 $52.97 $45.93 $45.93 $45.93 $45.93 $45.93 $45.93 $45.93 .................... .................... $17.77 $17.77 $17.77 $45.93 $45.93 $45.93 $45.93 $45.93 $49.17 $49.17 $49.17 $49.17 $49.17 $8.97 .................... $49.17 $51.15 $51.15 $26.88 $26.88 $26.88 $26.88 $26.88 $203.90 $51.15 $81.11 $51.15 $81.11 $51.15 $51.15 $51.15 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00112 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50791 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 78472 78473 78478 78480 78481 78483 78491 78492 78494 78496 78499 78580 78584 78585 78586 78587 78588 78591 78593 78594 78596 78599 78600 78601 78605 78606 78607 78608 78609 78610 78615 78630 78635 78645 78647 78650 78660 78699 78700 78701 78704 78707 78708 78709 78710 78715 78725 78730 78740 78760 78761 78799 78800 78801 78802 78803 78804 78805 78806 78807 78811 78812 78813 78814 78815 78816 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S X S S S S S S S S S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Gated heart, planar, single ...................... Gated heart, multiple ............................... Heart wall motion add-on ........................ Heart function add-on .............................. Heart first pass, single ............................. Heart first pass, multiple .......................... Heart image (pet), single ......................... Heart image (pet), multiple ...................... Heart image, spect .................................. Heart first pass add-on ............................ Cardiovascular nuclear exam .................. Lung perfusion imaging ........................... Lung V/Q image single breath ................. Lung V/Q imaging .................................... Aerosol lung image, single ...................... Aerosol lung image, multiple ................... Perfusion lung image ............................... Vent image, 1 breath, 1 proj .................... Vent image, 1 proj, gas ........................... Vent image, mult proj, gas ...................... Lung differential function ......................... Respiratory nuclear exam ........................ Brain imaging, ltd static ........................... Brain imaging, ltd w/flow .......................... Brain imaging, complete .......................... Brain imaging, compl w/flow .................... Brain imaging (3D) ................................... Brain imaging (PET) ................................ Brain imaging (PET) ................................ Brain flow imaging only ........................... Cerebral vascular flow image .................. Cerebrospinal fluid scan .......................... CSF ventriculography .............................. CSF shunt evaluation .............................. Cerebrospinal fluid scan .......................... CSF leakage imaging .............................. Nuclear exam of tear flow ....................... Nervous system nuclear exam ................ Kidney imaging, static .............................. Kidney imaging with flow ......................... Imaging renogram .................................... Kidney flow/function image ...................... Kidney flow/function image ...................... Kidney flow/function image ...................... Kidney imaging (3D) ................................ Renal vascular flow exam ....................... Kidney function study .............................. Urinary bladder retention ......................... Ureteral reflux study ................................ Testicular imaging .................................... Testicular imaging/flow ............................ Genitourinary nuclear exam .................... Tumor imaging, limited area .................... Tumor imaging, mult areas ...................... Tumor imaging, whole body .................... Tumor imaging (3D) ................................. Tumor imaging, whole body .................... Abscess imaging, ltd area ....................... Abscess imaging, whole body ................. Nuclear localization/abscess ................... Tumor imaging (pet), limited .................... Tumor image (pet)/skul-thigh ................... Tumor image (pet) full body .................... Tumor image pet/ct, limited ..................... Tumorimage pet/ct skul-thigh .................. Tumor image pet/ct full body ................... Relative weight APC 0398 0376 0399 0399 0398 0376 0285 0285 0398 0399 0398 0401 0378 0378 0401 0401 0378 0401 0401 0401 0378 0401 0402 0402 0402 0402 0402 1513 1513 0402 0402 0403 0403 0403 0403 0403 0403 0402 0267 0404 0404 0404 0405 0405 0404 0404 0389 0340 0404 0404 0404 0404 0406 0406 0406 0406 1508 0406 0406 0406 1513 1513 1513 1514 1514 1514 4.3093 5.1975 1.5192 1.5192 4.3093 5.1975 17.1798 17.1798 4.3093 1.5192 4.3093 3.415 5.4997 5.4997 3.415 3.415 5.4997 3.415 3.415 3.415 5.4997 3.415 5.1847 5.1847 5.1847 5.1847 5.1847 .................... .................... 5.1847 5.1847 3.6138 3.6138 3.6138 3.6138 3.6138 3.6138 5.1847 2.6327 3.8559 3.8559 3.8559 4.2674 4.2674 3.8559 3.8559 1.4976 0.6384 3.8559 3.8559 3.8559 3.8559 4.3035 4.3035 4.3035 4.3035 .................... 4.3035 4.3035 4.3035 .................... .................... .................... .................... .................... .................... Payment rate National unadjusted copayment Minimum unadjusted copayment $255.73 $308.44 $90.15 $90.15 $255.73 $308.44 $1,019.50 $1,019.50 $255.73 $90.15 $255.73 $202.66 $326.37 $326.37 $202.66 $202.66 $326.37 $202.66 $202.66 $202.66 $326.37 $202.66 $307.68 $307.68 $307.68 $307.68 $307.68 $1,150.00 $1,150.00 $307.68 $307.68 $214.45 $214.45 $214.45 $214.45 $214.45 $214.45 $307.68 $156.23 $228.82 $228.82 $228.82 $253.24 $253.24 $228.82 $228.82 $88.87 $37.88 $228.82 $228.82 $228.82 $228.82 $255.38 $255.38 $255.38 $255.38 $650.00 $255.38 $255.38 $255.38 $1,150.00 $1,150.00 $1,150.00 $1,250.00 $1,250.00 $1,250.00 $102.29 $121.42 $36.06 $36.06 $102.29 $121.42 $318.72 $318.72 $102.29 $36.06 $102.29 $81.06 $130.54 $130.54 $81.06 $81.06 $130.54 $81.06 $81.06 $81.06 $130.54 $81.06 $123.07 $123.07 $123.07 $123.07 $123.07 .................... .................... $123.07 $123.07 $85.78 $85.78 $85.78 $85.78 $85.78 $85.78 $123.07 $62.18 $91.52 $91.52 $91.52 $101.29 $101.29 $91.52 $91.52 $35.54 .................... $91.52 $91.52 $91.52 $91.52 $102.15 $102.15 $102.15 $102.15 .................... $102.15 $102.15 $102.15 .................... .................... .................... .................... .................... .................... $51.15 $61.69 $18.03 $18.03 $51.15 $61.69 $203.90 $203.90 $51.15 $18.03 $51.15 $40.53 $65.27 $65.27 $40.53 $40.53 $65.27 $40.53 $40.53 $40.53 $65.27 $40.53 $61.54 $61.54 $61.54 $61.54 $61.54 $230.00 $230.00 $61.54 $61.54 $42.89 $42.89 $42.89 $42.89 $42.89 $42.89 $61.54 $31.25 $45.76 $45.76 $45.76 $50.65 $50.65 $45.76 $45.76 $17.77 $7.58 $45.76 $45.76 $45.76 $45.76 $51.08 $51.08 $51.08 $51.08 $130.00 $51.08 $51.08 $51.08 $230.00 $230.00 $230.00 $250.00 $250.00 $250.00 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00113 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50792 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 78890 78891 78999 79005 79101 79200 79300 79403 79440 79445 79999 80048 80050 80051 80053 80055 80061 80069 80074 80076 80100 80101 80102 80103 80150 80152 80154 80156 80157 80158 80160 80162 80164 80166 80168 80170 80172 80173 80174 80176 80178 80182 80184 80185 80186 80188 80190 80192 80194 80196 80197 80198 80200 80201 80202 80299 80400 80402 80406 80408 80410 80412 80414 80415 80416 80417 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N N S S S S S S S S S A E A A E 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 A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Nuclear medicine data proc ..................... Nuclear med data proc ............................ Nuclear diagnostic exam ......................... Nuclear rx, oral admin ............................. Nuclear rx, iv admin ................................. Intracavitary nuclear trmt ......................... Interstitial nuclear therapy ....................... Hematopoetic nuclear therapy ................. Nuclear joint therapy ................................ Nuclear rx, intra-arterial ........................... Nuclear medicine therapy ........................ Basic metabolic panel .............................. General health panel ............................... Electrolyte panel ...................................... Comprehen metabolic panel .................... Obstetric panel ......................................... Lipid panel ............................................... Renal function panel ................................ Acute hepatitis panel ............................... Hepatic function panel ............................. Drug screen, qualitate/multi ..................... Drug screen, single .................................. Drug confirmation .................................... Drug analysis, tissue prep ....................... Assay of amikacin .................................... Assay of amitriptyline ............................... Assay of benzodiazepines ....................... Assay, carbamazepine, total ................... Assay, carbamazepine, free .................... Assay of cyclosporine .............................. Assay of desipramine .............................. Assay of digoxin ...................................... Assay, dipropylacetic acid ....................... Assay of doxepin ..................................... Assay of ethosuximide ............................. Assay of gentamicin ................................ Assay of gold ........................................... Assay of haloperidol ................................ Assay of imipramine ................................ Assay of lidocaine .................................... Assay of lithium ....................................... Assay of nortriptyline ............................... Assay of phenobarbital ............................ Assay of phenytoin, total ......................... Assay of phenytoin, free .......................... Assay of primidone .................................. Assay of procainamide ............................ Assay of procainamide ............................ Assay of quinidine ................................... Assay of salicylate ................................... Assay of tacrolimus ................................. Assay of theophylline ............................... Assay of tobramycin ................................ Assay of topiramate ................................. Assay of vancomycin ............................... Quantitative assay, drug .......................... Acth stimulation panel ............................. Acth stimulation panel ............................. Acth stimulation panel ............................. Aldosterone suppression eval ................. Calcitonin stimul panel ............................. CRH stimulation panel ............................. Testosterone response ............................ Estradiol response panel ......................... Renin stimulation panel ........................... Renin stimulation panel ........................... .................... .................... 0389 0407 0407 0407 0407 1507 0407 0407 0407 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.4976 3.9839 3.9839 3.9839 3.9839 .................... 3.9839 3.9839 3.9839 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $88.87 $236.42 $236.42 $236.42 $236.42 $550.00 $236.42 $236.42 $236.42 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $35.54 $94.56 $94.56 $94.56 $94.56 .................... $94.56 $94.56 $94.56 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $17.77 $47.28 $47.28 $47.28 $47.28 $110.00 $47.28 $47.28 $47.28 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00114 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50793 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 80418 80420 80422 80424 80426 80428 80430 80432 80434 80435 80436 80438 80439 80440 80500 80502 81000 81001 81002 81003 81005 81007 81015 81020 81025 81050 81099 82000 82003 82009 82010 82013 82016 82017 82024 82030 82040 82042 82043 82044 82045 82055 82075 82085 82088 82101 82103 82104 82105 82106 82108 82120 82127 82128 82131 82135 82136 82139 82140 82143 82145 82150 82154 82157 82160 82163 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A X X A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Pituitary evaluation panel ........................ Dexamethasone panel ............................. Glucagon tolerance panel ........................ Glucagon tolerance panel ........................ Gonadotropin hormone panel .................. Growth hormone panel ............................ Growth hormone panel ............................ Insulin suppression panel ........................ Insulin tolerance panel ............................. Insulin tolerance panel ............................. Metyrapone panel .................................... TRH stimulation panel ............................. TRH stimulation panel ............................. TRH stimulation panel ............................. Lab pathology consultation ...................... Lab pathology consultation ...................... Urinalysis, nonauto w/scope .................... Urinalysis, auto w/scope .......................... Urinalysis nonauto w/o scope .................. Urinalysis, auto, w/o scope ...................... Urinalysis ................................................. Urine screen for bacteria ......................... Microscopic exam of urine ....................... Urinalysis, glass test ................................ Urine pregnancy test ............................... Urinalysis, volume measure .................... Urinalysis test procedure ......................... Assay of blood acetaldehyde .................. Assay of acetaminophen ......................... Test for acetone/ketones ......................... Acetone assay ......................................... Acetylcholinesterase assay ..................... Acylcarnitines, qual .................................. Acylcarnitines, quant ................................ Assay of acth ........................................... Assay of adp & amp ................................ Assay of serum albumin .......................... Assay of urine albumin ............................ Microalbumin, quantitative ....................... Microalbumin, semiquant ......................... Albumin, ischemia modified ..................... Assay of ethanol ...................................... Assay of breath ethanol ........................... Assay of aldolase .................................... Assay of aldosterone ............................... Assay of urine alkaloids ........................... Alpha-1-antitrypsin, total .......................... Alpha-1-antitrypsin, pheno ....................... Alpha-fetoprotein, serum ......................... Alpha-fetoprotein, amniotic ...................... Assay of aluminum .................................. Amines, vaginal fluid qual ........................ Amino acid, single qual ........................... Amino acids, mult qual ............................ Amino acids, single quant ....................... Assay, aminolevulinic acid ....................... Amino acids, quant, 2-5 ........................... Amino acids, quan, 6 or more ................. Assay of ammonia ................................... Amniotic fluid scan ................................... Assay of amphetamines .......................... Assay of amylase .................................... Androstanediol glucuronide ..................... Assay of androstenedione ....................... Assay of androsterone ............................. Assay of angiotensin II ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0433 0342 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2581 0.156 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.32 $9.26 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.12 $3.70 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.06 $1.85 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00115 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50794 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 82164 82172 82175 82180 82190 82205 82232 82239 82240 82247 82248 82252 82261 82270 82273 82274 82286 82300 82306 82307 82308 82310 82330 82331 82340 82355 82360 82365 82370 82373 82374 82375 82376 82378 82379 82380 82382 82383 82384 82387 82390 82397 82415 82435 82436 82438 82441 82465 82480 82482 82485 82486 82487 82488 82489 82491 82492 82495 82507 82520 82523 82525 82528 82530 82533 82540 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Angiotensin I enzyme test ....................... Assay of apolipoprotein ........................... Assay of arsenic ...................................... Assay of ascorbic acid ............................. Atomic absorption .................................... Assay of barbiturates ............................... Assay of beta-2 protein ........................... Bile acids, total ........................................ Bile acids, cholylglycine ........................... Bilirubin, total ........................................... Bilirubin, direct ......................................... Fecal bilirubin test .................................... Assay of biotinidase ................................. Test for blood, feces ................................ Test for blood, other source .................... Assay test for blood, fecal ....................... Assay of bradykinin ................................. Assay of cadmium ................................... Assay of vitamin D ................................... Assay of vitamin D ................................... Assay of calcitonin ................................... Assay of calcium ...................................... Assay of calcium ...................................... Calcium infusion test ............................... Assay of calcium in urine ........................ Calculus analysis, qual ............................ Calculus assay, quant ............................. Calculus spectroscopy ............................. X-ray assay, calculus ............................... Assay, c-d transfer measure ................... Assay, blood carbon dioxide ................... Assay, blood carbon monoxide ............... Test for carbon monoxide ........................ Carcinoembryonic antigen ....................... Assay of carnitine .................................... Assay of carotene .................................... Assay, urine catecholamines ................... Assay, blood catecholamines .................. Assay, three catecholamines ................... Assay of cathepsin-d ............................... Assay of ceruloplasmin ............................ Chemiluminescent assay ......................... Assay of chloramphenicol ........................ Assay of blood chloride ........................... Assay of urine chloride ............................ Assay, other fluid chlorides ..................... Test for chlorohydrocarbons .................... Assay, bld/serum cholesterol ................... Assay, serum cholinesterase ................... Assay, rbc cholinesterase ........................ Assay, chondroitin sulfate ........................ Gas/liquid chromatography ...................... Paper chromatography ............................ Paper chromatography ............................ Thin layer chromatography ...................... Chromotography, quant, sing .................. Chromotography, quant, mult .................. Assay of chromium .................................. Assay of citrate ........................................ Assay of cocaine ..................................... Collagen crosslinks .................................. Assay of copper ....................................... Assay of corticosterone ........................... Cortisol, free ............................................ Total cortisol ............................................ Assay of creatine ..................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00116 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50795 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 82541 82542 82543 82544 82550 82552 82553 82554 82565 82570 82575 82585 82595 82600 82607 82608 82615 82626 82627 82633 82634 82638 82646 82649 82651 82652 82654 82656 82657 82658 82664 82666 82668 82670 82671 82672 82677 82679 82690 82693 82696 82705 82710 82715 82725 82726 82728 82731 82735 82742 82746 82747 82757 82759 82760 82775 82776 82784 82785 82787 82800 82803 82805 82810 82820 82926 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Column chromotography, qual ................ Column chromotography, quant .............. Column chromotograph/isotope ............... Column chromotograph/isotope ............... Assay of ck (cpk) ..................................... Assay of cpk in blood .............................. Creatine, MB fraction ............................... Creatine, isoforms .................................... Assay of creatinine .................................. Assay of urine creatinine ......................... Creatinine clearance test ......................... Assay of cryofibrinogen ........................... Assay of cryoglobulin ............................... Assay of cyanide ..................................... Vitamin B-12 ............................................ B-12 binding capacity .............................. Test for urine cystines ............................. Dehydroepiandrosterone ......................... Dehydroepiandrosterone ......................... Desoxycorticosterone .............................. Deoxycortisol ........................................... Assay of dibucaine number ..................... Assay of dihydrocodeinone ..................... Assay of dihydromorphinone ................... Assay of dihydrotestosterone .................. Assay of dihydroxyvitamin d .................... Assay of dimethadione ............................ Pancreatic elastase, fecal ........................ Enzyme cell activity ................................. Enzyme cell activity, ra ............................ Electrophoretic test .................................. Assay of epiandrosterone ........................ Assay of erythropoietin ............................ Assay of estradiol .................................... Assay of estrogens .................................. Assay of estrogen .................................... Assay of estriol ........................................ Assay of estrone ...................................... Assay of ethchlorvynol ............................. Assay of ethylene glycol .......................... Assay of etiocholanolone ......................... Fats/lipids, feces, qual ............................. Fats/lipids, feces, quant ........................... Assay of fecal fat ..................................... Assay of blood fatty acids ....................... Long chain fatty acids .............................. Assay of ferritin ........................................ Assay of fetal fibronectin ......................... Assay of fluoride ...................................... Assay of flurazepam ................................ Blood folic acid serum ............................. Assay of folic acid, rbc ............................ Assay of semen fructose ......................... Assay of rbc galactokinase ...................... Assay of galactose .................................. Assay galactose transferase ................... Galactose transferase test ....................... Assay of gammaglobulin igm .................. Assay of gammaglobulin ige ................... Igg 1, 2, 3 or 4, each ............................... Blood pH .................................................. Blood gases pH, pO2 & pCO2 ................ Blood gases W/02 saturation .................. Blood gases, O2 sat only ........................ Hemoglobin-oxygen affinity ..................... Assay of gastric acid ............................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00117 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50796 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 82928 82938 82941 82943 82945 82946 82947 82948 82950 82951 82952 82953 82955 82960 82962 82963 82965 82975 82977 82978 82979 82980 82985 83001 83002 83003 83008 83009 83010 83012 83013 83014 83015 83018 83020 83021 83026 83030 83033 83036 83045 83050 83051 83055 83060 83065 83068 83069 83070 83071 83080 83088 83090 83150 83491 83497 83498 83499 83500 83505 83516 83518 83519 83520 83525 83527 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Assay of gastric acid ............................... Gastrin test .............................................. Assay of gastrin ....................................... Assay of glucagon ................................... Glucose other fluid ................................... Glucagon tolerance test ........................... Assay, glucose, blood quant ................... Reagent strip/blood glucose .................... Glucose test ............................................. Glucose tolerance test (GTT) .................. GTT-added samples ................................ Glucose-tolbutamide test ......................... Assay of g6pd enzyme ............................ Test for G6PD enzyme ............................ Glucose blood test ................................... Assay of glucosidase ............................... Assay of gdh enzyme .............................. Assay of glutamine .................................. Assay of GGT .......................................... Assay of glutathione ................................ Assay, rbc glutathione ............................. Assay of glutethimide .............................. Glycated protein ....................................... Gonadotropin (FSH) ................................ Gonadotropin (LH) ................................... Assay, growth hormone (hgh) ................. Assay of guanosine ................................. H pylori (c-13), blood ............................... Assay of haptoglobin, quant .................... Assay of haptoglobins ............................. H pylori analysis ...................................... H pylori drug admin/collect ...................... Heavy metal screen ................................. Quantitative screen, metals ..................... Hemoglobin electrophoresis .................... Hemoglobin chromotography ................... Hemoglobin, copper sulfate ..................... Fetal hemoglobin, chemical ..................... Fetal hemoglobin assay, qual .................. Glycated hemoglobin test ........................ Blood methemoglobin test ....................... Blood methemoglobin assay ................... Assay of plasma hemoglobin .................. Blood sulfhemoglobin test ....................... Blood sulfhemoglobin assay .................... Assay of hemoglobin heat ....................... Hemoglobin stability screen ..................... Assay of urine hemoglobin ...................... Assay of hemosiderin, qual ..................... Assay of hemosiderin, quant ................... Assay of b hexosaminidase ..................... Assay of histamine .................................. Assay of homocystine .............................. Assay of for hva ....................................... Assay of corticosteroids ........................... Assay of 5-hiaa ........................................ Assay of progesterone ............................. Assay of progesterone ............................. Assay, free hydroxyproline ...................... Assay, total hydroxyproline ...................... Immunoassay, nonantibody ..................... Immunoassay, dipstick ............................ Immunoassay, nonantibody ..................... Immunoassay, RIA .................................. Assay of insulin ........................................ Assay of insulin ........................................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00118 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50797 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 83528 83540 83550 83570 83582 83586 83593 83605 83615 83625 83630 83632 83633 83634 83655 83661 83662 83663 83664 83670 83690 83715 83716 83718 83719 83721 83727 83735 83775 83785 83788 83789 83805 83825 83835 83840 83857 83858 83864 83866 83872 83873 83874 83880 83883 83885 83887 83890 83891 83892 83893 83894 83896 83897 83898 83901 83902 83903 83904 83905 83906 83912 83915 83916 83918 83919 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Assay of intrinsic factor ........................... Assay of iron ............................................ Iron binding test ....................................... Assay of idh enzyme ............................... Assay of ketogenic steroids ..................... Assay 17- ketosteroids ............................ Fractionation, ketosteroids ....................... Assay of lactic acid .................................. Lactate (LD) (LDH) enzyme .................... Assay of ldh enzymes ............................. Lactoferrin, fecal (qual) ............................ Placental lactogen ................................... Test urine for lactose ............................... Assay of urine for lactose ........................ Assay of lead ........................................... L/s ratio, fetal lung ................................... Foam stability, fetal lung .......................... Fluoro polarize, fetal lung ........................ Lamellar bdy, fetal lung ........................... Assay of lap enzyme ............................... Assay of lipase ........................................ Assay of blood lipoproteins ..................... Assay of blood lipoproteins ..................... Assay of lipoprotein ................................. Assay of blood lipoprotein ....................... Assay of blood lipoprotein ....................... Assay of lrh hormone .............................. Assay of magnesium ............................... Assay of md enzyme ............................... Assay of manganese ............................... Mass spectrometry qual .......................... Mass spectrometry quant ........................ Assay of meprobamate ............................ Assay of mercury ..................................... Assay of metanephrines .......................... Assay of methadone ................................ Assay of methemalbumin ........................ Assay of methsuximide ............................ Mucopolysaccharides .............................. Mucopolysaccharides screen .................. Assay synovial fluid mucin ...................... Assay of csf protein ................................. Assay of myoglobin ................................. Natriuretic peptide .................................... Assay, nephelometry not spec ................ Assay of nickel ......................................... Assay of nicotine ..................................... Molecule isolate ....................................... Molecule isolate nucleic ........................... Molecular diagnostics .............................. Molecule dot/slot/blot ............................... Molecule gel electrophor ......................... Molecular diagnostics .............................. Molecule nucleic transfer ......................... Molecule nucleic ampli ............................ Molecule nucleic ampli ............................ Molecular diagnostics .............................. Molecule mutation scan ........................... Molecule mutation identify ....................... Molecule mutation identify ....................... Molecule mutation identify ....................... Genetic examination ................................ Assay of nucleotidase .............................. Oligoclonal bands .................................... Organic acids, total, quant ....................... Organic acids, qual, each ........................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00119 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50798 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 83921 83925 83930 83935 83937 83945 83950 83970 83986 83992 84022 84030 84035 84060 84061 84066 84075 84078 84080 84081 84085 84087 84100 84105 84106 84110 84119 84120 84126 84127 84132 84133 84134 84135 84138 84140 84143 84144 84146 84150 84152 84153 84154 84155 84156 84157 84160 84163 84165 84166 84181 84182 84202 84203 84206 84207 84210 84220 84228 84233 84234 84235 84238 84244 84252 84255 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Organic acid, single, quant ...................... Assay of opiates ...................................... Assay of blood osmolality ........................ Assay of urine osmolality ......................... Assay of osteocalcin ................................ Assay of oxalate ...................................... Oncoprotein, her-2/neu ............................ Assay of parathormone ........................... Assay of body fluid acidity ....................... Assay for phencyclidine ........................... Assay of phenothiazine ........................... Assay of blood pku .................................. Assay of phenylketones ........................... Assay acid phosphatase .......................... Phosphatase, forensic exam ................... Assay prostate phosphatase ................... Assay alkaline phosphatase .................... Assay alkaline phosphatase .................... Assay alkaline phosphatases .................. Amniotic fluid enzyme test ....................... Assay of rbc pg6d enzyme ...................... Assay phosphohexose enzymes ............. Assay of phosphorus ............................... Assay of urine phosphorus ...................... Test for porphobilinogen .......................... Assay of porphobilinogen ........................ Test urine for porphyrins ......................... Assay of urine porphyrins ........................ Assay of feces porphyrins ....................... Assay of feces porphyrins ....................... Assay of serum potassium ...................... Assay of urine potassium ........................ Assay of prealbumin ................................ Assay of pregnanediol ............................. Assay of pregnanetriol ............................. Assay of pregnenolone ............................ Assay of 17-hydroxypregneno ................. Assay of progesterone ............................. Assay of prolactin .................................... Assay of prostaglandin ............................ Assay of psa, complexed ........................ Assay of psa, total ................................... Assay of psa, free .................................... Assay of protein, serum ........................... Assay of protein, urine ............................. Assay of protein, other ............................ Assay of protein, any source ................... Pappa, serum .......................................... Electrophoreisis of proteins ..................... Protein e-phoresis/urine/csf ..................... Western blot test ...................................... Protein, western blot test ......................... Assay RBC protoporphyrin ...................... Test RBC protoporphyrin ......................... Assay of proinsulin .................................. Assay of vitamin b-6 ................................ Assay of pyruvate .................................... Assay of pyruvate kinase ........................ Assay of quinine ...................................... Assay of estrogen .................................... Assay of progesterone ............................. Assay of endocrine hormone ................... Assay, nonendocrine receptor ................. Assay of renin .......................................... Assay of vitamin b-2 ................................ Assay of selenium ................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00120 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50799 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 84260 84270 84275 84285 84295 84300 84302 84305 84307 84311 84315 84375 84376 84377 84378 84379 84392 84402 84403 84425 84430 84432 84436 84437 84439 84442 84443 84445 84446 84449 84450 84460 84466 84478 84479 84480 84481 84482 84484 84485 84488 84490 84510 84512 84520 84525 84540 84545 84550 84560 84577 84578 84580 84583 84585 84586 84588 84590 84591 84597 84600 84620 84630 84681 84702 84703 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Assay of serotonin ................................... Assay of sex hormone globul .................. Assay of sialic acid .................................. Assay of silica .......................................... Assay of serum sodium ........................... Assay of urine sodium ............................. Assay of sweat sodium ............................ Assay of somatomedin ............................ Assay of somatostatin ............................. Spectrophotometry ................................... Body fluid specific gravity ........................ Chromatogram assay, sugars ................. Sugars, single, qual ................................. Sugars, multiple, qual .............................. Sugars, single, quant ............................... Sugars multiple quant .............................. Assay of urine sulfate .............................. Assay of testosterone .............................. Assay of total testosterone ...................... Assay of vitamin b-1 ................................ Assay of thiocyanate ............................... Assay of thyroglobulin ............................. Assay of total thyroxine ........................... Assay of neonatal thyroxine .................... Assay of free thyroxine ............................ Assay of thyroid activity ........................... Assay thyroid stim hormone .................... Assay of tsi .............................................. Assay of vitamin e ................................... Assay of transcortin ................................. Transferase (AST) (SGOT) ..................... Alanine amino (ALT) (SGPT) .................. Assay of transferrin .................................. Assay of triglycerides ............................... Assay of thyroid (t3 or t4) ........................ Assay, triiodothyronine (t3) ...................... Free assay (FT-3) .................................... T3 reverse ................................................ Assay of troponin, quant .......................... Assay duodenal fluid trypsin .................... Test feces for trypsin ............................... Assay of feces for trypsin ........................ Assay of tyrosine ..................................... Assay of troponin, qual ............................ Assay of urea nitrogen ............................ Urea nitrogen semi-quant ........................ Assay of urine/urea-n .............................. Urea-N clearance test .............................. Assay of blood/uric acid .......................... Assay of urine/uric acid ........................... Assay of feces/urobilinogen ..................... Test urine urobilinogen ............................ Assay of urine urobilinogen ..................... Assay of urine urobilinogen ..................... Assay of urine vma .................................. Assay of vip ............................................. Assay of vasopressin ............................... Assay of vitamin a ................................... Assay of nos vitamin ............................... Assay of vitamin k ................................... Assay of volatiles ..................................... Xylose tolerance test ............................... Assay of zinc ........................................... Assay of c-peptide ................................... Chorionic gonadotropin test ..................... Chorionic gonadotropin assay ................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00121 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50800 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 84830 84999 85002 85004 85007 85008 85009 85013 85014 85018 85025 85027 85032 85041 85044 85045 85046 85048 85049 85055 85060 85097 85130 85170 85175 85210 85220 85230 85240 85244 85245 85246 85247 85250 85260 85270 85280 85290 85291 85292 85293 85300 85301 85302 85303 85305 85306 85307 85335 85337 85345 85347 85348 85360 85362 85366 85370 85378 85379 85380 85384 85385 85390 85396 85400 85410 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A B X A A A A A A A A A A A A A A A A A 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 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Ovulation tests ......................................... Clinical chemistry test .............................. Bleeding time test .................................... Automated diff wbc count ........................ Differential WBC count ............................ Nondifferential WBC count ...................... Differential WBC count ............................ Spun microhematocrit .............................. Hematocrit ................................................ Hemoglobin .............................................. Automated hemogram ............................. Automated hemogram ............................. Manual cell count, each ........................... Red blood cell (RBC) count ..................... Reticulocyte count ................................... Reticulocyte count ................................... Reticyte/hgb concentrate ......................... White blood cell (WBC) count ................. Automated platelet count ......................... Reticulated platelet assay ........................ Blood smear interpretation ...................... Bone marrow interpretation ..................... Chromogenic substrate assay ................. Blood clot retraction ................................. Blood clot lysis time ................................. Blood clot factor II test ............................. Blood clot factor V test ............................ Blood clot factor VII test .......................... Blood clot factor VIII test ......................... Blood clot factor VIII test ......................... Blood clot factor VIII test ......................... Blood clot factor VIII test ......................... Blood clot factor VIII test ......................... Blood clot factor IX test ........................... Blood clot factor X test ............................ Blood clot factor XI test ........................... Blood clot factor XII test .......................... Blood clot factor XIII test ......................... Blood clot factor XIII test ......................... Blood clot factor assay ............................ Blood clot factor assay ............................ Antithrombin III test .................................. Antithrombin III test .................................. Blood clot inhibitor antigen ...................... Blood clot inhibitor test ............................ Blood clot inhibitor assay ......................... Blood clot inhibitor test ............................ Assay activated protein c ........................ Factor inhibitor test .................................. Thrombomodulin ...................................... Coagulation time ...................................... Coagulation time ...................................... Coagulation time ...................................... Euglobulin lysis ........................................ Fibrin degradation products ..................... Fibrinogen test ......................................... Fibrinogen test ......................................... Fibrin degradation .................................... Fibrin degradation, quant ......................... Fibrin degradation, vte ............................. Fibrinogen ................................................ Fibrinogen ................................................ Fibrinolysins screen ................................. Clotting assay, whole blood ..................... Fibrinolytic plasmin .................................. Fibrinolytic antiplasmin ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0343 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.4786 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $28.40 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $11.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $5.68 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00122 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50801 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 85415 85420 85421 85441 85445 85460 85461 85475 85520 85525 85530 85536 85540 85547 85549 85555 85557 85576 85597 85610 85611 85612 85613 85635 85651 85652 85660 85670 85675 85705 85730 85732 85810 85999 86000 86001 86003 86005 86021 86022 86023 86038 86039 86060 86063 86064 86077 86078 86079 86140 86141 86146 86147 86148 86155 86156 86157 86160 86161 86162 86171 86185 86215 86225 86226 86235 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A X X X A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Fibrinolytic plasminogen .......................... Fibrinolytic plasminogen .......................... Fibrinolytic plasminogen .......................... Heinz bodies, direct ................................. Heinz bodies, induced ............................. Hemoglobin, fetal ..................................... Hemoglobin, fetal ..................................... Hemolysin ................................................ Heparin assay .......................................... Heparin neutralization .............................. Heparin-protamine tolerance ................... Iron stain peripheral blood ....................... Wbc alkaline phosphatase ....................... RBC mechanical fragility ......................... Muramidase ............................................. RBC osmotic fragility ............................... RBC osmotic fragility ............................... Blood platelet aggregation ....................... Platelet neutralization .............................. Prothrombin time ..................................... Prothrombin test ...................................... Viper venom prothrombin time ................ Russell viper venom, diluted ................... Reptilase test ........................................... Rbc sed rate, nonautomated ................... Rbc sed rate, automated ......................... RBC sickle cell test .................................. Thrombin time, plasma ............................ Thrombin time, titer .................................. Thromboplastin inhibition ......................... Thromboplastin time, partial .................... Thromboplastin time, partial .................... Blood viscosity examination .................... Hematology procedure ............................ Agglutinins, febrile ................................... Allergen specific igg ................................. Allergen specific IgE ................................ Allergen specific IgE ................................ WBC antibody identification ..................... Platelet antibodies ................................... Immunoglobulin assay ............................. Antinuclear antibodies ............................. Antinuclear antibodies (ANA) .................. Antistreptolysin o, titer ............................. Antistreptolysin o, screen ........................ B cells, total count ................................... Physician blood bank service .................. Physician blood bank service .................. Physician blood bank service .................. C-reactive protein .................................... C-reactive protein, hs .............................. Glycoprotein antibody .............................. Cardiolipin antibody ................................. Phospholipid antibody .............................. Chemotaxis assay ................................... Cold agglutinin, screen ............................ Cold agglutinin, titer ................................. Complement, antigen ............................... Complement/function activity ................... Complement, total (CH50) ....................... Complement fixation, each ...................... Counterimmunoelectrophoresis ............... Deoxyribonuclease, antibody ................... DNA antibody ........................................... DNA antibody, single strand .................... Nuclear antigen antibody ......................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0433 0343 0433 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2581 0.4786 0.2581 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.32 $28.40 $15.32 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.12 $11.10 $6.12 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.06 $5.68 $3.06 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00123 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50802 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 86243 86255 86256 86277 86280 86294 86300 86301 86304 86308 86309 86310 86316 86317 86318 86320 86325 86327 86329 86331 86332 86334 86335 86336 86337 86340 86341 86343 86344 86353 86359 86360 86361 86376 86378 86379 86382 86384 86403 86406 86430 86431 86485 86490 86510 86580 86585 86586 86587 86590 86592 86593 86602 86603 86606 86609 86611 86612 86615 86617 86618 86619 86622 86625 86628 86631 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A X X X X X X A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Fc receptor ............................................... Fluorescent antibody, screen .................. Fluorescent antibody, titer ....................... Growth hormone antibody ....................... Hemagglutination inhibition ...................... Immunoassay, tumor, qual ...................... Immunoassay, tumor, ca 15-3 ................. Immunoassay, tumor, ca 19-9 ................. Immunoassay, tumor, ca 125 .................. Heterophile antibodies ............................. Heterophile antibodies ............................. Heterophile antibodies ............................. Immunoassay, tumor other ...................... Immunoassay,infectious agent ................ Immunoassay,infectious agent ................ Serum immunoelectrophoresis ................ Other immunoelectrophoresis .................. Immunoelectrophoresis assay ................. Immunodiffusion ....................................... Immunodiffusion ouchterlony ................... Immune complex assay ........................... Immunofixation procedure ....................... Immunfix e-phorsis/urine/csf .................... Inhibin A ................................................... Insulin antibodies ..................................... Intrinsic factor antibody ............................ Islet cell antibody ..................................... Leukocyte histamine release ................... Leukocyte phagocytosis .......................... Lymphocyte transformation ..................... T cells, total count ................................... T cell, absolute count/ratio ...................... T cell, absolute count .............................. Microsomal antibody ................................ Migration inhibitory factor ........................ Nk cells, total count ................................. Neutralization test, viral ........................... nitroblue tetrazolium dye ......................... Particle agglutination test ........................ Particle agglutination test ........................ Rheumatoid factor test ............................ Rheumatoid factor, quant ........................ Skin test, candida .................................... Coccidioidomycosis skin test ................... Histoplasmosis skin test .......................... TB intradermal test .................................. TB tine test .............................................. Skin test, unlisted .................................... Stem cells, total count ............................. Streptokinase, antibody ........................... Blood serology, qualitative ....................... Blood serology, quantitative .................... Antinomyces antibody .............................. Adenovirus antibody ................................ Aspergillus antibody ................................. Bacterium antibody .................................. Bartonella antibody .................................. Blastomyces antibody .............................. Bordetella antibody .................................. Lyme disease antibody ............................ Lyme disease antibody ............................ Borrelia antibody ...................................... Brucella antibody ..................................... Campylobacter antibody .......................... Candida antibody ..................................... Chlamydia antibody ................................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0341 0341 0341 0341 0341 0341 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.1112 0.1112 0.1112 0.1112 0.1112 0.1112 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.60 $6.60 $6.60 $6.60 $6.60 $6.60 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1.32 $1.32 $1.32 $1.32 $1.32 $1.32 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00124 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50803 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 86632 86635 86638 86641 86644 86645 86648 86651 86652 86653 86654 86658 86663 86664 86665 86666 86668 86671 86674 86677 86682 86684 86687 86688 86689 86692 86694 86695 86696 86698 86701 86702 86703 86704 86705 86706 86707 86708 86709 86710 86713 86717 86720 86723 86727 86729 86732 86735 86738 86741 86744 86747 86750 86753 86756 86757 86759 86762 86765 86768 86771 86774 86777 86778 86781 86784 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Chlamydia igm antibody .......................... Coccidioides antibody .............................. Q fever antibody ...................................... Cryptococcus antibody ............................ CMV antibody .......................................... CMV antibody, IgM .................................. Diphtheria antibody .................................. Encephalitis antibody ............................... Encephalitis antibody ............................... Encephalitis antibody ............................... Encephalitis antibody ............................... Enterovirus antibody ................................ Epstein-barr antibody ............................... Epstein-barr antibody ............................... Epstein-barr antibody ............................... Ehrlichia antibody .................................... Francisella tularensis ............................... Fungus antibody ...................................... Giardia lamblia antibody .......................... Helicobacter pylori ................................... Helminth antibody .................................... Hemophilus influenza .............................. Htlv-i antibody .......................................... Htlv-ii antibody ......................................... HTLV/HIV confirmatory test ..................... Hepatitis, delta agent ............................... Herpes simplex test ................................. Herpes simplex test ................................. Herpes simplex type 2 ............................. Histoplasma ............................................. HIV-1 ........................................................ HIV-2 ........................................................ HIV-1/HIV-2, single assay ....................... Hep b core antibody, total ....................... Hep b core antibody, igm ........................ Hep b surface antibody ........................... Hep be antibody ...................................... Hep a antibody, total ............................... Hep a antibody, igm ................................ Influenza virus antibody ........................... Legionella antibody .................................. Leishmania antibody ................................ Leptospira antibody ................................. Listeria monocytogenes ab ...................... Lymph choriomeningitis ab ...................... Lympho venereum antibody .................... Mucormycosis antibody ........................... Mumps antibody ...................................... Mycoplasma antibody .............................. Neisseria meningitidis .............................. Nocardia antibody .................................... Parvovirus antibody ................................. Malaria antibody ...................................... Protozoa antibody nos ............................. Respiratory virus antibody ....................... Rickettsia antibody ................................... Rotavirus antibody ................................... Rubella antibody ...................................... Rubeola antibody ..................................... Salmonella antibody ................................ Shigella antibody ..................................... Tetanus antibody ..................................... Toxoplasma antibody ............................... Toxoplasma antibody, igm ....................... Treponema pallidum, confirm .................. Trichinella antibody .................................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00125 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50804 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 86787 86790 86793 86800 86803 86804 86805 86806 86807 86808 86812 86813 86816 86817 86821 86822 86849 86850 86860 86870 86880 86885 86886 86890 86891 86900 86901 86903 86904 86905 86906 86910 86911 86920 86921 86922 86927 86930 86931 86932 86940 86941 86945 86950 86965 86970 86971 86972 86975 86976 86977 86978 86985 86999 87001 87003 87015 87040 87045 87046 87070 87071 87073 87075 87076 87077 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A X X X X X X X X X X X X X X E E X X X X X X X A A X X X X X X X X X X X X A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Varicella-zoster antibody ......................... Virus antibody nos ................................... Yersinia antibody ..................................... Thyroglobulin antibody ............................. Hepatitis c ab test .................................... Hep c ab test, confirm ............................. Lymphocytotoxicity assay ........................ Lymphocytotoxicity assay ........................ Cytotoxic antibody screening ................... Cytotoxic antibody screening ................... HLA typing, A, B, or C ............................. HLA typing, A, B, or C ............................. HLA typing, DR/DQ ................................. HLA typing, DR/DQ ................................. Lymphocyte culture, mixed ...................... Lymphocyte culture, primed .................... Immunology procedure ............................ RBC antibody screen ............................... RBC antibody elution ............................... RBC antibody identification ..................... Coombs test, direct .................................. Coombs test, indirect, qual ...................... Coombs test, indirect, titer ....................... Autologous blood process ....................... Autologous blood, op salvage ................. Blood typing, ABO ................................... Blood typing, Rh (D) ................................ Blood typing, antigen screen ................... Blood typing, patient serum ..................... Blood typing, RBC antigens .................... Blood typing, Rh phenotype .................... Blood typing, paternity test ...................... Blood typing, antigen system .................. Compatibility test ..................................... Compatibility test ..................................... Compatibility test ..................................... Plasma, fresh frozen ................................ Frozen blood prep ................................... Frozen blood thaw ................................... Frozen blood freeze/thaw ........................ Hemolysins/agglutinins, auto ................... Hemolysins/agglutinins ............................ Blood product/irradiation .......................... Leukacyte transfusion .............................. Pooling blood platelets ............................ RBC pretreatment .................................... RBC pretreatment .................................... RBC pretreatment .................................... RBC pretreatment, serum ........................ RBC pretreatment, serum ........................ RBC pretreatment, serum ........................ RBC pretreatment, serum ........................ Split blood or products ............................. Transfusion procedure ............................. Small animal inoculation .......................... Small animal inoculation .......................... Specimen concentration .......................... Blood culture for bacteria ........................ Feces culture, bacteria ............................ Stool cultr, bacteria, each ........................ Culture, bacteria, other ............................ Culture bacteri aerobic othr ..................... Culture bacteria anaerobic ...................... Cultr bacteria, except blood ..................... Culture anaerobe ident, each .................. Culture aerobic identify ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0345 0346 0346 0409 0409 0409 0347 0346 0409 0409 0345 0346 0345 0345 .................... .................... 0346 0345 0346 0345 0347 0347 0347 .................... .................... 0345 0345 0345 0345 0345 0346 0345 0345 0345 0345 0345 0345 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2277 0.3434 0.3434 0.1258 0.1258 0.1258 0.8434 0.3434 0.1258 0.1258 0.2277 0.3434 0.2277 0.2277 .................... .................... 0.3434 0.2277 0.3434 0.2277 0.8434 0.8434 0.8434 .................... .................... 0.2277 0.2277 0.2277 0.2277 0.2277 0.3434 0.2277 0.2277 0.2277 0.2277 0.2277 0.2277 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $13.51 $20.38 $20.38 $7.47 $7.47 $7.47 $50.05 $20.38 $7.47 $7.47 $13.51 $20.38 $13.51 $13.51 .................... .................... $20.38 $13.51 $20.38 $13.51 $50.05 $50.05 $50.05 .................... .................... $13.51 $13.51 $13.51 $13.51 $13.51 $20.38 $13.51 $13.51 $13.51 $13.51 $13.51 $13.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.01 $4.54 $4.54 $2.22 $2.22 $2.22 $12.35 $4.54 $2.22 $2.22 $3.01 $4.54 $3.01 $3.01 .................... .................... $4.54 $3.01 $4.54 $3.01 $12.35 $12.35 $12.35 .................... .................... $3.01 $3.01 $3.01 $3.01 $3.01 $4.54 $3.01 $3.01 $3.01 $3.01 $3.01 $3.01 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2.70 $4.08 $4.08 $1.49 $1.49 $1.49 $10.01 $4.08 $1.49 $1.49 $2.70 $4.08 $2.70 $2.70 .................... .................... $4.08 $2.70 $4.08 $2.70 $10.01 $10.01 $10.01 .................... .................... $2.70 $2.70 $2.70 $2.70 $2.70 $4.08 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00126 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50805 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 87081 87084 87086 87088 87101 87102 87103 87106 87107 87109 87110 87116 87118 87140 87143 87147 87149 87152 87158 87164 87166 87168 87169 87172 87176 87177 87181 87184 87185 87186 87187 87188 87190 87197 87205 87206 87207 87210 87220 87230 87250 87252 87253 87254 87255 87260 87265 87267 87269 87270 87271 87272 87273 87274 87275 87276 87277 87278 87279 87280 87281 87283 87285 87290 87299 87300 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Culture screen only .................................. Culture of specimen by kit ....................... Urine culture/colony count ....................... Urine bacteria culture .............................. Skin fungi culture ..................................... Fungus isolation culture ........................... Blood fungus culture ................................ Fungi identification, yeast ........................ Fungi identification, mold ......................... Mycoplasma ............................................. Chlamydia culture .................................... Mycobacteria culture ................................ Mycobacteric identification ....................... Culture type immunofluoresc ................... Culture typing, glc/hplc ............................ Culture type, immunologic ....................... Culture type, nucleic acid ........................ Culture type pulse field gel ...................... Culture typing, added method ................. Dark field examination ............................. Dark field examination ............................. Macroscopic exam arthropod .................. Macroscopic exam parasite ..................... Pinworm exam ......................................... Tissue homogenization, cultr ................... Ova and parasites smears ...................... Microbe susceptible, diffuse .................... Microbe susceptible, disk ........................ Microbe susceptible, enzyme .................. Microbe susceptible, mic ......................... Microbe susceptible, mlc ......................... Microbe suscept, macrobroth .................. Microbe suscept, mycobacteri ................. Bactericidal level, serum .......................... Smear, gram stain ................................... Smear, fluorescent/acid stai .................... Smear, special stain ................................ Smear, wet mount, saline/ink .................. Tissue exam for fungi .............................. Assay, toxin or antitoxin .......................... Virus inoculate, eggs/animal .................... Virus inoculation, tissue ........................... Virus inoculate tissue, addl ...................... Virus inoculation, shell via ....................... Genet virus isolate, hsv ........................... Adenovirus ag, if ...................................... Pertussis ag, if ......................................... Enterovirus antibody, dfa ......................... Giardia ag, if ............................................ Chlamydia trachomatis ag, if ................... Cryptosporidum/gardia ag, if ................... Cryptosporidium ag, if .............................. Herpes simplex 2, ag, if ........................... Herpes simplex 1, ag, if ........................... Influenza b, ag, if ..................................... Influenza a, ag, if ..................................... Legionella micdadei, ag, if ....................... Legion pneumophilia ag, if ...................... Parainfluenza, ag, if ................................. Respiratory syncytial ag, if ...................... Pneumocystis carinii, ag, if ...................... Rubeola, ag, if ......................................... Treponema pallidum, ag, if ...................... Varicella zoster, ag, if .............................. Antibody detection, nos, if ....................... Ag detection, polyval, if ........................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00127 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50806 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 87301 87320 87324 87327 87328 87329 87332 87335 87336 87337 87338 87339 87340 87341 87350 87380 87385 87390 87391 87400 87420 87425 87427 87430 87449 87450 87451 87470 87471 87472 87475 87476 87477 87480 87481 87482 87485 87486 87487 87490 87491 87492 87495 87496 87497 87510 87511 87512 87515 87516 87517 87520 87521 87522 87525 87526 87527 87528 87529 87530 87531 87532 87533 87534 87535 87536 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Adenovirus ag, eia ................................... Chylmd trach ag, eia ............................... Clostridium ag, eia ................................... Cryptococcus neoform ag, eia ................. Cryptosporidium ag, eia ........................... Giardia ag, eia ......................................... Cytomegalovirus ag, eia .......................... E coli 0157 ag, eia ................................... Entamoeb hist dispr, ag, eia .................... Entamoeb hist group, ag, eia .................. Hpylori, stool, eia ..................................... H pylori ag, eia ........................................ Hepatitis b surface ag, eia ....................... Hepatitis b surface, ag, eia ...................... Hepatitis be ag, eia .................................. Hepatitis delta ag, eia .............................. Histoplasma capsul ag, eia ..................... Hiv-1 ag, eia ............................................ Hiv-2 ag, eia ............................................ Influenza a/b, ag, eia ............................... Resp syncytial ag, eia ............................. Rotavirus ag, eia ...................................... Shiga-like toxin ag, eia ............................ Strep a ag, eia ......................................... Ag detect nos, eia, mult ........................... Ag detect nos, eia, single ........................ Ag detect polyval, eia, mult ..................... Bartonella, dna, dir probe ........................ Bartonella, dna, amp probe ..................... Bartonella, dna, quant ............................. Lyme dis, dna, dir probe .......................... Lyme dis, dna, amp probe ....................... Lyme dis, dna, quant ............................... Candida, dna, dir probe ........................... Candida, dna, amp probe ........................ Candida, dna, quant ................................ Chylmd pneum, dna, dir probe ................ Chylmd pneum, dna, amp probe ............. Chylmd pneum, dna, quant ..................... Chylmd trach, dna, dir probe ................... Chylmd trach, dna, amp probe ................ Chylmd trach, dna, quant ........................ Cytomeg, dna, dir probe .......................... Cytomeg, dna, amp probe ....................... Cytomeg, dna, quant ............................... Gardner vag, dna, dir probe .................... Gardner vag, dna, amp probe ................. Gardner vag, dna, quant ......................... Hepatitis b, dna, dir probe ....................... Hepatitis b, dna, amp probe .................... Hepatitis b, dna, quant ............................ Hepatitis c, rna, dir probe ........................ Hepatitis c, rna, amp probe ..................... Hepatitis c, rna, quant ............................. Hepatitis g, dna, dir probe ....................... Hepatitis g, dna, amp probe .................... Hepatitis g, dna, quant ............................ Hsv, dna, dir probe .................................. Hsv, dna, amp probe ............................... Hsv, dna, quant ....................................... Hhv-6, dna, dir probe ............................... Hhv-6, dna, amp probe ............................ Hhv-6, dna, quant .................................... Hiv-1, dna, dir probe ................................ Hiv-1, dna, amp probe ............................. Hiv-1, dna, quant ..................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00128 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50807 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 87537 87538 87539 87540 87541 87542 87550 87551 87552 87555 87556 87557 87560 87561 87562 87580 87581 87582 87590 87591 87592 87620 87621 87622 87650 87651 87652 87660 87797 87798 87799 87800 87801 87802 87803 87804 87807 87810 87850 87880 87899 87901 87902 87903 87904 87999 88000 88005 88007 88012 88014 88016 88020 88025 88027 88028 88029 88036 88037 88040 88045 88099 88104 88106 88107 88108 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E E E E E E E E E E E E E E E E X X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Hiv-2, dna, dir probe ................................ Hiv-2, dna, amp probe ............................. Hiv-2, dna, quant ..................................... Legion pneumo, dna, dir prob ................. Legion pneumo, dna, amp prob .............. Legion pneumo, dna, quant ..................... Mycobacteria, dna, dir probe ................... Mycobacteria, dna, amp probe ................ Mycobacteria, dna, quant ........................ M.tuberculo, dna, dir probe ..................... M.tuberculo, dna, amp probe .................. M.tuberculo, dna, quant ........................... M.avium-intra, dna, dir prob .................... M.avium-intra, dna, amp prob ................. M.avium-intra, dna, quant ........................ M.pneumon, dna, dir probe ..................... M.pneumon, dna, amp probe .................. M.pneumon, dna, quant ........................... N.gonorrhoeae, dna, dir prob .................. N.gonorrhoeae, dna, amp prob ............... N.gonorrhoeae, dna, quant ...................... Hpv, dna, dir probe .................................. Hpv, dna, amp probe ............................... Hpv, dna, quant ....................................... Strep a, dna, dir probe ............................ Strep a, dna, amp probe ......................... Strep a, dna, quant .................................. Trichomonas vagin, dir probe .................. Detect agent nos, dna, dir ....................... Detect agent nos, dna, amp .................... Detect agent nos, dna, quant .................. Detect agnt mult, dna, direc .................... Detect agnt mult, dna, ampli ................... Strep b assay w/optic .............................. Clostridium toxin a w/optic ....................... Influenza assay w/optic ........................... Rsv assay w/optic .................................... Chylmd trach assay w/optic ..................... N. gonorrhoeae assay w/optic ................. Strep a assay w/optic .............................. Agent nos assay w/optic .......................... Genotype, dna, hiv reverse t ................... Genotype, dna, hepatitis C ...................... Phenotype, dna hiv w/culture .................. Phenotype, dna hiv w/clt add .................. Microbiology procedure ........................... Autopsy (necropsy), gross ....................... Autopsy (necropsy), gross ....................... Autopsy (necropsy), gross ....................... Autopsy (necropsy), gross ....................... Autopsy (necropsy), gross ....................... Autopsy (necropsy), gross ....................... Autopsy (necropsy), complete ................. Autopsy (necropsy), complete ................. Autopsy (necropsy), complete ................. Autopsy (necropsy), complete ................. Autopsy (necropsy), complete ................. Limited autopsy ........................................ Limited autopsy ........................................ Forensic autopsy (necropsy) ................... Coroner’s autopsy (necropsy) ................. Necropsy (autopsy) procedure ................ Cytopathology, fluids ............................... Cytopathology, fluids ............................... Cytopathology, fluids ............................... Cytopath, concentrate tech ...................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0433 0433 0433 0433 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2581 0.2581 0.2581 0.2581 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.32 $15.32 $15.32 $15.32 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.12 $6.12 $6.12 $6.12 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.06 $3.06 $3.06 $3.06 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00129 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50808 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 88112 88125 88130 88140 88141 88142 88143 88147 88148 88150 88152 88153 88154 88155 88160 88161 88162 88164 88165 88166 88167 88172 88173 88174 88175 88182 88184 88185 88187 88188 88189 88199 88230 88233 88235 88237 88239 88240 88241 88245 88248 88249 88261 88262 88263 88264 88267 88269 88271 88272 88273 88274 88275 88280 88283 88285 88289 88291 88299 88300 88302 88304 88305 88307 88309 88311 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI X X A A N A A A A A A A A A X X X A A A A X X A A X X X X X X A A A A A A A A A A A A A A A A A A A A A A A A A A A X X X X X X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Cytopath, cell enhance tech .................... Forensic cytopathology ............................ Sex chromatin identification ..................... Sex chromatin identification ..................... Cytopath, c/v, interpret ............................ Cytopath, c/v, thin layer ........................... Cytopath c/v thin layer redo .................... Cytopath, c/v, automated ......................... Cytopath, c/v, auto rescreen ................... Cytopath, c/v, manual .............................. Cytopath, c/v, auto redo .......................... Cytopath, c/v, redo .................................. Cytopath, c/v, select ................................ Cytopath, c/v, index add-on ..................... Cytopath smear, other source ................. Cytopath smear, other source ................. Cytopath smear, other source ................. Cytopath tbs, c/v, manual ........................ Cytopath tbs, c/v, redo ............................ Cytopath tbs, c/v, auto redo .................... Cytopath tbs, c/v, select .......................... Cytopathology eval of fna ........................ Cytopath eval, fna, report ........................ Cytopath, c/v auto, in fluid ....................... Cytopath c/v auto fluid redo .................... Cell marker study ..................................... Flowcytometry/ tc, 1 marker .................... Flowcytometry/tc, add-on ......................... Flowcytometry/read, 2-8 .......................... Flowcytometry/read, 9-15 ........................ Flowcytometry/read, 16 & > ..................... Cytopathology procedure ......................... Tissue culture, lymphocyte ...................... Tissue culture, skin/biopsy ...................... Tissue culture, placenta ........................... Tissue culture, bone marrow ................... Tissue culture, tumor ............................... Cell cryopreserve/storage ........................ Frozen cell preparation ............................ Chromosome analysis, 20-25 .................. Chromosome analysis, 50-100 ................ Chromosome analysis, 100 ..................... Chromosome analysis, 5 ......................... Chromosome analysis, 15-20 .................. Chromosome analysis, 45 ....................... Chromosome analysis, 20-25 .................. Chromosome analys, placenta ................ Chromosome analys, amniotic ................ Cytogenetics, dna probe .......................... Cytogenetics, 3-5 ..................................... Cytogenetics, 10-30 ................................. Cytogenetics, 25-99 ................................. Cytogenetics, 100-300 ............................. Chromosome karyotype study ................. Chromosome banding study .................... Chromosome count, additional ................ Chromosome study, additional ................ Cyto/molecular report .............................. Cytogenetic study .................................... Surgical path, gross ................................. Tissue exam by pathologist ..................... Tissue exam by pathologist ..................... Tissue exam by pathologist ..................... Tissue exam by pathologist ..................... Tissue exam by pathologist ..................... Decalcify tissue ........................................ 0343 0342 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0433 0433 0433 .................... .................... .................... .................... 0343 0343 .................... .................... 0344 0344 0343 0433 0433 0343 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0342 0433 0433 0343 0343 0344 0344 0342 0.4786 0.156 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2581 0.2581 0.2581 .................... .................... .................... .................... 0.4786 0.4786 .................... .................... 0.7996 0.7996 0.4786 0.2581 0.2581 0.4786 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.156 0.2581 0.2581 0.4786 0.4786 0.7996 0.7996 0.156 $28.40 $9.26 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.32 $15.32 $15.32 .................... .................... .................... .................... $28.40 $28.40 .................... .................... $47.45 $47.45 $28.40 $15.32 $15.32 $28.40 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.26 $15.32 $15.32 $28.40 $28.40 $47.45 $47.45 $9.26 $11.10 $3.70 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.12 $6.12 $6.12 .................... .................... .................... .................... $11.10 $11.10 .................... .................... $15.66 $15.66 $11.10 $6.12 $6.12 $11.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.70 $6.12 $6.12 $11.10 $11.10 $15.66 $15.66 $3.70 $5.68 $1.85 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.06 $3.06 $3.06 .................... .................... .................... .................... $5.68 $5.68 .................... .................... $9.49 $9.49 $5.68 $3.06 $3.06 $5.68 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1.85 $3.06 $3.06 $5.68 $5.68 $9.49 $9.49 $1.85 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00130 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50809 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 88312 88313 88314 88318 88319 88321 88323 88325 88329 88331 88332 88342 88346 88347 88348 88349 88355 88356 88358 88360 88361 88362 88365 88367 88368 88371 88372 88380 88399 88400 89050 89051 89055 89060 89100 89105 89125 89130 89132 89135 89136 89140 89141 89160 89190 89220 89225 89230 89235 89240 89250 89251 89253 89254 89255 89257 89258 89259 89260 89261 89264 89268 89272 89280 89281 89290 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI X X X X X X X X X X X X X X X X X X X X X X X X X A A A A A A A A A X X A X X X X X X A A X A X A A X X X X X X X X X X X X X X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Special stains ........................................... Special stains ........................................... Histochemical stain .................................. Chemical histochemistry .......................... Enzyme histochemistry ............................ Microslide consultation ............................ Microslide consultation ............................ Comprehensive review of data ................ Path consult introp ................................... Path consult intraop, 1 bloc ..................... Path consult intraop, add’l ....................... Immunohistochemistry ............................. Immunofluorescent study ......................... Immunofluorescent study ......................... Electron microscopy ................................ Scanning electron microscopy ................. Analysis, skeletal muscle ......................... Analysis, nerve ........................................ Analysis, tumor ........................................ Tumor immunohistochem/manual ........... Immunohistochemistry, tumor .................. Nerve teasing preparations ..................... Tissue hybridization ................................. Insitu hybridization, auto .......................... Insitu hybridization, manual ..................... Protein, western blot tissue ..................... Protein analysis w/probe ......................... Microdissection ........................................ Surgical pathology procedure .................. Bilirubin total transcut .............................. Body fluid cell count ................................ Body fluid cell count ................................ Leukocyte assessment, fecal .................. Exam,synovial fluid crystals ..................... Sample intestinal contents ....................... Sample intestinal contents ....................... Specimen fat stain ................................... Sample stomach contents ....................... Sample stomach contents ....................... Sample stomach contents ....................... Sample stomach contents ....................... Sample stomach contents ....................... Sample stomach contents ....................... Exam feces for meat fibers ..................... Nasal smear for eosinophils .................... Sputum specimen collection .................... Starch granules, feces ............................. Collect sweat for test ............................... Water load test ........................................ Pathology lab procedure .......................... Cultr oocyte/embryo <4 days ................... Cultr oocyte/embryo <4 days ................... Embryo hatching ...................................... Oocyte identification ................................ Prepare embryo for transfer .................... Sperm identification ................................. Cryopreservation embryo(s) .................... Cryopreservation, sperm ......................... Sperm isolation, simple ........................... Sperm isolation, complex ........................ Identify sperm tissue ................................ Insemination of oocytes ........................... Extended culture of oocytes .................... Assist oocyte fertilization ......................... Assist oocyte fertilization ......................... Biopsy, oocyte polar body ....................... 0433 0433 0342 0433 0343 0433 0343 0344 0433 0343 0433 0343 0343 0343 0661 0661 0343 0344 0344 0344 0344 0344 0344 0344 0344 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0360 0360 .................... 0360 0360 0360 0360 0360 0360 .................... .................... 0343 .................... 0433 .................... .................... 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0348 0.2581 0.2581 0.156 0.2581 0.4786 0.2581 0.4786 0.7996 0.2581 0.4786 0.2581 0.4786 0.4786 0.4786 3.3775 3.3775 0.4786 0.7996 0.7996 0.7996 0.7996 0.7996 0.7996 0.7996 0.7996 .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.4739 1.4739 .................... 1.4739 1.4739 1.4739 1.4739 1.4739 1.4739 .................... .................... 0.4786 .................... 0.2581 .................... .................... 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 $15.32 $15.32 $9.26 $15.32 $28.40 $15.32 $28.40 $47.45 $15.32 $28.40 $15.32 $28.40 $28.40 $28.40 $200.43 $200.43 $28.40 $47.45 $47.45 $47.45 $47.45 $47.45 $47.45 $47.45 $47.45 .................... .................... .................... .................... .................... .................... .................... .................... .................... $87.47 $87.47 .................... $87.47 $87.47 $87.47 $87.47 $87.47 $87.47 .................... .................... $28.40 .................... $15.32 .................... .................... $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $6.12 $6.12 $3.70 $6.12 $11.10 $6.12 $11.10 $15.66 $6.12 $11.10 $6.12 $11.10 $11.10 $11.10 $80.17 $80.17 $11.10 $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 .................... .................... .................... .................... .................... .................... .................... .................... .................... $34.98 $34.98 .................... $34.98 $34.98 $34.98 $34.98 $34.98 $34.98 .................... .................... $11.10 .................... $6.12 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.06 $3.06 $1.85 $3.06 $5.68 $3.06 $5.68 $9.49 $3.06 $5.68 $3.06 $5.68 $5.68 $5.68 $40.09 $40.09 $5.68 $9.49 $9.49 $9.49 $9.49 $9.49 $9.49 $9.49 $9.49 .................... .................... .................... .................... .................... .................... .................... .................... .................... $17.49 $17.49 .................... $17.49 $17.49 $17.49 $17.49 $17.49 $17.49 .................... .................... $5.68 .................... $3.06 .................... .................... $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00131 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50810 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued SI CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment X ..... A ..... A ..... A ..... A ..... A ..... A ..... A ..... X ..... X ..... X ..... X ..... X ..... X ..... X ..... X ..... X ..... E ..... E ..... E ..... E ..... E ..... N ..... E ..... K ..... K ..... E ..... E ..... E ..... N ..... E ..... E ..... N ..... K ..... E ..... B ..... B ..... B ..... B ..... X ..... X ..... S ..... S ..... K ..... N ..... K ..... K ..... B ..... N ..... N ..... N ..... K ..... N ..... N ..... N ..... N ..... L ...... L ...... L ...... L ...... E ..... N ..... E ..... K ..... K ..... N ..... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Biopsy, oocyte polar body ....................... Semen analysis w/huhner ....................... Semen analysis ....................................... Semen analysis, complete ....................... Semen analysis & motility ....................... Sperm antibody test ................................. Sperm evaluation test .............................. Evaluation, cervical mucus ...................... Cryopreserve testicular tiss ..................... Storage/year embryo(s) ........................... Storage/year sperm/semen ..................... Storage/year reprod tissue ...................... Storage/year oocyte ................................. Thawing cryopresrved embryo ................ Thawing cryopresrved sperm .................. Thaw cryoprsvrd reprod tiss .................... Thawing cryopresrved oocyte .................. Human ig, im ........................................... Human ig, iv ............................................. Botulinum antitoxin .................................. Botulism ig, iv .......................................... Cmv ig, iv ................................................. Diphtheria antitoxin .................................. Hep b ig, im ............................................. Rabies ig, im/sc ....................................... Rabies ig, heat treated ............................ Rsv ig, im, 50mg ...................................... 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 ............................... Flu vaccine, 6-35 mo, im ......................... Flu vaccine no preserv 3 & > .................. Flu vaccine, 6-35 mo, im ......................... Flu vaccine, 3 yrs, im .............................. Flu vaccine, nasal .................................... Lyme disease vaccine, im ....................... Pneumococcal vacc, ped <5 ................... Rabies vaccine, im .................................. Rabies vaccine, id ................................... Rotovirus vaccine, oral ............................ 0348 .................... .................... .................... .................... .................... .................... .................... 0348 0348 0348 0348 0348 0348 0348 0348 0348 .................... .................... .................... .................... .................... .................... .................... 9133 9134 .................... .................... .................... .................... .................... .................... .................... 9135 .................... .................... .................... .................... .................... 0353 0353 1491 1491 9136 .................... 9169 9137 .................... .................... .................... .................... 9138 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 9139 9140 .................... 0.7927 .................... .................... .................... .................... .................... .................... .................... 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 0.7927 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.3954 0.3954 .................... .................... 0.9499 .................... .................... .................... .................... .................... .................... .................... 0.9674 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.4959 .................... $47.04 .................... .................... .................... .................... .................... .................... .................... $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 $47.04 .................... .................... .................... .................... .................... .................... .................... $64.56 $69.79 .................... .................... .................... .................... .................... .................... .................... $96.58 .................... .................... .................... .................... .................... $23.46 $23.46 $5.00 $5.00 $56.37 .................... $128.95 $124.54 .................... .................... .................... .................... $57.41 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $128.04 $88.77 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.41 .................... .................... .................... .................... .................... .................... .................... $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 .................... .................... .................... .................... .................... .................... .................... $12.91 $13.96 .................... .................... .................... .................... .................... .................... .................... $19.32 .................... .................... .................... .................... .................... $4.69 $4.69 $1.00 $1.00 $11.27 .................... $25.79 $24.91 .................... .................... .................... .................... $11.48 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $25.61 $17.75 .................... CPT/ HCPCS 89291 89300 89310 89320 89321 89325 89329 89330 89335 89342 89343 89344 89346 89352 89353 89354 89356 90281 90283 90287 90288 90291 90296 90371 90375 90376 90378 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 90655 90656 90657 90658 90660 90665 90669 90675 90676 90680 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00132 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50811 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued SI CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment N ..... N ..... N ..... N ..... N ..... N ..... N ..... N ..... N ..... N ..... N ..... N ..... N ..... K ..... N ..... N ..... N ..... N ..... K ..... N ..... N ..... N ..... N ..... N ..... E ..... N ..... N ..... L ...... K ..... K ..... K ..... F ..... F ..... F ..... F ..... F ..... E ..... N ..... S ..... N ..... X ..... X ..... X ..... X ..... X ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... S ..... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Typhoid vaccine, oral ............................... Typhoid vaccine, im ................................. Typhoid vaccine, h-p, sc/id ...................... Typhoid vaccine, akd, sc ......................... Dtap-hib-ip vaccine, im ............................ Dtap vaccine, 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 .................................. Pneumococcal vaccine ............................ Meningococcal vaccine, sc ...................... Meningococcal vaccine, im ...................... Encephalitis vaccine, sc .......................... Hepb vacc, ill pat 3 dose im .................... Hep b vacc, adol, 2 dose, im .................. Hepb vacc ped/adol 3 dose im ................ Hep b vaccine, adult, im .......................... Hepb vacc, ill pat 4 dose im .................... 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 ....................... 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 ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 9141 .................... .................... .................... .................... 9142 .................... .................... .................... .................... .................... .................... .................... .................... .................... 9143 9145 9144 .................... .................... .................... .................... .................... .................... .................... 0120 .................... 0353 0359 0359 0359 0352 0323 0323 0322 0322 0323 0323 0323 0323 0322 0322 0323 0323 0323 0323 0322 0322 0323 0323 0323 0323 0322 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.9467 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.8948 .................... .................... .................... .................... .................... .................... .................... .................... 2.0193 .................... 0.3954 0.8312 0.8312 0.8312 0.1413 1.6227 1.6227 1.2319 1.2319 1.6227 1.6227 1.6227 1.6227 1.2319 1.2319 1.6227 1.6227 1.6227 1.6227 1.2319 1.2319 1.6227 1.6227 1.6227 1.6227 1.2319 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $56.18 .................... .................... .................... .................... $64.29 .................... .................... .................... .................... .................... .................... .................... .................... .................... $56.75 $53.10 $67.73 .................... .................... .................... .................... .................... .................... .................... $119.83 .................... $23.46 $49.33 $49.33 $49.33 $8.39 $96.30 $96.30 $73.10 $73.10 $96.30 $96.30 $96.30 $96.30 $73.10 $73.10 $96.30 $96.30 $96.30 $96.30 $73.10 $73.10 $96.30 $96.30 $96.30 $96.30 $73.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $28.21 .................... .................... .................... .................... .................... .................... $20.08 $20.08 .................... .................... $20.08 $20.08 $20.08 $20.08 .................... .................... $20.08 $20.08 $20.08 $20.08 .................... .................... $20.08 $20.08 $20.08 $20.08 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $11.24 .................... .................... .................... .................... $12.86 .................... .................... .................... .................... .................... .................... .................... .................... .................... $11.35 $10.62 $13.55 .................... .................... .................... .................... .................... .................... .................... $23.97 .................... $4.69 $9.87 $9.87 $9.87 $1.68 $19.26 $19.26 $14.62 $14.62 $19.26 $19.26 $19.26 $19.26 $14.62 $14.62 $19.26 $19.26 $19.26 $19.26 $14.62 $14.62 $19.26 $19.26 $19.26 $19.26 $14.62 CPT/ HCPCS 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 90732 90733 90734 90735 90740 90743 90744 90746 90747 90748 90749 90780 90781 90782 90783 90784 90788 90799 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90816 90817 90818 90819 90821 90822 90823 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00133 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50812 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 90939 90940 90945 90947 90989 90993 90997 90999 91000 91010 91011 91012 91020 91030 91034 91035 91037 91038 91040 91052 91055 91060 91065 91100 91105 91110 91120 91122 91123 91132 91133 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI S S S S S S S S S S S X S S E E E S E N N N S A S E E E E E E E E S E N N S E B B E B X X X X X X X S X X X X X X X X X T T T N X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................... Hemodialysis study, transcut ................... Hemodialysis access study ..................... Dialysis, one evaluation ........................... Dialysis, repeated eval ............................ Dialysis training, complete ....................... Dialysis training, incompl ......................... Hemoperfusion ......................................... Dialysis procedure ................................... Esophageal intubation ............................. Esophagus motility study ......................... Esophagus motility study ......................... Esophagus motility study ......................... Gastric motility ......................................... Acid perfusion of esophagus ................... Gastroesophageal reflux test ................... G-esoph reflx tst w/electrod ..................... Esoph imped function test ....................... Esoph imped funct test > 1h ................... Esoph balloon distension tst .................... Gastric analysis test ................................ Gastric intubation for smear .................... Gastric saline load test ............................ Breath hydrogen test ............................... Pass intestine bleeding tube ................... Gastric intubation treatment .................... Gi tract capsule endoscopy ..................... Rectal sensation test ............................... Anal pressure record ............................... Irrigate fecal impaction ............................ Electrogastrography ................................. Electrogastrography w/test ...................... 0322 0323 0323 0323 0323 0323 0324 0324 0325 0325 0325 0374 0323 0320 .................... .................... .................... 0323 .................... .................... .................... .................... 0322 .................... 0321 .................... .................... .................... .................... .................... .................... .................... .................... 0170 .................... .................... .................... 0170 .................... .................... .................... .................... .................... 0361 0361 0361 0361 0361 0361 0361 1506 0361 0361 0360 0361 0360 0360 0360 0360 0360 0142 0156 0156 .................... 0360 0360 1.2319 1.6227 1.6227 1.6227 1.6227 1.6227 2.0997 2.0997 1.3189 1.3189 1.3189 1.0414 1.6227 5.3765 .................... .................... .................... 1.6227 .................... .................... .................... .................... 1.2319 .................... 1.3579 .................... .................... .................... .................... .................... .................... .................... .................... 5.8994 .................... .................... .................... 5.8994 .................... .................... .................... .................... .................... 3.6216 3.6216 3.6216 3.6216 3.6216 3.6216 3.6216 .................... 3.6216 3.6216 1.4739 3.6216 1.4739 1.4739 1.4739 1.4739 1.4739 9.3487 2.5751 2.5751 .................... 1.4739 1.4739 $73.10 $96.30 $96.30 $96.30 $96.30 $96.30 $124.60 $124.60 $78.27 $78.27 $78.27 $61.80 $96.30 $319.06 .................... .................... .................... $96.30 .................... .................... .................... .................... $73.10 .................... $80.58 .................... .................... .................... .................... .................... .................... .................... .................... $350.09 .................... .................... .................... $350.09 .................... .................... .................... .................... .................... $214.92 $214.92 $214.92 $214.92 $214.92 $214.92 $214.92 $450.00 $214.92 $214.92 $87.47 $214.92 $87.47 $87.47 $87.47 $87.47 $87.47 $554.78 $152.81 $152.81 .................... $87.47 $87.47 .................... $20.08 $20.08 $20.08 $20.08 $20.08 .................... .................... $17.10 $17.10 $17.10 .................... $20.08 $80.06 .................... .................... .................... $20.08 .................... .................... .................... .................... .................... .................... $21.71 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 .................... $83.23 $83.23 $34.98 $83.23 $34.98 $34.98 $34.98 $34.98 $34.98 $152.78 $40.52 $40.52 .................... $34.98 $34.98 $14.62 $19.26 $19.26 $19.26 $19.26 $19.26 $24.92 $24.92 $15.65 $15.65 $15.65 $12.36 $19.26 $63.81 .................... .................... .................... $19.26 .................... .................... .................... .................... $14.62 .................... $16.12 .................... .................... .................... .................... .................... .................... .................... .................... $70.02 .................... .................... .................... $70.02 .................... .................... .................... .................... .................... $42.98 $42.98 $42.98 $42.98 $42.98 $42.98 $42.98 $90.00 $42.98 $42.98 $17.49 $42.98 $17.49 $17.49 $17.49 $17.49 $17.49 $110.96 $30.56 $30.56 .................... $17.49 $17.49 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00134 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50813 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 91299 92002 92004 92012 92014 92015 92018 92019 92020 92060 92065 92070 92081 92082 92083 92100 92120 92130 92135 92136 92140 92225 92226 92230 92235 92240 92250 92260 92265 92270 92275 92283 92284 92285 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 92396 92499 92502 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI X V V V V E T T S S S N S S S N S S S S S S S T S S S S S S S S S S S S E X X X E X X X X X S N E E E X X X X X E X E E E E E E S T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ............................. Orthoptic/pleoptic training ........................ Fitting of contact lens .............................. Visual field examination(s) ....................... Visual field examination(s) ....................... Visual field examination(s) ....................... Serial tonometry exam(s) ........................ Tonography & eye evaluation .................. Water provocation tonography ................ Opthalmic dx imaging .............................. Ophthalmic biometry ................................ Glaucoma provocative tests .................... Special eye exam, initial .......................... Special eye exam, subsequent ............... Eye exam with photos ............................. Eye exam with photos ............................. Icg angiography ....................................... Eye exam with photos ............................. Ophthalmoscopy/dynamometry ............... Eye muscle evaluation ............................. Electro-oculography ................................. Electroretinography .................................. Color vision examination ......................... Dark adaptation eye exam ...................... 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 ................................ Supply of contact lenses ......................... Eye service or procedure ........................ Ear and throat examination ..................... 0360 0601 0601 0600 0601 .................... 0699 0699 0230 0230 0698 .................... 0230 0230 0230 .................... 0230 0230 0230 0698 0698 0230 0230 0699 0231 0231 0230 0698 0230 0230 0231 0230 0698 0230 0698 0698 .................... 0362 0362 0362 .................... 0362 0362 0362 0362 0362 0230 .................... .................... .................... .................... 0362 0362 0362 0362 0362 .................... 0362 .................... .................... .................... .................... .................... .................... 0230 0251 1.4739 1.0038 1.0038 0.8688 1.0038 .................... 10.0177 10.0177 0.7858 0.7858 1.2438 .................... 0.7858 0.7858 0.7858 .................... 0.7858 0.7858 0.7858 1.2438 1.2438 0.7858 0.7858 10.0177 1.9278 1.9278 0.7858 1.2438 0.7858 0.7858 1.9278 0.7858 1.2438 0.7858 1.2438 1.2438 .................... 2.6607 2.6607 2.6607 .................... 2.6607 2.6607 2.6607 2.6607 2.6607 0.7858 .................... .................... .................... .................... 2.6607 2.6607 2.6607 2.6607 2.6607 .................... 2.6607 .................... .................... .................... .................... .................... .................... 0.7858 2.0101 $87.47 $59.57 $59.57 $51.56 $59.57 .................... $594.48 $594.48 $46.63 $46.63 $73.81 .................... $46.63 $46.63 $46.63 .................... $46.63 $46.63 $46.63 $73.81 $73.81 $46.63 $46.63 $594.48 $114.40 $114.40 $46.63 $73.81 $46.63 $46.63 $114.40 $46.63 $73.81 $46.63 $73.81 $73.81 .................... $157.89 $157.89 $157.89 .................... $157.89 $157.89 $157.89 $157.89 $157.89 $46.63 .................... .................... .................... .................... $157.89 $157.89 $157.89 $157.89 $157.89 .................... $157.89 .................... .................... .................... .................... .................... .................... $46.63 $119.29 $34.98 .................... .................... .................... .................... .................... .................... .................... $14.97 $14.97 $16.55 .................... $14.97 $14.97 $14.97 .................... $14.97 $14.97 $14.97 $16.55 $16.55 $14.97 $14.97 .................... $44.61 $44.61 $14.97 $16.55 $14.97 $14.97 $44.61 $14.97 $16.55 $14.97 $16.55 $16.55 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.97 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.97 .................... $17.49 $11.91 $11.91 $10.31 $11.91 .................... $118.90 $118.90 $9.33 $9.33 $14.76 .................... $9.33 $9.33 $9.33 .................... $9.33 $9.33 $9.33 $14.76 $14.76 $9.33 $9.33 $118.90 $22.88 $22.88 $9.33 $14.76 $9.33 $9.33 $22.88 $9.33 $14.76 $9.33 $14.76 $14.76 .................... $31.58 $31.58 $31.58 .................... $31.58 $31.58 $31.58 $31.58 $31.58 $9.33 .................... .................... .................... .................... $31.58 $31.58 $31.58 $31.58 $31.58 .................... $31.58 .................... .................... .................... .................... .................... .................... $9.33 $23.86 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00135 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50814 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 92504 92506 92507 92508 92510 92511 92512 92516 92520 92526 92531 92532 92533 92534 92541 92542 92543 92544 92545 92546 92547 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 92586 92587 92588 92590 92591 92592 92593 92594 92595 92596 92597 92601 92602 92603 92604 92605 92606 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N A A A E T X X X A N N N N X X X X X X X X E X X X X X E E X X X X X X X X X X X X X X X X X X S S X X E E E E E E X A X X X X A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................. Positional nystagmus test ........................ Caloric vestibular test .............................. Optokinetic nystagmus test ..................... Oscillating tracking test ............................ Sinusoidal rotational test ......................... Supplemental electrical test ..................... 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, limit ....................... 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 .......................... Voice Prosthetic Evaluation ..................... 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 ..................... .................... .................... .................... .................... .................... 0071 0363 0660 0660 .................... .................... .................... .................... .................... 0363 0363 0660 0363 0363 0660 0363 0660 .................... 0364 0365 0364 0364 0365 .................... .................... 0364 0364 0364 0364 0364 0364 0364 0364 0364 0365 0364 0364 0364 0366 0365 0365 0364 0660 0216 0218 0363 0363 .................... .................... .................... .................... .................... .................... 0364 .................... 0366 0366 0366 0366 .................... .................... .................... .................... .................... .................... .................... 0.7915 0.9128 1.6419 1.6419 .................... .................... .................... .................... .................... 0.9128 0.9128 1.6419 0.9128 0.9128 1.6419 0.9128 1.6419 .................... 0.4708 1.2356 0.4708 0.4708 1.2356 .................... .................... 0.4708 0.4708 0.4708 0.4708 0.4708 0.4708 0.4708 0.4708 0.4708 1.2356 0.4708 0.4708 0.4708 1.7743 1.2356 1.2356 0.4708 1.6419 2.672 1.1408 0.9128 0.9128 .................... .................... .................... .................... .................... .................... 0.4708 .................... 1.7743 1.7743 1.7743 1.7743 .................... .................... .................... .................... .................... .................... .................... $46.97 $54.17 $97.44 $97.44 .................... .................... .................... .................... .................... $54.17 $54.17 $97.44 $54.17 $54.17 $97.44 $54.17 $97.44 .................... $27.94 $73.32 $27.94 $27.94 $73.32 .................... .................... $27.94 $27.94 $27.94 $27.94 $27.94 $27.94 $27.94 $27.94 $27.94 $73.32 $27.94 $27.94 $27.94 $105.29 $73.32 $73.32 $27.94 $97.44 $158.56 $67.70 $54.17 $54.17 .................... .................... .................... .................... .................... .................... $27.94 .................... $105.29 $105.29 $105.29 $105.29 .................... .................... .................... .................... .................... .................... .................... $11.31 $17.44 $30.66 $30.66 .................... .................... .................... .................... .................... $17.44 $17.44 $30.66 $17.44 $17.44 $30.66 $17.44 $30.66 .................... $9.06 $18.95 $9.06 $9.06 $18.95 .................... .................... $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $18.95 $9.06 $9.06 $9.06 $30.04 $18.95 $18.95 $9.06 $30.66 .................... .................... $17.44 $17.44 .................... .................... .................... .................... .................... .................... $9.06 .................... $30.04 $30.04 $30.04 $30.04 .................... .................... .................... .................... .................... .................... .................... $9.39 $10.83 $19.49 $19.49 .................... .................... .................... .................... .................... $10.83 $10.83 $19.49 $10.83 $10.83 $19.49 $10.83 $19.49 .................... $5.59 $14.66 $5.59 $5.59 $14.66 .................... .................... $5.59 $5.59 $5.59 $5.59 $5.59 $5.59 $5.59 $5.59 $5.59 $14.66 $5.59 $5.59 $5.59 $21.06 $14.66 $14.66 $5.59 $19.49 $31.71 $13.54 $10.83 $10.83 .................... .................... .................... .................... .................... .................... $5.59 .................... $21.06 $21.06 $21.06 $21.06 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00136 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50815 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 92979 92980 92981 92982 92984 92986 92987 92990 92992 92993 92995 92996 92997 92998 93000 93005 93010 93012 93014 93015 93016 93017 93018 93024 93025 93040 93041 93042 93224 93225 93226 93227 93230 93231 93232 93233 93235 93236 93237 93268 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A E A E A E X N X X S S S S C C T T C T S S T T T T T T T C C T T T T B S A N B B B X B X X B S B B X X B B X X B B X B B ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... 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 .......................... 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 .................................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0364 .................... 0364 0364 0094 0094 0679 0679 .................... .................... 0676 0103 .................... 0676 0670 0416 0104 0104 0083 0083 0083 0083 0083 .................... .................... 0082 0082 0081 0081 .................... 0099 .................... .................... .................... .................... .................... 0100 .................... 0100 0100 .................... 0099 .................... .................... 0097 0097 .................... .................... 0097 0097 .................... .................... 0097 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.4708 .................... 0.4708 0.4708 2.5363 2.5363 5.5774 5.5774 .................... .................... 2.4105 14.7142 .................... 2.4105 25.4131 19.5542 79.0094 79.0094 50.8925 50.8925 50.8925 50.8925 50.8925 .................... .................... 85.0126 85.0126 34.4473 34.4473 .................... 0.3821 .................... .................... .................... .................... .................... 2.4968 .................... 2.4968 2.4968 .................... 0.3821 .................... .................... 1.0223 1.0223 .................... .................... 1.0223 1.0223 .................... .................... 1.0223 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $27.94 .................... $27.94 $27.94 $150.51 $150.51 $330.98 $330.98 .................... .................... $143.05 $873.18 .................... $143.05 $1,508.09 $1,160.40 $4,688.65 $4,688.65 $3,020.11 $3,020.11 $3,020.11 $3,020.11 $3,020.11 .................... .................... $5,044.90 $5,044.90 $2,044.21 $2,044.21 .................... $22.67 .................... .................... .................... .................... .................... $148.17 .................... $148.17 $148.17 .................... $22.67 .................... .................... $60.67 $60.67 .................... .................... $60.67 $60.67 .................... .................... $60.67 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.06 .................... $9.06 $9.06 $47.62 $47.62 $95.30 $95.30 .................... .................... .................... $223.63 .................... .................... $472.46 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,085.20 $1,085.20 .................... .................... .................... .................... .................... .................... .................... .................... .................... $41.44 .................... $41.44 $41.44 .................... .................... .................... .................... $23.79 $23.79 .................... .................... $23.79 $23.79 .................... .................... $23.79 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $5.59 .................... $5.59 $5.59 $30.10 $30.10 $66.20 $66.20 .................... .................... $28.61 $174.64 .................... $28.61 $301.62 $232.08 $937.73 $937.73 $604.02 $604.02 $604.02 $604.02 $604.02 .................... .................... $1,008.98 $1,008.98 $408.84 $408.84 .................... $4.53 .................... .................... .................... .................... .................... $29.63 .................... $29.63 $29.63 .................... $4.53 .................... .................... $12.13 $12.13 .................... .................... $12.13 $12.13 .................... .................... $12.13 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00137 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50816 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 93270 93271 93272 93278 93303 93304 93307 93308 93312 93313 93314 93315 93316 93317 93318 93320 93321 93325 93350 93501 93503 93505 93508 93510 93511 93514 93524 93526 93527 93528 93529 93530 93531 93532 93533 93539 93540 93541 93542 93543 93544 93545 93555 93556 93561 93562 93571 93572 93580 93581 93600 93602 93603 93609 93610 93612 93613 93615 93616 93618 93619 93620 93621 93622 93623 93624 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI X X B S S S S S S S N S S N S S S S S T T T T T T T T T T T T T T T T N N N N N N N N N N N S S T T T T T T T T T T T T T T T T T T ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ECG recording ......................................... Ecg/monitoring and analysis .................... Ecg/review, interpret only ........................ ECG/signal-averaged ............................... Echo transthoracic ................................... Echo transthoracic ................................... Echo exam of heart ................................. Echo exam of heart ................................. Echo transesophageal ............................. Echo transesophageal ............................. Echo transesophageal ............................. Echo transesophageal ............................. Echo transesophageal ............................. Echo transesophageal ............................. Echo transesophageal intraop ................. Doppler echo exam, heart ....................... Doppler echo exam, heart ....................... Doppler color flow add-on ....................... Echo transthoracic ................................... Right heart catheterization ....................... Insert/place heart catheter ....................... Biopsy of heart lining ............................... Cath placement, angiography .................. 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 catheterization ....................... Rt 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 .............................. Cardiac output measurement .................. Cardiac output measurement .................. Heart flow reserve measure .................... Heart flow reserve measure .................... Transcath closure of asd ......................... Transcath closure of vsd ......................... Bundle of His recording ........................... Intra-atrial recording ................................. Right ventricular recording ....................... Map tachycardia, add-on ......................... Intra-atrial pacing ..................................... Intraventricular pacing ............................. Electrophys map 3d, add-on ................... Esophageal recording .............................. Esophageal recording .............................. Heart rhythm pacing ................................ Electrophysiology evaluation ................... Electrophysiology evaluation ................... Electrophysiology evaluation ................... Electrophysiology evaluation ................... Stimulation, pacing heart ......................... Electrophysiologic study .......................... 0097 0097 .................... 0099 0269 0697 0269 0697 0270 0270 .................... 0270 0270 .................... 0270 0671 0697 0697 0269 0080 0103 0103 0080 000 0080 0080 0080 0080 0080 0080 0080 0080 0080 0080 0080 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0670 0416 0434 0434 0087 0087 0087 0087 0087 0087 0087 0087 0087 0087 0085 0085 0085 0085 0087 0085 1.0223 1.0223 .................... 0.3821 3.2437 1.5357 3.2437 1.5357 6.0192 6.0192 .................... 6.0192 6.0192 .................... 6.0192 1.7028 1.5357 1.5357 3.2437 37.1361 14.7142 14.7142 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 37.1361 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 25.4131 19.5542 90.7877 90.7877 30.7101 30.7101 30.7101 30.7101 30.7101 30.7101 30.7101 30.7101 30.7101 30.7101 35.1882 35.1882 35.1882 35.1882 30.7101 35.1882 $60.67 $60.67 .................... $22.67 $192.49 $91.13 $192.49 $91.13 $357.20 $357.20 .................... $357.20 $357.20 .................... $357.20 $101.05 $91.13 $91.13 $192.49 $2,203.77 $873.18 $873.18 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 $2,203.77 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,508.09 $1,160.40 $5,387.61 $5,387.61 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $1,822.43 $2,088.17 $2,088.17 $2,088.17 $2,088.17 $1,822.43 $2,088.17 $23.79 $23.79 .................... .................... $76.99 $36.45 $76.99 $36.45 $142.88 $142.88 .................... $142.88 $142.88 .................... $142.88 $40.42 $36.45 $36.45 $76.99 $838.92 $223.63 $223.63 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 $838.92 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $472.46 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $426.25 $426.25 $426.25 $426.25 .................... $426.25 $12.13 $12.13 .................... $4.53 $38.50 $18.23 $38.50 $18.23 $71.44 $71.44 .................... $71.44 $71.44 .................... $71.44 $20.21 $18.23 $18.23 $38.50 $440.75 $174.64 $174.64 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 $440.75 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $301.62 $232.08 $1,077.52 $1,077.52 $364.49 $364.49 $364.49 $364.49 $364.49 $364.49 $364.49 $364.49 $364.49 $364.49 $417.63 $417.63 $417.63 $417.63 $364.49 $417.63 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00138 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50817 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 93631 93640 93641 93642 93650 93651 93652 93660 93662 93668 93701 93720 93721 93722 93724 93727 93731 93732 93733 93734 93735 93736 93740 93741 93742 93743 93744 93745 93760 93762 93770 93784 93786 93788 93790 93797 93798 93799 93875 93880 93882 93886 93888 93890 93892 93893 93922 93923 93924 93925 93926 93930 93931 93965 93970 93971 93975 93976 93978 93979 93980 93981 93990 94010 94014 94015 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI T S S S T T T S S E S B X B S S S S S S S S X S S S S S E E N E X X B S S S S S S S S S S S S S S S S S S S S S S S S S S S S X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Heart pacing, mapping ............................ Evaluation heart device ........................... Electrophysiology evaluation ................... Electrophysiology evaluation ................... Ablate heart dysrhythm focus .................. Ablate heart dysrhythm focus .................. Ablate heart dysrhythm focus .................. Tilt table evaluation .................................. Intracardiac ecg (ice) ............................... Peripheral vascular rehab ........................ Bioimpedance, thoracic ........................... Total body plethysmography ................... Plethysmography tracing ......................... Plethysmography report ........................... Analyze pacemaker system ..................... Analyze ilr system .................................... Analyze pacemaker system ..................... Analyze pacemaker system ..................... Telephone analy, pacemaker .................. Analyze pacemaker system ..................... Analyze pacemaker system ..................... Telephonic analy, pacemaker .................. Temperature gradient studies .................. Analyze ht pace device sngl .................... Analyze ht pace device sngl .................... Analyze ht pace device dual ................... Analyze ht pace device dual ................... Set-up cardiovert-defibrill ......................... Cephalic thermogram .............................. Peripheral thermogram ............................ Measure venous pressure ....................... Ambulatory BP monitoring ....................... Ambulatory BP recording ......................... Ambulatory BP analysis ........................... Review/report BP recording ..................... Cardiac rehab .......................................... Cardiac rehab/monitor ............................. Cardiovascular procedure ........................ Extracranial study .................................... Extracranial study .................................... Extracranial study .................................... Intracranial study ..................................... Intracranial study ..................................... Tcd, vasoreactivity study ......................... Tcd, emboli detect w/o inj ........................ Tcd, emboli detect w/inj ........................... Extremity study ........................................ Extremity study ........................................ Extremity study ........................................ Lower extremity study .............................. Lower extremity study .............................. Upper extremity study .............................. Upper extremity study .............................. Extremity study ........................................ Extremity study ........................................ Extremity study ........................................ Vascular study ......................................... Vascular study ......................................... Vascular study ......................................... Vascular study ......................................... Penile vascular study ............................... Penile vascular study ............................... Doppler flow testing ................................. Breathing capacity test ............................ Patient recorded spirometry .................... Patient recorded spirometry .................... 0087 0084 0084 0084 0086 0086 0086 0101 0670 .................... 0099 .................... 0368 .................... 0690 0690 0690 0690 0690 0690 0690 0690 0368 0689 0689 0689 0689 0689 .................... .................... .................... .................... 0097 0097 .................... 0095 0095 0096 0096 0267 0267 0267 0266 0266 0266 0266 0096 0096 0096 0267 0266 0267 0266 0096 0267 0266 0267 0267 0266 0266 0267 0266 0266 0368 0367 0367 30.7101 10.0205 10.0205 10.0205 44.2596 44.2596 44.2596 4.2787 25.4131 .................... 0.3821 .................... 0.9761 .................... 0.3755 0.3755 0.3755 0.3755 0.3755 0.3755 0.3755 0.3755 0.9761 0.5735 0.5735 0.5735 0.5735 0.5735 .................... .................... .................... .................... 1.0223 1.0223 .................... 0.5885 0.5885 1.6307 1.6307 2.6327 2.6327 2.6327 1.6393 1.6393 1.6393 1.6393 1.6307 1.6307 1.6307 2.6327 1.6393 2.6327 1.6393 1.6307 2.6327 1.6393 2.6327 2.6327 1.6393 1.6393 2.6327 1.6393 1.6393 0.9761 0.6659 0.6659 $1,822.43 $594.65 $594.65 $594.65 $2,626.50 $2,626.50 $2,626.50 $253.91 $1,508.09 .................... $22.67 .................... $57.92 .................... $22.28 $22.28 $22.28 $22.28 $22.28 $22.28 $22.28 $22.28 $57.92 $34.03 $34.03 $34.03 $34.03 $34.03 .................... .................... .................... .................... $60.67 $60.67 .................... $34.92 $34.92 $96.77 $96.77 $156.23 $156.23 $156.23 $97.28 $97.28 $97.28 $97.28 $96.77 $96.77 $96.77 $156.23 $97.28 $156.23 $97.28 $96.77 $156.23 $97.28 $156.23 $156.23 $97.28 $97.28 $156.23 $97.28 $97.28 $57.92 $39.52 $39.52 .................... .................... .................... .................... $833.33 $833.33 $833.33 $101.56 $472.46 .................... .................... .................... $23.16 .................... $8.91 $8.91 $8.91 $8.91 $8.91 $8.91 $8.91 $8.91 $23.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... $23.79 $23.79 .................... $13.96 $13.96 $38.70 $38.70 $62.18 $62.18 $62.18 $38.91 $38.91 $38.91 $38.91 $38.70 $38.70 $38.70 $62.18 $38.91 $62.18 $38.91 $38.70 $62.18 $38.91 $62.18 $62.18 $38.91 $38.91 $62.18 $38.91 $38.91 $23.16 $14.80 $14.80 $364.49 $118.93 $118.93 $118.93 $525.30 $525.30 $525.30 $50.78 $301.62 .................... $4.53 .................... $11.58 .................... $4.46 $4.46 $4.46 $4.46 $4.46 $4.46 $4.46 $4.46 $11.58 $6.81 $6.81 $6.81 $6.81 $6.81 .................... .................... .................... .................... $12.13 $12.13 .................... $6.98 $6.98 $19.35 $19.35 $31.25 $31.25 $31.25 $19.46 $19.46 $19.46 $19.46 $19.35 $19.35 $19.35 $31.25 $19.46 $31.25 $19.46 $19.35 $31.25 $19.46 $31.25 $31.25 $19.46 $19.46 $31.25 $19.46 $19.46 $11.58 $7.90 $7.90 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00139 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50818 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 94016 94060 94070 94150 94200 94240 94250 94260 94350 94360 94370 94375 94400 94450 94452 94453 94620 94621 94640 94642 94656 94657 94660 94662 94664 94667 94668 94680 94681 94690 94720 94725 94750 94760 94761 94762 94770 94772 94799 95004 95010 95015 95024 95027 95028 95044 95052 95056 95060 95065 95070 95071 95075 95078 95115 95117 95120 95125 95130 95131 95132 95133 95134 95144 95145 95146 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A X X X X X X X X X X X X X X X X X S S S S S S S S S X X X X X X N N N X X X X X X X X X X X X X X X X X X X X B B B B B B B X X X ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Review patient spirometry ....................... Evaluation of wheezing ............................ Evaluation of wheezing ............................ Vital capacity test ..................................... Lung function test (MBC/MVV) ................ Residual lung capacity ............................. Expired gas collection .............................. Thoracic gas volume ............................... Lung nitrogen washout curve .................. Measure airflow resistance ...................... Breath airway closing volume .................. Respiratory flow volume loop .................. CO2 breathing response curve ............... Hypoxia response curve .......................... Hast w/report ........................................... Hast w/oxygen titrate ............................... Pulmonary stress test/simple ................... Pulm stress test/complex ......................... Airway inhalation treatment ..................... Aerosol inhalation treatment .................... Initial ventilator mgmt ............................... Continued ventilator mgmt ....................... Pos airway pressure, CPAP .................... Neg press ventilation, cnp ....................... Aerosol or vapor inhalations .................... Chest wall manipulation ........................... Chest wall manipulation ........................... Exhaled air analysis, o2 .......................... Exhaled air analysis, o2/co2 .................... Exhaled air analysis ................................. Monoxide diffusing capacity .................... Membrane diffusion capacity ................... Pulmonary compliance study ................... Measure blood oxygen level .................... Measure blood oxygen level .................... Measure blood oxygen level .................... Exhaled carbon dioxide test .................... Breath recording, infant ........................... Pulmonary service/procedure .................. Percut allergy skin tests .......................... Percut allergy titrate test .......................... Id allergy titrate-drug/bug ......................... Id allergy test, drug/bug ........................... Skin end point titration ............................. Id allergy test-delayed type ..................... Allergy patch tests ................................... Photo patch test ....................................... 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 ......................... .................... 0368 0369 0367 0367 0368 0367 0367 0367 0367 0367 0367 0367 0368 0368 0368 0368 0369 0077 0078 0079 0079 0068 0079 0077 0077 0077 0367 0368 0368 0368 0368 0368 .................... .................... .................... 0367 0369 0367 0381 0381 0381 0381 0381 0381 0381 0381 0370 0370 0381 0369 0369 0361 0370 0352 0353 .................... .................... .................... .................... .................... .................... .................... 0353 0353 0359 .................... 0.9761 2.7519 0.6659 0.6659 0.9761 0.6659 0.6659 0.6659 0.6659 0.6659 0.6659 0.6659 0.9761 0.9761 0.9761 0.9761 2.7519 0.3444 1.0236 2.3482 2.3482 1.2293 2.3482 0.3444 0.3444 0.3444 0.6659 0.9761 0.9761 0.9761 0.9761 0.9761 .................... .................... .................... 0.6659 2.7519 0.6659 0.1884 0.1884 0.1884 0.1884 0.1884 0.1884 0.1884 0.1884 1.1232 1.1232 0.1884 2.7519 2.7519 3.6216 1.1232 0.1413 0.3954 .................... .................... .................... .................... .................... .................... .................... 0.3954 0.3954 0.8312 .................... $57.92 $163.31 $39.52 $39.52 $57.92 $39.52 $39.52 $39.52 $39.52 $39.52 $39.52 $39.52 $57.92 $57.92 $57.92 $57.92 $163.31 $20.44 $60.74 $139.35 $139.35 $72.95 $139.35 $20.44 $20.44 $20.44 $39.52 $57.92 $57.92 $57.92 $57.92 $57.92 .................... .................... .................... $39.52 $163.31 $39.52 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $66.65 $66.65 $11.18 $163.31 $163.31 $214.92 $66.65 $8.39 $23.46 .................... .................... .................... .................... .................... .................... .................... $23.46 $23.46 $49.33 .................... $23.16 $44.18 $14.80 $14.80 $23.16 $14.80 $14.80 $14.80 $14.80 $14.80 $14.80 $14.80 $23.16 $23.16 $23.16 $23.16 $44.18 $7.74 $14.55 .................... .................... $29.18 .................... $7.74 $7.74 $7.74 $14.80 $23.16 $23.16 $23.16 $23.16 $23.16 .................... .................... .................... $14.80 $44.18 $14.80 $2.35 $2.35 $2.35 $2.35 $2.35 $2.35 $2.35 $2.35 .................... .................... $2.35 $44.18 $44.18 $83.23 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $11.58 $32.66 $7.90 $7.90 $11.58 $7.90 $7.90 $7.90 $7.90 $7.90 $7.90 $7.90 $11.58 $11.58 $11.58 $11.58 $32.66 $4.09 $12.15 $27.87 $27.87 $14.59 $27.87 $4.09 $4.09 $4.09 $7.90 $11.58 $11.58 $11.58 $11.58 $11.58 .................... .................... .................... $7.90 $32.66 $7.90 $2.24 $2.24 $2.24 $2.24 $2.24 $2.24 $2.24 $2.24 $13.33 $13.33 $2.24 $32.66 $32.66 $42.98 $13.33 $1.68 $4.69 .................... .................... .................... .................... .................... .................... .................... $4.69 $4.69 $9.87 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00140 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50819 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 95147 95148 95149 95165 95170 95180 95199 95250 95805 95806 95807 95808 95810 95811 95812 95813 95816 95819 95822 95824 95827 95829 95830 95831 95832 95833 95834 95851 95852 95857 95858 95860 95861 95863 95864 95867 95868 95869 95870 95872 95875 95900 95903 95904 95920 95921 95922 95923 95925 95926 95927 95928 95929 95930 95933 95934 95936 95937 95950 95951 95953 95954 95955 95956 95957 95958 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI X X X X X X X X S S S S S S S S S S S S S S B A A A A A A S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Sleep study, unattended .......................... Sleep study, attended .............................. Polysomnography, 1-3 ............................. Polysomnography, 4 or more .................. Polysomnography w/cpap ........................ Electroencephalogram (EEG) .................. Eeg, over 1 hour ...................................... Electroencephalogram (EEG) .................. Electroencephalogram (EEG) .................. Sleep electroencephalogram ................... Eeg, cerebral death only ......................... night electroencephalogram .................... Surgery electrocorticogram ...................... Insert electrodes for EEG ........................ Limb muscle testing, manual ................... Hand muscle testing, manual .................. Body muscle testing, manual .................. Body muscle testing, manual .................. Range of motion measurements ............. Range of motion measurements ............. Tensilon test ............................................ Tensilon test & myogram ......................... Muscle test, one limb ............................... Muscle test, 2 limbs ................................. Muscle test, 3 limbs ................................. Muscle test, 4 limbs ................................. Muscle test, head or neck ....................... Muscle test cran nerve bilat .................... Muscle test, thor paraspinal .................... Muscle test, nonparaspinal ...................... Muscle test, one fiber .............................. Limb exercise test .................................... Motor nerve conduction test .................... Motor nerve conduction test .................... Sense nerve conduction test ................... Intraop nerve test add-on ........................ Autonomic nerv function test ................... Autonomic nerv function test ................... Autonomic nerv function test ................... Somatosensory testing ............................ Somatosensory testing ............................ Somatosensory testing ............................ C motor evoked, uppr limbs .................... C motor evoked, lwr limbs ....................... Visual evoked potential test ..................... Blink reflex test ........................................ H-reflex test ............................................. H-reflex test ............................................. Neuromuscular junction test .................... Ambulatory eeg monitoring ...................... EEG monitoring/videorecord .................... EEG monitoring/computer ....................... EEG monitoring/giving drugs ................... EEG during surgery ................................. Eeg monitoring, cable/radio ..................... EEG digital analysis ................................. EEG monitoring/function test ................... 0359 0353 0352 0353 0352 0370 0370 0421 0209 0213 0209 0209 0209 0209 0213 0213 0213 0213 0213 0214 0213 0214 .................... .................... .................... .................... .................... .................... .................... 0218 0215 0218 0218 0218 0218 0218 0218 0215 0215 0218 0215 0215 0215 0215 0216 0218 0218 0218 0216 0216 0216 0218 0218 0216 0215 0215 0215 0218 0209 0209 0209 0214 0213 0209 0214 0213 0.8312 0.3954 0.1413 0.3954 0.1413 1.1232 1.1232 1.66 11.5713 2.2932 11.5713 11.5713 11.5713 11.5713 2.2932 2.2932 2.2932 2.2932 2.2932 1.1353 2.2932 1.1353 .................... .................... .................... .................... .................... .................... .................... 1.1408 0.6115 1.1408 1.1408 1.1408 1.1408 1.1408 1.1408 0.6115 0.6115 1.1408 0.6115 0.6115 0.6115 0.6115 2.672 1.1408 1.1408 1.1408 2.672 2.672 2.672 1.1408 1.1408 2.672 0.6115 0.6115 0.6115 1.1408 11.5713 11.5713 11.5713 1.1353 2.2932 11.5713 1.1353 2.2932 $49.33 $23.46 $8.39 $23.46 $8.39 $66.65 $66.65 $98.51 $686.68 $136.09 $686.68 $686.68 $686.68 $686.68 $136.09 $136.09 $136.09 $136.09 $136.09 $67.37 $136.09 $67.37 .................... .................... .................... .................... .................... .................... .................... $67.70 $36.29 $67.70 $67.70 $67.70 $67.70 $67.70 $67.70 $36.29 $36.29 $67.70 $36.29 $36.29 $36.29 $36.29 $158.56 $67.70 $67.70 $67.70 $158.56 $158.56 $158.56 $67.70 $67.70 $158.56 $36.29 $36.29 $36.29 $67.70 $686.68 $686.68 $686.68 $67.37 $136.09 $686.68 $67.37 $136.09 .................... .................... .................... .................... .................... .................... .................... .................... $274.67 $54.43 $274.67 $274.67 $274.67 $274.67 $54.43 $54.43 $54.43 $54.43 $54.43 $26.94 $54.43 $26.94 .................... .................... .................... .................... .................... .................... .................... .................... $14.51 .................... .................... .................... .................... .................... .................... $14.51 $14.51 .................... $14.51 $14.51 $14.51 $14.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.51 $14.51 $14.51 .................... $274.67 $274.67 $274.67 $26.94 $54.43 $274.67 $26.94 $54.43 $9.87 $4.69 $1.68 $4.69 $1.68 $13.33 $13.33 $19.70 $137.34 $27.22 $137.34 $137.34 $137.34 $137.34 $27.22 $27.22 $27.22 $27.22 $27.22 $13.47 $27.22 $13.47 .................... .................... .................... .................... .................... .................... .................... $13.54 $7.26 $13.54 $13.54 $13.54 $13.54 $13.54 $13.54 $7.26 $7.26 $13.54 $7.26 $7.26 $7.26 $7.26 $31.71 $13.54 $13.54 $13.54 $31.71 $31.71 $31.71 $13.54 $13.54 $31.71 $7.26 $7.26 $7.26 $13.54 $137.34 $137.34 $137.34 $13.47 $27.22 $137.34 $13.47 $27.22 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00141 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50820 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 95961 95962 95965 95966 95967 95970 95971 95972 95973 95974 95975 95978 95979 95990 95991 95999 96000 96001 96002 96003 96004 96100 96105 96110 96111 96115 96117 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI S S T T T S S S S S S S S T T S S S S S E X A X X X X S S S S S E S S S S S N S S S N S S S S T T S N S T T T S N S S S T T T T A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Electrode stimulation, brain ..................... Electrode stim, brain add-on ................... Meg, spontaneous ................................... Meg, evoked, single ................................. 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 addon ................. 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 ........................... Assess lth/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 ............................ Pump refilling, maintenance .................... 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 ........................................ 0216 0216 0430 0430 0430 0218 0692 0692 0692 0692 0692 0692 0692 0125 0125 0215 0216 0216 0218 0215 .................... 0373 .................... 0373 0373 0373 0373 0432 0432 0432 0432 0432 .................... 0116 0116 0116 0116 0117 .................... 0117 0116 0117 .................... 0117 0116 0116 0116 0125 0125 0116 .................... 0116 0016 0015 0015 0001 .................... 0001 0001 0683 0013 0013 0013 0010 .................... .................... 2.672 2.672 11.404 11.404 11.404 1.1408 2.0111 2.0111 2.0111 2.0111 2.0111 2.0111 2.0111 1.9331 1.9331 0.6115 2.672 2.672 1.1408 0.6115 .................... 2.1926 .................... 2.1926 2.1926 2.1926 2.1926 0.6949 0.6949 0.6949 0.6949 0.6949 .................... 1.1453 1.1453 1.1453 1.1453 3.2378 .................... 3.2378 1.1453 3.2378 .................... 3.2378 1.1453 1.1453 1.1453 1.9331 1.9331 1.1453 .................... 1.1453 2.5834 1.6514 1.6514 0.4213 .................... 0.4213 0.4213 1.9006 1.1078 1.1078 1.1078 0.5719 .................... .................... $158.56 $158.56 $676.75 $676.75 $676.75 $67.70 $119.34 $119.34 $119.34 $119.34 $119.34 $119.34 $119.34 $114.72 $114.72 $36.29 $158.56 $158.56 $67.70 $36.29 .................... $130.12 .................... $130.12 $130.12 $130.12 $130.12 $41.24 $41.24 $41.24 $41.24 $41.24 .................... $67.97 $67.97 $67.97 $67.97 $192.14 .................... $192.14 $67.97 $192.14 .................... $192.14 $67.97 $67.97 $67.97 $114.72 $114.72 $67.97 .................... $67.97 $153.31 $98.00 $98.00 $25.00 .................... $25.00 $25.00 $112.79 $65.74 $65.74 $65.74 $33.94 .................... .................... .................... .................... .................... .................... .................... .................... $30.16 $30.16 $30.16 $30.16 $30.16 $30.16 $30.16 .................... .................... $14.51 .................... .................... .................... $14.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $42.54 .................... $42.54 .................... $42.54 .................... $42.54 .................... .................... .................... .................... .................... .................... .................... .................... $33.57 $20.29 $20.29 $7.00 .................... $7.00 $7.00 $25.34 $14.20 $14.20 $14.20 $9.65 .................... .................... $31.71 $31.71 $135.35 $135.35 $135.35 $13.54 $23.87 $23.87 $23.87 $23.87 $23.87 $23.87 $23.87 $22.94 $22.94 $7.26 $31.71 $31.71 $13.54 $7.26 .................... $26.02 .................... $26.02 $26.02 $26.02 $26.02 $8.25 $8.25 $8.25 $8.25 $8.25 .................... $13.59 $13.59 $13.59 $13.59 $38.43 .................... $38.43 $13.59 $38.43 .................... $38.43 $13.59 $13.59 $13.59 $22.94 $22.94 $13.59 .................... $13.59 $30.66 $19.60 $19.60 $5.00 .................... $5.00 $5.00 $22.56 $13.15 $13.15 $13.15 $6.79 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00142 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50821 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A E E A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E E E E S S S S S S S S E B B B ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ................. 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 ....................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0060 0060 0060 0060 0060 0060 0060 0060 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.4935 0.4935 0.4935 0.4935 0.4935 0.4935 0.4935 0.4935 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $29.29 $29.29 $29.29 $29.29 $29.29 $29.29 $29.29 $29.29 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $5.86 $5.86 $5.86 $5.86 $5.86 $5.86 $5.86 $5.86 .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00143 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50822 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 99190 99191 99192 99195 99199 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99231 99232 99233 99234 99235 99236 99238 99239 99241 99242 99243 99244 99245 99251 99252 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI B E E B B B B B B B E N B B B E B B B B N N T E E N B N N C C C X B V V V V V V V V V V B B B B E E E E E E B B B E E V V V V V C C ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 ....................... Anogenital exam, child ............................ Ocular function screen ............................. Visual acuity screen ................................. Induction of vomiting ................................ Hyperbaric oxygen therapy ...................... Regional hypothermia .............................. Total body hypothermia ........................... Special pump services ............................. Special pump services ............................. Special pump services ............................. 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 ..................................... 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 ............................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0191 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0372 .................... 0600 0600 0601 0602 0602 0600 0600 0601 0602 0602 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0600 0600 0601 0602 0602 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.167 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.57 .................... 0.8688 0.8688 1.0038 1.4284 1.4284 0.8688 0.8688 1.0038 1.4284 1.4284 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.8688 0.8688 1.0038 1.4284 1.4284 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.91 .................... .................... .................... .................... .................... .................... .................... .................... .................... $33.83 .................... $51.56 $51.56 $59.57 $84.77 $84.77 $51.56 $51.56 $59.57 $84.77 $84.77 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $51.56 $51.56 $59.57 $84.77 $84.77 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $2.78 .................... .................... .................... .................... .................... .................... .................... .................... .................... $10.09 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1.98 .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.77 .................... $10.31 $10.31 $11.91 $16.95 $16.95 $10.31 $10.31 $11.91 $16.95 $16.95 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $10.31 $10.31 $11.91 $16.95 $16.95 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00144 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50823 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 99358 99359 99360 99361 99362 99371 99372 99373 99374 99375 99377 99378 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI C C C C C C V V V V V V V V V V B N N S N C C C C C C B B B B B B B B B B B B B B B B B B B B B B B N N C C N N B E E B B B B E B E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................... Pt transport, 30-74 min ............................ Pt transport, addl 30 min ......................... Critical care, first hour ............................. Critical care, add=l 30 min ....................... Ped critical care, initial ............................. Ped critical care, subseq ......................... Neonatal critical care ............................... Neonatal critical care ............................... Neonatal critical care ............................... 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 .................... Prolonged serv, w/o contact .................... Prolonged serv, w/o contact .................... Physician standby services ..................... 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 ........................ .................... .................... .................... .................... .................... .................... 0600 0600 0601 0602 0602 0610 0610 0611 0612 0612 .................... .................... .................... 0620 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.8688 0.8688 1.0038 1.4284 1.4284 1.2947 1.2947 2.2718 3.9853 3.9853 .................... .................... .................... 8.2996 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $51.56 $51.56 $59.57 $84.77 $84.77 $76.83 $76.83 $134.82 $236.50 $236.50 .................... .................... .................... $492.52 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $19.48 $19.48 $35.76 $54.12 $54.12 .................... .................... .................... $135.68 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $10.31 $10.31 $11.91 $16.95 $16.95 $15.37 $15.37 $26.96 $47.30 $47.30 .................... .................... .................... $98.50 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00145 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50824 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS 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 ....... A0021 ...... A0080 ...... A0090 ...... A0100 ...... A0110 ...... A0120 ...... A0130 ...... A0140 ...... A0160 ...... A0170 ...... A0180 ...... A0190 ...... A0200 ...... A0210 ...... A0225 ...... A0380 ...... A0382 ...... SI B B E E E E E E E E E E E E E E E E E E E E E E V N C E N S E B B B 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 E E A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... 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 .................. Outside state ambulance serv ................. Noninterest escort in non er .................... Interest escort in non er .......................... Nonemergency transport taxi .................. Nonemergency transport bus .................. Noner transport mini-bus ......................... Noner transport wheelch van .................. Nonemergency transport air .................... Noner transport case worker ................... Noner transport parking fees ................... Noner transport lodgng recip ................... Noner transport meals recip .................... Noner transport lodgng escrt ................... Noner transport meals escort .................. Neonatal emergency transport ................ Basic life support mileage ....................... Basic support routine suppls ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0600 .................... .................... .................... .................... 0094 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.8688 .................... .................... .................... .................... 2.5363 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $51.56 .................... .................... .................... .................... $150.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $47.62 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $10.31 .................... .................... .................... .................... $30.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00146 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50825 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A0384 A0390 A0392 A0394 A0396 A0398 A0420 A0422 A0424 A0425 A0426 A0427 A0428 A0429 A0430 A0431 A0432 A0433 A0434 A0435 A0436 A0800 A0888 A0999 A4206 A4207 A4208 A4209 A4210 A4211 A4212 A4213 A4215 A4216 A4217 A4220 A4221 A4222 A4223 A4230 A4231 A4232 A4244 A4245 A4246 A4247 A4248 A4250 A4253 A4254 A4255 A4256 A4257 A4258 A4259 A4260 A4261 A4262 A4263 A4265 A4266 A4267 A4268 A4269 A4270 A4280 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A A A A A A A A A A A A A A A A A A A A A B E A E E E E E B B E E A A N Y Y E Y Y Y E E E E N E Y Y Y Y Y Y Y E E N N Y E E E E A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Bls defibrillation supplies ......................... Advanced life support mileag .................. Als defibrillation supplies ......................... Als IV drug therapy supplies ................... Als esophageal intub suppls .................... Als routine disposble suppls .................... Ambulance waiting 1/2 hr ........................ Ambulance 02 life sustaining ................... Extra ambulance attendant ...................... Ground mileage ....................................... Als 1 ......................................................... ALS1-emergency ..................................... bls ............................................................ BLS-emergency ....................................... Fixed wing air transport ........................... Rotary wing air transport ......................... PI volunteer ambulance co ...................... als 2 ......................................................... Specialty care transport ........................... Fixed wing air mileage ............................. Rotary wing air mileage ........................... Amb trans 7pm-7am ................................ Noncovered ambulance mileage ............. Unlisted ambulance service ..................... 1 CC sterile syringe&needle .................... 2 CC sterile syringe&needle .................... 3 CC sterile syringe&needle .................... 5+ CC sterile syringe&needle .................. Nonneedle injection device ...................... Supp for self-adm injections .................... Non coring needle or stylet ..................... 20+ CC syringe only ................................ Sterile needle ........................................... Sterile water/saline, 10 ml ....................... Sterile water/saline, 500 ml ..................... Infusion pump refill kit .............................. Maint drug infus cath per wk ................... Drug infusion pump supplies ................... Infusion supplies w/o pump ..................... Infus insulin pump non needl .................. Infusion insulin pump needle ................... Syringe w/needle insulin 3cc ................... Alcohol or peroxide per pint .................... Alcohol wipes per box ............................. Betadine/phisohex solution ...................... Betadine/iodine swabs/wipes ................... Chlorhexidine antisept ............................. Urine reagent strips/tablets ...................... Blood glucose/reagent strips ................... Battery for glucose monitor ..................... Glucose monitor platforms ....................... Calibrator solution/chips .......................... Replace Lensshield Cartridge ................. Lancet device each .................................. Lancets per box ....................................... Levonorgestrel implant ............................ Cervical cap contraceptive ...................... Temporary tear duct plug ........................ Permanent tear duct plug ........................ Paraffin ..................................................... Diaphragm ............................................... Male condom ........................................... Female condom ....................................... Spermicide ............................................... Disposable endoscope sheath ................ Brst prsths adhsv attchmnt ...................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00147 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50826 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A4281 A4282 A4283 A4284 A4285 A4286 A4290 A4300 A4301 A4305 A4306 A4310 A4311 A4312 A4313 A4314 A4315 A4316 A4320 A4321 A4322 A4326 A4327 A4328 A4330 A4331 A4332 A4333 A4334 A4335 A4338 A4340 A4344 A4346 A4348 A4349 A4351 A4352 A4353 A4354 A4355 A4356 A4357 A4358 A4359 A4361 A4362 A4364 A4365 A4366 A4367 A4368 A4369 A4371 A4372 A4373 A4375 A4376 A4377 A4378 A4379 A4380 A4381 A4382 A4383 A4384 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI E E E E E E B 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 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Replacement breastpump tube ............... Replacement breastpump adpt ............... Replacement breastpump cap ................. Replcmnt breast pump shield .................. Replcmnt breast pump bottle .................. Replcmnt breastpump lok ring ................. Sacral nerve stim test lead ...................... Cath impl vasc access portal .................. Implantable access syst perc .................. Drug delivery system >=50 ML ............... Drug delivery system <=5 ML ................. Insert tray w/o bag/cath ........................... Catheter w/o bag 2-way latex .................. Cath w/o bag 2-way silicone ................... Catheter w/bag 3-way .............................. Cath w/drainage 2-way latex ................... Cath w/drainage 2-way silcne ................. Cath w/drainage 3-way ............................ Irrigation tray ............................................ Cath therapeutic irrig agent ..................... Irrigation syringe ...................................... Male external catheter ............................. Fem urinary collect dev cup .................... Fem urinary collect pouch ....................... Stool collection pouch .............................. Extension drainage tubing ....................... Lubricant for cath insertion ...................... Urinary cath anchor device ...................... Urinary cath leg strap .............................. Incontinence supply ................................. Indwelling catheter latex .......................... Indwelling catheter special ...................... Cath indw foley 2 way silicn .................... Cath indw foley 3 way ............................. Male ext cath extended wear .................. Disposable male external cat .................. Straight tip urine catheter ........................ Coude tip urinary catheter ....................... Intermittent urinary cath ........................... Cath insertion tray w/bag ......................... Bladder irrigation tubing ........................... Ext ureth clmp or compr dvc ................... Bedside drainage bag .............................. Urinary leg or abdomen bag .................... Urinary suspensory w/o leg b .................. Ostomy face plate .................................... Solid skin barrier ...................................... Adhesive, liquid or equal ......................... Adhesive remover wipes ......................... Ostomy vent ............................................. Ostomy belt .............................................. Ostomy filter ............................................. Skin barrier liquid per oz ......................... Skin barrier powder per oz ...................... Skin barrier solid 4x4 equiv ..................... Skin barrier with flange ............................ Drainable plastic pch w fcpl ..................... Drainable rubber pch w fcplt ................... Drainable plstic pch w/o fp ...................... Drainable rubber pch w/o fp .................... Urinary plastic pouch w fcpl .................... Urinary rubber pouch w fcplt ................... Urinary plastic pouch w/o fp .................... Urinary hvy plstc pch w/o fp .................... Urinary rubber pouch w/o fp .................... Ostomy faceplt/silicone ring ..................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00148 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50827 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A4385 A4387 A4388 A4389 A4390 A4391 A4392 A4393 A4394 A4395 A4396 A4397 A4398 A4399 A4400 A4402 A4404 A4405 A4406 A4407 A4408 A4409 A4410 A4413 A4414 A4415 A4416 A4417 A4418 A4419 A4420 A4421 A4422 A4423 A4424 A4425 A4426 A4427 A4428 A4429 A4430 A4431 A4432 A4433 A4434 A4450 A4452 A4455 A4458 A4462 A4465 A4470 A4480 A4481 A4483 A4490 A4495 A4500 A4510 A4520 A4550 A4554 A4555 A4556 A4557 A4558 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E A A A A A A A A A A A A A A A A E A A A A A A E E E E E B E E Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Ost skn barrier sld ext wear .................... Ost clsd pouch w att st barr .................... Drainable pch w ex wear barr ................. Drainable pch w st wear barr .................. Drainable pch ex wear convex ................ Urinary pouch w ex wear barr ................. Urinary pouch w st wear barr .................. Urine pch w ex wear bar conv ................ Ostomy pouch liq deodorant ................... Ostomy pouch solid deodorant ................ Peristomal hernia supprt blt ..................... Irrigation supply sleeve ............................ Ostomy irrigation bag .............................. Ostomy irrig cone/cath w brs ................... Ostomy irrigation set ................................ Lubricant per ounce ................................. Ostomy ring each .................................... Nonpectin based ostomy paste ............... Pectin based ostomy paste ..................... Ext wear ost skn barr <=4sq÷ ................. Ext wear ost skn barr >4sq÷ ................... Ost skn barr w flng <=4 sq÷ .................... Ost skn barr w flng >4sq÷ ....................... 2 pc drainable ost pouch ......................... Ostomy sknbarr w flng <=4sq÷ ................ Ostomy skn barr w flng >4sq÷ ................ Ost pch clsd w barrier/filtr ........................ Ost pch w bar/bltinconv/fltr ...................... Ost pch clsd w/o bar w filtr ...................... Ost pch for bar w flange/flt ...................... Ost pch clsd for bar w lk fl ...................... Ostomy supply misc ................................ Ost pouch absorbent material ................. Ost pch for bar w lk fl/fltr ......................... Ost pch drain w bar & filter ..................... Ost pch drain for barrier fl ....................... Ost pch drain 2 piece system .................. Ost pch drain/barr lk flng/f ....................... Urine ost pouch w faucet/tap ................... Urine ost pch bar w lock fln ..................... Ost pch urine w lock flng/ft ...................... Urine ost pch bar w lock fln ..................... Ost pch urine w lock flng/ft ...................... Urine ost pch bar w lock fln ..................... Ost pch urine w lock flng/ft ...................... Non-waterproof tape ................................ Waterproof tape ....................................... Adhesive remover per ounce .................. Reusable enema bag .............................. Abdmnl drssng holder/binder ................... Non-elastic extremity binder .................... Gravlee jet washer ................................... Vabra aspirator ........................................ Tracheostoma filter .................................. Moisture exchanger ................................. Above knee surgical stocking .................. Thigh length surg stocking ...................... Below knee surgical stocking .................. Full length surg stocking .......................... Incontinence garment anytype ................ Surgical trays ........................................... Disposable underpads ............................. Disposable underpad small ..................... Electrodes, pair ........................................ Lead wires, pair ....................................... Conductive paste or gel ........................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00149 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50828 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A4561 A4562 A4565 A4570 A4575 A4580 A4590 A4595 A4605 A4606 A4608 A4611 A4612 A4613 A4614 A4615 A4616 A4617 A4618 A4619 A4620 A4623 A4624 A4625 A4626 A4627 A4628 A4629 A4630 A4632 A4633 A4634 A4635 A4636 A4637 A4638 A4639 A4640 A4641 A4642 A4643 A4644 A4645 A4646 A4647 A4649 A4651 A4652 A4653 A4656 A4657 A4660 A4663 A4670 A4671 A4672 A4673 A4674 A4680 A4690 A4706 A4707 A4708 A4709 A4714 A4719 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI N N A E E E E Y Y A Y Y Y Y A Y Y Y Y Y Y A Y A A E Y A Y Y Y A Y Y Y Y Y Y N H B B B B B A A A A A A A A E B B B B A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Pessary rubber, any type ........................ Pessary, non rubber,any type ................. Slings ....................................................... Splint ........................................................ Hyperbaric o2 chamber disps .................. Cast supplies (plaster) ............................. Special casting material ........................... TENS suppl 2 lead per month ................. Trach suction cath close sys ................... Oxygen probe used w oximeter .............. Transtracheal oxygen cath ...................... Heavy duty battery ................................... Battery cables .......................................... Battery charger ........................................ Hand-held PEFR meter ........................... Cannula nasal .......................................... Tubing (oxygen) per foot ......................... Mouth piece ............................................. Breathing circuits ..................................... Face tent .................................................. Variable concentration mask ................... Tracheostomy inner cannula ................... Tracheal suction tube .............................. Trach care kit for new trach .................... Tracheostomy cleaning brush ................. Spacer bag/reservoir ............................... Oropharyngeal suction cath ..................... Tracheostomy care kit ............................. Repl bat t.e.n.s. own by pt ...................... Infus pump rplcemnt battery .................... Uvl replacement bulb ............................... Replacement bulb th lightbox .................. Underarm crutch pad ............................... Handgrip for cane etc .............................. Repl tip cane/crutch/walker ..................... Repl batt pulse gen sys ........................... Infrared ht sys replcmnt pad .................... Alternating pressure pad ......................... Diagnostic imaging agent ........................ Satumomab pendetide per dose ............. High dose contrast MRI ........................... Contrast 100-199 MGs iodine ................. Contrast 200-299 MGs iodine ................. Contrast 300-399 MGs iodine ................. Supp- paramagnetic contr mat ................ Surgical supplies ...................................... Calibrated microcap tube ......................... Microcapillary tube sealant ...................... PD catheter anchor belt ........................... Dialysis needle ......................................... Dialysis syringe w/wo needle .................. Sphyg/bp app w cuff and stet .................. Dialysis blood pressure cuff .................... Automatic bp monitor, dial ....................... Disposable cycler set ............................... Drainage ext line, dialysis ........................ Ext line w easy lock connect ................... Chem/antisept solution, 8oz .................... Activated carbon filter, ea ........................ Dialyzer, each .......................................... Bicarbonate conc sol per gal ................... Bicarbonate conc pow per pac ................ Acetate conc sol per gallon ..................... Acid conc sol per gallon .......................... Treated water per gallon ......................... ÷Y set÷ tubing .......................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0704 .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00150 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50829 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A4720 A4721 A4722 A4723 A4724 A4725 A4726 A4728 A4730 A4736 A4737 A4740 A4750 A4755 A4760 A4765 A4766 A4770 A4771 A4772 A4773 A4774 A4802 A4860 A4870 A4890 A4911 A4913 A4918 A4927 A4928 A4929 A4930 A4931 A4932 A5051 A5052 A5053 A5054 A5055 A5061 A5062 A5063 A5071 A5072 A5073 A5081 A5082 A5093 A5102 A5105 A5112 A5113 A5114 A5119 A5121 A5122 A5126 A5131 A5200 A5500 A5501 A5503 A5504 A5505 A5506 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI 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 E A A A A A A A A A A A A A A A A A A A A A A A A A Y Y Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Dialysat sol fld vol > 249cc ...................... Dialysat sol fld vol > 999cc ...................... Dialys sol fld vol > 1999cc ....................... Dialys sol fld vol > 2999cc ....................... Dialys sol fld vol > 3999cc ....................... Dialys sol fld vol > 4999cc ....................... Dialys sol fld vol > 5999cc ....................... Dialysate solution, non-dex ..................... Fistula cannulation set, ea ....................... Topical anesthetic, per gram ................... Inj anesthetic per 10 ml ........................... Shunt accessory ...................................... Art or venous blood tubing ...................... Comb art/venous blood tubing ................ Dialysate sol test kit, each ....................... Dialysate conc pow per pack .................. Dialysate conc sol add 10 ml .................. Blood collection tube/vacuum .................. Serum clotting time tube .......................... Blood glucose test strips ......................... Occult blood test strips ............................ Ammonia test strips ................................. Protamine sulfate per 50 mg ................... Disposable catheter tips .......................... Plumb/elec wk hm hemo equip ............... Repair/maint cont hemo equip ................ Drain bag/bottle ....................................... Misc dialysis supplies noc ....................... Venous pressure clamp ........................... Non-sterile gloves .................................... Surgical mask .......................................... Tourniquet for dialysis, ea ....................... Sterile, gloves per pair ............................. Reusable oral thermometer ..................... Reusable rectal thermometer .................. Pouch clsd w barr attached ..................... Clsd ostomy pouch w/o barr .................... Clsd ostomy pouch faceplate .................. Clsd ostomy pouch w/flange ................... Stoma cap ................................................ Pouch drainable w barrier at ................... Drnble ostomy pouch w/o barr ................ Drain ostomy pouch w/flange .................. Urinary pouch w/barrier ........................... Urinary pouch w/o barrier ........................ Urinary pouch on barr w/flng ................... Continent stoma plug ............................... Continent stoma catheter ........................ Ostomy accessory convex inse ............... Bedside drain btl w/wo tube .................... Urinary suspensory .................................. Urinary leg bag ........................................ Latex leg strap ......................................... Foam/fabric leg strap ............................... Skin barrier wipes box pr 50 ................... Solid skin barrier 6x6 ............................... Solid skin barrier 8x8 ............................... Disk/foam pad +or- adhesive ................... Appliance cleaner .................................... Percutaneous catheter anchor ................ Diab shoe for density insert ..................... Diabetic custom molded shoe ................. Diabetic shoe w/roller/rockr ..................... Diabetic shoe with wedge ........................ Diab shoe w/metatarsal bar ..................... Diabetic shoe w/off set heel .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00151 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50830 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A5507 A5508 A5509 A5510 A5511 A6000 A6010 A6011 A6021 A6022 A6023 A6024 A6025 A6154 A6196 A6197 A6198 A6199 A6200 A6201 A6202 A6203 A6204 A6205 A6206 A6207 A6208 A6209 A6210 A6211 A6212 A6213 A6214 A6215 A6216 A6217 A6218 A6219 A6220 A6221 A6222 A6223 A6224 A6228 A6229 A6230 A6231 A6232 A6233 A6234 A6235 A6236 A6237 A6238 A6239 A6240 A6241 A6242 A6243 A6244 A6245 A6246 A6247 A6248 A6250 A6251 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y E E E E A A A A A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Modification diabetic shoe ....................... Diabetic deluxe shoe ............................... Direct heat form shoe insert .................... Compression form shoe insert ................ Custom fab molded shoe inser ............... Wound warming wound cover ................. Collagen based wound filler .................... Collagen gel/paste wound fil ................... Collagen dressing <=16 sq in .................. Collagen drsg>6<=48 sq in ..................... Collagen dressing >48 sq in .................... Collagen dsg wound filler ........................ Silicone gel sheet, each .......................... Wound pouch each .................................. Alginate dressing <=16 sq in ................... Alginate drsg >16 <=48 sq in .................. alginate dressing > 48 sq in .................... Alginate drsg wound filler ........................ Compos drsg <=16 no border ................. Compos drsg >16<=48 no bdr ................ Compos drsg >48 no border ................... Composite drsg <= 16 sq in .................... Composite drsg >16<=48 sq in ............... Composite drsg > 48 sq in ...................... Contact layer <= 16 sq in ........................ Contact layer >16<= 48 sq in .................. Contact layer > 48 sq in .......................... Foam drsg <=16 sq in w/o bdr ................ Foam drg >16<=48 sq in w/o b ............... Foam drg > 48 sq in w/o brdr .................. Foam drg <=16 sq in w/border ................ Foam drg >16<=48 sq in w/bdr ............... Foam drg > 48 sq in w/border ................. Foam dressing wound filler ..................... Non-sterile gauze<=16 sq in ................... Non-sterile gauze>16<=48 sq ................. Non-sterile gauze > 48 sq in ................... Gauze <= 16 sq in w/border .................... Gauze >16 <=48 sq in w/bordr ................ Gauze > 48 sq in w/border ...................... Gauze <=16 in no w/sal w/o b ................ Gauze >16<=48 no w/sal w/o b .............. Gauze > 48 in no w/sal w/o b ................. Gauze <= 16 sq in water/sal ................... Gauze >16<=48 sq in watr/sal ................ Gauze > 48 sq in water/salne ................. Hydrogel dsg<=16 sq in .......................... Hydrogel dsg>16<=48 sq in .................... Hydrogel dressing >48 sq in .................... Hydrocolld drg <=16 w/o bdr ................... Hydrocolld drg >16<=48 w/o b ................ Hydrocolld drg > 48 in w/o b ................... Hydrocolld drg <=16 in w/bdr .................. Hydrocolld drg >16<=48 w/bdr ................ Hydrocolld drg > 48 in w/bdr ................... Hydrocolld drg filler paste ........................ Hydrocolloid drg filler dry ......................... Hydrogel drg <=16 in w/o bdr .................. Hydrogel drg >16<=48 w/o bdr ................ Hydrogel drg >48 in w/o bdr .................... Hydrogel drg <= 16 in w/bdr .................... Hydrogel drg >16<=48 in w/b .................. Hydrogel drg > 48 sq in w/b .................... Hydrogel drsg gel filler ............................. Skin seal protect moisturizr ..................... Absorpt drg <=16 sq in w/o b .................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00152 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50831 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A6252 A6253 A6254 A6255 A6256 A6257 A6258 A6259 A6260 A6261 A6262 A6266 A6402 A6403 A6404 A6407 A6410 A6411 A6412 A6441 A6442 A6443 A6444 A6445 A6446 A6447 A6448 A6449 A6450 A6451 A6452 A6453 A6454 A6455 A6456 A6501 A6502 A6503 A6504 A6505 A6506 A6507 A6508 A6509 A6510 A6511 A6512 A6550 A6551 A7000 A7001 A7002 A7003 A7004 A7005 A7006 A7007 A7008 A7009 A7010 A7011 A7012 A7013 A7014 A7015 A7016 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A A A A A A A A A A A A A A A A A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Absorpt drg >16 <=48 w/o bdr ................ Absorpt drg > 48 sq in w/o b ................... Absorpt drg <=16 sq in w/bdr .................. Absorpt drg >16<=48 in w/bdr ................. Absorpt drg > 48 sq in w/bdr ................... Transparent film <= 16 sq in ................... Transparent film >16<=48 in ................... Transparent film > 48 sq in ..................... Wound cleanser any type/size ................ Wound filler gel/paste /oz ........................ Wound filler dry form / gram .................... Impreg gauze no h20/sal/yard ................. Sterile gauze <= 16 sq in ........................ Sterile gauze>16 <= 48 sq in .................. Sterile gauze > 48 sq in .......................... Packing strips, non-impreg ...................... Sterile eye pad ......................................... Non-sterile eye pad ................................. Occlusive eye patch ................................ Pad band w>=3÷ <5÷/yd ......................... Conform band n/s w<3÷/yd ..................... Conform band n/s w>=3÷<5÷/yd ............. Conform band n/s w>=5÷/yd ................... Conform band s w <3÷/yd ....................... Conform band s w>=3÷ <5÷/yd ............... Conform band s w >=5÷/yd ..................... Lt compres band <3÷/yd .......................... Lt compres band >=3÷ <5÷/yd ................ Lt compres band >=5÷/yd ........................ Mod compres band w>=3÷<5÷/yd ........... High compres band w>=3÷<5÷yd ............ Self-adher band w <3÷/yd ....................... Self-adher band w>=3÷ <5÷/yd ............... Self-adher band >=5÷/yd ......................... Zinc paste band w >=3÷<5÷/yd ............... Compres burngarment bodysuit .............. Compres burngarment chinstrp ............... Compres burngarment facehood ............. Cmprsburngarment glove-wrist ................ Cmprsburngarment glove-elbow .............. Cmprsburngrmnt glove-axilla ................... Cmprs burngarment foot-knee ................. Cmprs burngarment foot-thigh ................. Compres burn garment jacket ................. Compres burn garment leotard ............... Compres burn garment panty .................. Compres burn garment, noc .................... Neg pres wound ther drsg set ................. Neg press wound ther canistr ................. Disposable canister for pump .................. Nondisposable pump canister ................. Tubing used w suction pump .................. Nebulizer administration set .................... Disposable nebulizer sml vol ................... Nondisposable nebulizer set ................... Filtered nebulizer admin set .................... Lg vol nebulizer disposable ..................... Disposable nebulizer prefill ...................... Nebulizer reservoir bottle ......................... Disposable corrugated tubing .................. Nondispos corrugated tubing ................... Nebulizer water collec devic .................... Disposable compressor filter ................... Compressor nondispos filter .................... Aerosol mask used w nebulize ................ Nebulizer dome & mouthpiece ................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00153 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50832 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A7017 A7018 A7025 A7026 A7030 A7031 A7032 A7033 A7034 A7035 A7036 A7037 A7038 A7039 A7040 A7041 A7042 A7043 A7044 A7045 A7046 A7501 A7502 A7503 A7504 A7505 A7506 A7507 A7508 A7509 A7520 A7521 A7522 A7523 A7524 A7525 A7526 A7527 A9150 A9152 A9153 A9180 A9270 A9280 A9300 A9500 A9502 A9503 A9504 A9505 A9507 A9508 A9510 A9511 A9512 A9513 A9514 A9515 A9516 A9517 A9519 A9520 A9521 A9522 A9523 A9524 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y Y Y Y Y Y Y Y Y Y A A A A Y Y Y A A A A A A A A A A A A A A A A A B E E E E E E H H N N H H H H H N N N N H H N N H B B H ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Nebulizer not used w oxygen .................. Water distilled w/nebulizer ....................... Replace chest compress vest ................. Replace chst cmprss sys hose ................ CPAP full face mask ................................ Replacement facemask interfa ................ Replacement nasal cushion .................... Replacement nasal pillows ...................... Nasal application device .......................... Pos airway press headgear ..................... Pos airway press chinstrap ..................... Pos airway pressure tubing ..................... Pos airway pressure filter ........................ Filter, non disposable w pap ................... One way chest drain valve ...................... Water seal drain container ...................... Implanted pleural catheter ....................... Vacuum drainagebottle/tubing ................. PAP oral interface .................................... Repl exhalation port for PAP ................... Repl water chamber, PAP dev ................ Tracheostoma valve w diaphra ............... Replacement diaphragm/fplate ................ HMES filter holder or cap ........................ Tracheostoma HMES filter ...................... HMES or trach valve housing .................. HMES/trachvalve adhesivedisk ............... Integrated filter & holder .......................... Housing & Integrated Adhesiv ................. Heat & moisture exchange sys ............... Trach/laryn tube non-cuffed ..................... Trach/laryn tube cuffed ............................ Trach/laryn tube stainless ........................ Tracheostomy shower protect ................. Tracheostoma stent/stud/bttn .................. Tracheostomy mask ................................ Tracheostomy tube collar ........................ Trach/laryn tube plug/stop ....................... Misc/exper non-prescript dru ................... Single vitamin nos ................................... Multi-vitamin nos ...................................... Lice treatment, topical ............................. Non-covered item or service ................... Alert device, noc ...................................... Exercise equipment ................................. 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, pe ................... Technetium TC99m Disofenin ................. Technetium TC 99m depreotide .............. Technetium tc99m pertechnetate ............ Technetium tc-99m mebrofenin ............... Technetium tc99m pyrophosphate .......... Technetium tc-99m pentetate .................. I-123 sodium iodide capsule .................... Th I131 so iodide cap millic ..................... Technetium tc-99m macroag albu ........... Technetium tc-99m sulfur clld ................. Technetium tc-99m exametazine ............ Indium 111i britumomabtiuxetan ............. Yttrium 90i britumomabtiuxetan ............... Iodinated I-131 serumalbumin ................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1600 0705 .................... .................... 1603 1604 1045 9146 9147 .................... .................... .................... .................... 9148 1064 .................... .................... 1096 .................... .................... 9100 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00154 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50833 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS A9525 A9526 A9528 A9529 A9530 A9531 A9532 A9533 A9534 A9600 A9605 A9699 A9700 A9900 A9901 A9999 B4034 B4035 B4036 B4081 B4082 B4083 B4086 B4100 B4102 B4103 B4104 B4149 B4150 B4152 B4153 B4154 B4155 B4157 B4158 B4159 B4160 B4161 B4162 B4164 B4168 B4172 B4176 B4178 B4180 B4184 B4186 B4189 B4193 B4197 B4199 B4216 B4220 B4222 B4224 B5000 B5100 B5200 B9000 B9002 B9004 B9006 B9998 B9999 C1079 C1080 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI E H H H H H H B B H H N B A A Y A A A A A A A E Y Y E Y A A A A A Y Y Y Y Y Y A 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 H ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Low/iso-osmolar contrast mat .................. Ammonia N-13, per dose ........................ 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 ............................... Samarium sm153 lexidronamm ............... Noc therapeutic radiopharm .................... Echocardiography Contrast ..................... Supply/accessory/service ........................ Delivery/set up/dispensing ....................... DME supply or accessory, nos ................ Enter feed supkit syr by day .................... Enteral feed supp pump per d ................. Enteral feed sup kit grav by .................... Enteral ng tubing w/ stylet ....................... Enteral ng tubing w/o stylet ..................... Enteral stomach tube levine .................... Gastrostomy/jejunostomy tube ................ Food thickener oral .................................. EF adult fluids and electro ....................... EF ped fluid and electrolyte ..................... Additive for enteral formula ..................... EF blenderized foods ............................... Enteral formulae category i ..................... Enteral formulae category ii ..................... Enteral formulae category III ................... Enteral formulae category IV ................... Enteral formulae category v .................... EF special metabolic inherit .................... EF ped complete intact nut ..................... EF ped complete soy based .................... EF ped calorie dense > / =0.7kc ............. EF ped hydrolyzed/amino acid ................ EF ped specmetabolic inherit .................. Parenteral 50% dextrose solu ................. Parenteral sol amino acid 3 ..................... Parenteral sol amino acid 5 ..................... Parenteral sol amino acid 7- ................... Parenteral sol amino acid > ..................... Parenteral sol carb > 50% ....................... Parenteral sol lipids 10% ......................... Parenteral sol lipids 20% ......................... Parenteral sol amino acid & .................... Parenteral sol 52-73 gm prot ................... Parenteral sol 74-100 gm pro .................. Parenteral sol > 100gm prote .................. Parenteral nutrition additiv ....................... Parenteral supply kit premix .................... Parenteral supply kit homemi .................. Parenteral administration ki ..................... Parenteral sol renal-amirosy .................... Parenteral sol hepatic-fream ................... Parenteral sol stres-brnch c .................... Enter infusion pump w/o alrm .................. Enteral infusion pump w/ ala ................... Parenteral infus pump portab .................. Parenteral infus pump statio .................... Enteral supp not otherwise c ................... Parenteral supp not othrws c .................. CO 57/58 per 0.5 uCi .............................. I-131 tositumomab, dx ............................. .................... 0737 1088 1065 1150 9149 9150 .................... .................... 0701 0702 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1080 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00155 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50834 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS C1081 C1082 C1083 C1091 C1092 C1093 C1122 C1178 C1200 C1201 C1300 C1305 C1713 C1714 C1715 C1716 C1717 C1718 C1719 C1720 C1721 C1722 C1724 C1725 C1726 C1727 C1728 C1729 C1730 C1731 C1732 C1733 C1750 C1751 C1752 C1753 C1754 C1755 C1756 C1757 C1758 C1759 C1760 C1762 C1763 C1764 C1765 C1766 C1767 C1768 C1769 C1770 C1771 C1772 C1773 C1775 C1776 C1777 C1778 C1779 C1780 C1781 C1782 C1783 C1784 C1785 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI H H H H H H H K N H S K N N N H H H H H N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N H N N N N N N N N N N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... I-131 tositumomab, tx .............................. In-111 ibritumomab tiuxetan .................... Yttrium 90 ibritumomab tiuxe ................... IN111 oxyquinoline,per 0.5 mCi .............. IN 111 pentetate per 0.5 mCi .................. TC99M fanolesomab ............................... Tc 99M ARCITUMOMAB PER VIAL ....... BUSULFAN IV, 6 Mg ............................... TC 99M Sodium Glucoheptonat .............. TC 99M SUCCIMER, PER Vial ............... HYPERBARIC Oxygen ............................ Apligraf, 44cm2 ........................................ Anchor/screw bn/bn,tis/bn ....................... Cath, trans atherectomy, dir .................... Brachytherapy needle .............................. Brachytx source, Gold 198 ...................... Brachytx source, HDR Ir-192 .................. Brachytx source, Iodine 125 .................... Brachytx sour,Non-HDR Ir-192 ................ Brachytx sour, Palladium 103 .................. AICD, dual chamber ................................ AICD, single chamber .............................. Cath, trans atherec,rotation ..................... Cath, translumin non-laser ...................... Cath, bal dil, non-vascular ....................... Cath, bal tis dis, non-vas ......................... Cath, brachytx seed adm ........................ Cath, drainage ......................................... Cath, EP, 19 or few elect ........................ Cath, EP, 20 or more elec ....................... Cath, EP, diag/abl, 3D/vect ..................... Cath, EP, othr than cool-tip ..................... Cath, hemodialysis,long-term .................. Cath, inf, per/cent/midline ........................ Cath,hemodialysis,short-term .................. Cath, intravas ultrasound ......................... Catheter, intradiscal ................................. Catheter, intraspinal ................................. Cath, pacing, transesoph ......................... Cath, thrombectomy/embolect ................. Catheter, ureteral ..................................... Cath, intra echocardiography .................. Closure dev, vasc .................................... Conn tiss, human(inc fascia) ................... Conn tiss, non-human ............................. Event recorder, cardiac ........................... Adhesion barrier ...................................... Intro/sheath,strble,non-peel ..................... Generator, neurostim, imp ....................... Graft, vascular ......................................... Guide wire ................................................ Imaging coil, MR, insertable .................... Rep dev, urinary, w/sling ......................... Infusion pump, programmable ................. Ret dev, insertable ................................... FDG, per dose (4-40 mCi/ml) .................. Joint device (implantable) ........................ Lead, AICD, endo single coil ................... Lead, neurostimulator .............................. Lead, pmkr, transvenous VDD ................ Lens, intraocular (new tech) .................... Mesh (implantable) .................................. Morcellator ............................................... Ocular imp, aqueous drain de ................. Ocular dev, intraop, det ret ...................... Pmkr, dual, rate-resp ............................... 1081 9118 9117 1091 1092 1093 9151 1178 .................... 1201 0659 1305 .................... .................... .................... 1716 1717 1718 1719 1720 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1775 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.2851 .................... .................... 1.5473 12.9222 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $16.92 .................... .................... $91.82 $766.84 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.38 .................... .................... $18.36 $153.37 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00156 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50835 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS C1786 ...... C1787 ...... C1788 ...... C1789 ...... C1813 ...... C1814 ...... C1815 ...... C1816 ...... C1817 ...... C1818 ...... C1819 ...... C1874 ...... C1875 ...... C1876 ...... C1877 ...... C1878 ...... C1879 ...... C1880 ...... C1881 ...... C1882 ...... C1883 ...... C1884 ...... C1885 ...... C1887 ...... C1888 ...... C1891 ...... C1892 ...... C1893 ...... C1894 ...... C1895 ...... C1896 ...... C1897 ...... C1898 ...... C1899 ...... C1900 ...... C2614 ...... C2615 ...... C2616 ...... C2617 ...... C2618 ...... C2619 ...... C2620 ...... C2621 ...... C2622 ...... C2625 ...... C2626 ...... C2627 ...... C2628 ...... C2629 ...... C2630 ...... C2631 ...... C2632 ...... C2633 ...... C2634 ...... C2635 ...... C2636 ...... C8900* ..... C8901* ..... C8902* ..... C8903* ..... C8904* ..... C8905* ..... C8906* ..... C8907* ..... C8908* ..... C8909* ..... SI N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N H N N N N N N N N N N N N N H H H H H S S S S S S S S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Pmkr, single, rate-resp ............................ Patient progr, neurostim .......................... Port, indwelling, imp ................................ Prosthesis, breast, imp ............................ Prosthesis, penile, inflatab ....................... Retinal tamp, silicone oil .......................... Pros, urinary sph, imp ............................. Receiver/transmitter, neuro ..................... Septal defect imp sys .............................. Integrated keratoprosthesis ..................... Tissue local excision ................................ Stent, coated/cov w/del sys ..................... Stent, coated/cov w/o del sy ................... Stent, non-coa/non-cov w/del .................. Stent, non-coat/cov w/o del ..................... Matrl for vocal cord .................................. Tissue marker, implantable ..................... Vena cava filter ........................................ Dialysis access system ............................ AICD, other than sing/dual ...................... Adapt/ext, pacing/neuro lead ................... Embolization Protect syst ........................ Cath, translumin angio laser .................... Catheter, guiding ..................................... Endovas non-cardiac abl cath ................. Infusion pump,non-prog, perm ................ Intro/sheath,fixed,peel-away .................... Intro/sheath, fixed,non-peel ..................... Intro/sheath, non-laser ............................. Lead, AICD, endo dual coil ..................... Lead, AICD, non sing/dual ...................... Lead, neurostim test kit ........................... Lead, pmkr, other than trans ................... Lead, pmkr/AICD combination ................. Lead coronary venous ............................. Probe, perc lumb disc .............................. Sealant, pulmonary, liquid ....................... Brachytx source, Yttrium-90 .................... Stent, non-cor, tem w/o del ..................... Probe, cryoablation .................................. Pmkr, dual, non rate-resp ........................ Pmkr, single, non rate-resp ..................... Pmkr, other than sing/dual ...................... Prosthesis, penile, non-inf ....................... Stent, non-cor, tem w/del sy .................... Infusion pump, non-prog,temp ................. Cath, suprapubic/cystoscopic .................. Catheter, occlusion .................................. Intro/sheath, laser .................................... Cath, EP, cool-tip ..................................... Rep dev, urinary, w/o sling ...................... Brachytx sol, I-125, per mCi .................... Brachytx source, Cesium-131 ................. Brachytx source, HA, I-125 ..................... Brachytx source, HA, P-103 .................... Brachytx linear source, P-10 ................... MRA w/cont, abd ..................................... MRA w/o cont, abd .................................. MRA w/o fol w/cont, abd ......................... MRI w/cont, breast, uni ............................ MRI w/o cont, breast, uni ........................ MRI w/o fol w/cont, brst, un ..................... MRI w/cont, breast, bi .............................. MRI w/o cont, breast, bi .......................... MRI w/o fol w/cont, breast, ...................... MRA w/cont, chest ................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 2616 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 2632 2633 2634 2635 2636 0284 0336 0337 0284 0336 0337 0284 0336 0337 0284 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 6.4201 6.0742 8.7945 6.4201 6.0742 8.7945 6.4201 6.0742 8.7945 6.4201 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $380.99 $360.46 $521.89 $380.99 $360.46 $521.89 $380.99 $360.46 $521.89 $380.99 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $152.39 $144.18 $208.75 $152.39 $144.18 $208.75 $152.39 $144.18 $208.75 $152.39 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $76.20 $72.09 $104.38 $76.20 $72.09 $104.38 $76.20 $72.09 $104.38 $76.20 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00157 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50836 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS C8910* ..... C8911* ..... C8912* ..... C8913* ..... C8914* ..... C8918* ..... C8919* ..... C8920* ..... C9000 ...... C9003 ...... C9007 ...... C9008 ...... C9009 ...... C9013 ...... C9102 ...... C9103 ...... C9105 ...... C9112 ...... C9113 ...... C9121 ...... C9123 ...... C9127 ...... C9128 ...... C9200 ...... C9201 ...... C9202 ...... C9203 ...... C9205 ...... C9206 ...... C9211 ...... C9212 ...... C9218 ...... C9220 ...... C9221 ...... C9222 ...... C9223 ...... C9399 ...... C9400 ...... C9401 ...... C9402 ...... C9403 ...... C9404 ...... C9405 ...... C9410 ...... C9411 ...... C9413 ...... C9414 ...... C9415 ...... C9417 ...... C9418 ...... C9419 ...... C9420 ...... C9421 ...... C9422 ...... C9423 ...... C9424 ...... C9425 ...... C9426 ...... C9427 ...... C9428 ...... C9429 ...... C9430 ...... C9431 ...... C9432 ...... C9433 ...... C9435 ...... SI S S S S S S S S H K K K K N H H K D N K K K K K K D D K K K K K G G G D A D D D D D D D D D D D D D D D D D D D D D D D D D D D D D ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... MRA w/o cont, chest ............................... MRA w/o fol w/cont, chest ....................... MRA w/cont, lwr ext ................................. MRA w/o cont, lwr ext ............................. MRA w/o fol w/cont, lwr ext ..................... MRA w/cont, pelvis .................................. MRA w/o cont, pelvis ............................... MRA w/o fol w/cont, pelvis ...................... Na chromateCr51, per 0.25mCi .............. Palivizumab, per 50 mg ........................... Baclofen Intrathecal kit-1am .................... Baclofen Refill Kit-500mcg ...................... Baclofen Refill Kit-2000mcg .................... Co 57 cobaltous chloride ......................... 51 Na Chromate, 50mCi .......................... Na Iothalamate I-125, 10 uCi .................. Hep B imm glob, per 1 ml ....................... Perflutren lipid micro, 2ml ........................ Inj pantoprazole sodium, via .................... Injection, argatroban ................................ Transcyte, 247cm2 .................................. Paclitaxel protein pr ................................. Inj pegaptanib sodium ............................. Orcel, 36 cm2 .......................................... Dermagraft, 37.5cm2 ............................... Octafluoropropane ................................... Perflexane lipid micro .............................. Oxaliplatin ................................................ Integra, per cm2 ...................................... Inj, alefacept, IV ....................................... Inj, alefacept, IM ...................................... Injection, Azacitidine ................................ Sodium hyaluronate ................................. Graftjacket Reg Matrix ............................. Graftjacket SftTis ..................................... Inj adenosine, tx dx ................................. Unclass drugs/biologicals ........................ 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 .................... Dexrazoxane HCl inj, brand .................... Pamidronate disodium, brand .................. Na hyaluronate bran ................................ Etoposide oral, brand .............................. Doxorubic hcl chemo, brand .................... Bleomycin sulfate inj, brand .................... Cisplatin inj, brand ................................... Inj cladribine, brand ................................. Cyclophosphamide inj, brand .................. Cyclophosphamide lyo, brand ................. Cytarabine hcl inj, brand .......................... Dacarbazine inj, brand ............................. Daunorubicin, brand ................................ Etoposide inj, brand ................................. Floxuridine inj, brand ............................... Ifosfomide inj, brand ................................ Mesna injection, brand ............................ Idarubicin hcl inj, brand ........................... Leuprolide acetate bran ........................... Paclitaxel inj, brand ................................. Mitomycin inj, brand ................................. Thiotepa inj, brand ................................... Gonadorelin hydroch, brand .................... 0336 0337 0284 0336 0337 0284 0336 0337 9130 9003 9152 9008 9009 .................... 9132 9153 9105 .................... .................... 9121 9123 9127 9128 9200 9201 .................... .................... 9205 9206 9211 9212 9218 9220 9221 9222 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 6.0742 8.7945 6.4201 6.0742 8.7945 6.4201 6.0742 8.7945 .................... 4.1491 0.8562 0.2447 0.7209 .................... .................... .................... 1.8813 .................... .................... 0.1897 .................... .................... .................... 2.6893 6.2066 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $360.46 $521.89 $380.99 $360.46 $521.89 $380.99 $360.46 $521.89 .................... $246.22 $50.81 $14.52 $42.78 .................... .................... .................... $111.64 .................... .................... $11.26 $719.41 $8.59 $1,074.27 $159.59 $368.32 .................... .................... $84.06 $9.23 $571.01 $402.00 $4.03 $203.84 $1,234.36 $890.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $144.18 $208.75 $152.39 $144.18 $208.75 $152.39 $144.18 $208.75 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $72.09 $104.38 $76.20 $72.09 $104.38 $76.20 $72.09 $104.38 .................... $49.24 $10.16 $2.90 $8.56 .................... .................... .................... $22.33 .................... .................... $2.25 $143.88 $1.72 $214.85 $31.92 $73.66 .................... .................... $16.81 $1.85 $114.20 $80.40 $0.81 $40.77 $246.87 $178.15 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00158 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50837 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS C9436 C9437 C9438 C9439 C9440 C9704 C9713 C9716 C9718 C9719 C9720 C9721 C9722 C9723 C9724 D0120 D0140 D0150 D0160 D0170 D0180 D0210 D0220 D0230 D0240 D0250 D0260 D0270 D0272 D0274 D0277 D0290 D0310 D0320 D0321 D0322 D0330 D0340 D0350 D0415 D0416 D0421 D0425 D0431 D0460 D0470 D0472 D0473 D0474 D0475 D0476 D0477 D0478 D0479 D0480 D0481 D0482 D0483 D0484 D0485 D0502 D0999 D1110 D1120 D1201 D1203 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI D D D D D T T S T T T T S S T E E S E E E E E E S S S S S S S E E E E E E E E E B B E B S E B B B B B B B B B B B B B B B B E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Azathioprine parenteral,brnd ................... Carmus bischl nitro inj ............................. Cyclosporine oral, brand .......................... Diethylstilbestrol injection ........................ Vinorelbine tar,brand ............................... Inj inert subs upper GI ............................. Non-contact laser vap prosta .................. RF Energy to Anus .................................. Kyphoplasty, first vertebra ....................... Kyphoplasty, each addl ........................... HE ESW tx, tennis elbow ........................ HE ESW tx, plantar fasciitis .................... KV imaging w/IR tracking ........................ Dyn IR Perf Img ....................................... EPS gast cardia plic ................................ Periodic oral evaluation ........................... Limit oral eval problm focus .................... Comprehensve oral evaluation ................ Extensv oral eval prob focus ................... Re-eval,est pt,problem focus ................... Comp periodontal evaluation ................... Intraor complete film series ..................... Intraoral periapical first f .......................... Intraoral periapical ea add ....................... 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 ...................... Dental film skull/facial bon ....................... Dental saliography ................................... Dental tmj arthrogram incl i ..................... Dental other tmj films ............................... Dental tomographic survey ...................... Dental panoramic film .............................. Dental cephalometric film ........................ Oral/facial images .................................... Bacteriologic study ................................... Viral culture .............................................. Gen tst suscept oral disease ................... Caries susceptibility test .......................... Diag tst detect mucos abnorm ................ Pulp vitality test ........................................ Diagnostic casts ....................................... Gross exam, prep & report ...................... 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 ................... Dental prophylaxis adult .......................... Dental prophylaxis child ........................... Topical fluor w prophy child ..................... Topical fluor w/o prophy chi .................... .................... .................... .................... .................... .................... 1556 0429 1519 0051 0051 1547 1547 1502 1502 0422 .................... .................... 0330 .................... .................... .................... .................... .................... .................... 0330 0330 0330 0330 0330 0330 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 42.3147 .................... 36.5271 36.5271 .................... .................... .................... .................... 22.9647 .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,750.00 $2,511.08 $1,750.00 $2,167.63 $2,167.63 $850.00 $850.00 $75.00 $75.00 $1,362.79 .................... .................... $425.82 .................... .................... .................... .................... .................... .................... $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $448.81 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $350.00 $502.22 $350.00 $433.53 $433.53 $170.00 $170.00 $15.00 $15.00 $272.56 .................... .................... $85.16 .................... .................... .................... .................... .................... .................... $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00159 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50838 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D1204 D1205 D1310 D1320 D1330 D1351 D1510 D1515 D1520 D1525 D1550 D2140 D2150 D2160 D2161 D2330 D2331 D2332 D2335 D2390 D2391 D2392 D2393 D2394 D2410 D2420 D2430 D2510 D2520 D2530 D2542 D2543 D2544 D2610 D2620 D2630 D2642 D2643 D2644 D2650 D2651 D2652 D2662 D2663 D2664 D2710 D2712 D2720 D2721 D2722 D2740 D2750 D2751 D2752 D2780 D2781 D2782 D2783 D2790 D2791 D2792 D2794 D2799 D2910 D2915 D2920 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI E E E E E E S S S S S 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 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 E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Topical fluor w/o prophy adu ................... Topical fluoride w/ prophy a .................... Nutri counsel-control caries ..................... Tobacco counseling ................................. Oral hygiene instruction ........................... Dental sealant per tooth .......................... Space maintainer fxd unilat ..................... Fixed bilat space maintainer .................... Remove unilat space maintain ................ Remove bilat space maintain .................. Recement space maintainer .................... Amalgam one surface permanen ............ Amalgam two surfaces permane ............. Amalgam three surfaces perma .............. Amalgam 4 or > surfaces perm ............... Resin one surface-anterior ...................... Resin two surfaces-anterior ..................... Resin three surfaces-anterio ................... Resin 4/> surf or w incis an ..................... Ant resin-based cmpst crown .................. Post 1 srfc resinbased cmpst .................. Post 2 srfc resinbased cmpst .................. Post 3 srfc resinbased cmpst .................. Post >=4srfc resinbase cmpst ................. Dental gold foil one surface ..................... Dental gold foil two surface ..................... Dental gold foil three surfa ...................... Dental inlay metalic 1 surf ....................... Dental inlay metallic 2 surf ...................... Dental inlay metl 3/more sur ................... Dental onlay metallic 2 surf ..................... Dental onlay metallic 3 surf ..................... Dental onlay metl 4/more sur .................. Inlay porcelain/ceramic 1 su .................... Inlay porcelain/ceramic 2 su .................... Dental onlay porc 3/more sur .................. Dental onlay porcelin 2 surf ..................... Dental onlay porcelin 3 surf ..................... Dental onlay porc 4/more sur .................. Inlay composite/resin one su ................... Inlay composite/resin two su ................... Dental inlay resin 3/mre sur .................... Dental onlay resin 2 surface .................... Dental onlay resin 3 surface .................... Dental onlay resin 4/mre sur ................... Crown resin laboratory ............................ Crown 3/4 resin-based compos ............... Crown resin w/ high noble me ................. Crown resin w/ base metal ...................... Crown resin w/ noble metal ..................... Crown porcelain/ceramic subs ................ Crown porcelain w/ h noble m ................. Crown porcelain fused base m ................ Crown porcelain w/ noble met ................. Crown 3/4 cast hi noble met ................... Crown 3/4 cast base metal ...................... Crown 3/4 cast noble metal ..................... Crown 3/4 porcelain/ceramic ................... Crown full cast high noble m ................... Crown full cast base metal ...................... Crown full cast noble metal ..................... Crown-titanium ......................................... Provisional crown ..................................... Dental recement inlay .............................. Recement cast or prefab post ................. Dental recement crown ............................ .................... .................... .................... .................... .................... .................... 0330 0330 0330 0330 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 7.1756 7.1756 7.1756 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 $425.82 $425.82 $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 $85.16 $85.16 $85.16 $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00160 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50839 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D2930 D2931 D2932 D2933 D2934 D2940 D2950 D2951 D2952 D2953 D2954 D2955 D2957 D2960 D2961 D2962 D2971 D2975 D2980 D2999 D3110 D3120 D3220 D3221 D3230 D3240 D3310 D3320 D3330 D3331 D3332 D3333 D3346 D3347 D3348 D3351 D3352 D3353 D3410 D3421 D3425 D3426 D3430 D3450 D3460 D3470 D3910 D3920 D3950 D3999 D4210 D4211 D4240 D4241 D4245 D4249 D4260 D4261 D4263 D4264 D4265 D4266 D4267 D4268 D4270 D4271 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI E E E E E E E E E E E E E E E E E E E S E E E E E E E E E E E E E E E E E E E E E E E E S E E E E S E E E E E E S E S S E E E S S S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Prefab stnlss steel crwn pri ..................... Prefab stnlss steel crown pe ................... Prefabricated resin crown ........................ Prefab stainless steel crown .................... Prefab steel crown primary ...................... Dental sedative filling ............................... Core build-up incl any pins ...................... Tooth pin retention ................................... Post and core cast + crown ..................... Each addtnl cast post .............................. Prefab post/core + crown ........................ Post removal ............................................ Each addtnl prefab post .......................... Laminate labial veneer ............................ Lab labial veneer resin ............................ Lab labial veneer porcelain ..................... Add proc construct new crown ................ Coping ...................................................... Crown repair ............................................ Dental unspec restorative pr ................... Pulp cap direct ......................................... Pulp cap indirect ...................................... Therapeutic pulpotomy ............................ Gross pulpal debridement ....................... Pulpal therapy anterior prim .................... Pulpal therapy posterior pri ..................... Anterior .................................................... Root canal therapy 2 canals .................... Root canal therapy 3 canals .................... Non-surg tx root canal obs ...................... Incomplete endodontic tx ......................... Internal root repair ................................... Retreat root canal anterior ....................... Retreat root canal bicuspid ...................... Retreat root canal molar .......................... Apexification/recalc initial ......................... Apexification/recalc interim ...................... Apexification/recalc final .......................... Apicoect/perirad surg anter ..................... Root surgery bicuspid .............................. Root surgery molar .................................. Root surgery ea add root ........................ Retrograde filling ...................................... Root amputation ...................................... Endodontic endosseous implan ............... Intentional replantation ............................ Isolation- tooth w rubb dam ..................... Tooth splitting .......................................... Canal prep/fitting of dowel ....................... Endodontic procedure .............................. Gingivectomy/plasty per quad ................. Gingivectomy/plasty per toot ................... Gingival flap proc w/ planin ..................... Gngvl flap w rootplan 1-3 th .................... Apically positioned flap ............................ Crown lengthen hard tissue ..................... Osseous surgery per quadrant ................ Osseous surgl-3teethperquad ................. Bone replce graft first site ....................... Bone replce graft each add ..................... Bio mtrls to aid soft/os reg ...................... Guided tiss regen resorble ...................... Guided tiss regen nonresorb ................... Surgical revision procedure ..................... Pedicle soft tissue graft pr ....................... Free soft tissue graft proc ....................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... .................... 0330 .................... .................... .................... .................... .................... .................... 0330 .................... 0330 0330 .................... .................... .................... 0330 0330 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... 7.1756 .................... 7.1756 7.1756 .................... .................... .................... 7.1756 7.1756 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... .................... $425.82 .................... .................... .................... .................... .................... .................... $425.82 .................... $425.82 $425.82 .................... .................... .................... $425.82 $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... $85.16 .................... $85.16 $85.16 .................... .................... .................... $85.16 $85.16 $85.16 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00161 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50840 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D4273 D4274 D4275 D4276 D4320 D4321 D4341 D4342 D4355 D4381 D4910 D4920 D4999 D5110 D5120 D5130 D5140 D5211 D5212 D5213 D5214 D5225 D5226 D5281 D5410 D5411 D5421 D5422 D5510 D5520 D5610 D5620 D5630 D5640 D5650 D5660 D5670 D5671 D5710 D5711 D5720 D5721 D5730 D5731 D5740 D5741 D5750 D5751 D5760 D5761 D5810 D5811 D5820 D5821 D5850 D5851 D5860 D5861 D5862 D5867 D5875 D5899 D5911 D5912 D5913 D5914 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI S E E E E E E E S S 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 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 S S E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Subepithelial tissue graft ......................... Distal/proximal wedge proc ..................... Soft tissue allograft .................................. Con tissue w dble ped graft .................... Provision splnt intracoronal ..................... Provisional splint extracoro ...................... Periodontal scaling & root ....................... Periodontal scaling 1-3teeth .................... Full mouth debridement ........................... Localized chemo delivery ........................ Periodontal maint procedures .................. Unscheduled dressing change ................ Unspecified periodontal proc ................... Dentures complete maxillary ................... Dentures complete mandible ................... Dentures immediat maxillary ................... Dentures immediat mandible ................... Dentures maxill part resin ........................ Dentures mand part resin ........................ Dentures maxill part metal ....................... Dentures mandibl part metal ................... Maxillary part denture flex ....................... Mandibular part denture flex .................... Removable partial denture ...................... Dentures adjust cmplt maxil .................... Dentures adjust cmplt mand .................... Dentures adjust part maxill ...................... Dentures adjust part mandbl ................... Dentur repr broken compl bas ................. Replace denture teeth complt ................. Dentures repair resin base ...................... Rep part denture cast frame ................... Rep partial denture clasp ........................ Replace part denture teeth ...................... Add tooth to partial denture ..................... Add clasp to partial denture .................... Replc tth&acrlc on mtl frmwk ................... Replc tth&acrlc mandibular ...................... Dentures rebase cmplt maxil ................... Dentures rebase cmplt mand .................. Dentures rebase part maxill .................... Dentures rebase part mandbl .................. Denture reln cmplt maxil ch ..................... Denture reln cmplt mand chr ................... Denture reln part maxil chr ...................... Denture reln part mand chr ..................... Denture reln cmplt max lab ..................... Denture reln cmplt mand lab ................... Denture reln part maxil lab ...................... Denture reln part mand lab ..................... Denture interm cmplt maxill ..................... Denture interm cmplt mandbl .................. Denture interm part maxill ....................... Denture interm part mandbl ..................... Denture tiss conditn maxill ...................... Denture tiss condtin mandbl .................... Overdenture complete ............................. Overdenture partial .................................. Precision attachment ............................... Replacement of precision att ................... Prosthesis modification ............................ Removable prosthodontic proc ................ Facial moulage sectional ......................... Facial moulage complete ......................... Nasal prosthesis ...................................... Auricular prosthesis ................................. 0330 .................... .................... .................... .................... .................... .................... .................... 0330 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 0330 .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... 7.1756 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 7.1756 .................... .................... $425.82 .................... .................... .................... .................... .................... .................... .................... $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... .................... $85.16 $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 $85.16 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00162 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50841 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D5915 D5916 D5919 D5922 D5923 D5924 D5925 D5926 D5927 D5928 D5929 D5931 D5932 D5933 D5934 D5935 D5936 D5937 D5951 D5952 D5953 D5954 D5955 D5958 D5959 D5960 D5982 D5983 D5984 D5985 D5986 D5987 D5988 D5999 D6010 D6040 D6050 D6053 D6054 D6055 D6056 D6057 D6058 D6059 D6060 D6061 D6062 D6063 D6064 D6065 D6066 D6067 D6068 D6069 D6070 D6071 D6072 D6073 D6074 D6075 D6076 D6077 D6078 D6079 D6080 D6090 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI 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 S S S E S 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 E E E E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Orbital prosthesis ..................................... Ocular prosthesis ..................................... Facial prosthesis ...................................... Nasal septal prosthesis ........................... Ocular prosthesis interim ......................... Cranial prosthesis .................................... Facial augmentation implant .................... Replacement nasal prosthesis ................ Auricular replacement .............................. Orbital replacement ................................. Facial replacement .................................. Surgical obturator .................................... Postsurgical obturator .............................. Refitting of obturator ................................ Mandibular flange prosthesis ................... Mandibular denture prosth ....................... Temp obturator prosthesis ....................... Trismus appliance .................................... Feeding aid .............................................. Pediatric speech aid ................................ Adult speech aid ...................................... Superimposed prosthesis ........................ Palatal lift prosthesis ................................ Intraoral con def inter plt ......................... Intraoral con def mod palat ..................... Modify speech aid prosthesis .................. Surgical stent ........................................... Radiation applicator ................................. Radiation shield ....................................... Radiation cone locator ............................. Fluoride applicator ................................... Commissure splint ................................... Surgical splint .......................................... Maxillofacial prosthesis ............................ Odontics endosteal implant ..................... Odontics eposteal implant ....................... Odontics transosteal implnt ..................... Implnt/abtmnt spprt remv dnt ................... Implnt/abtmnt spprt remvprtl .................... Implant connecting bar ............................ Prefabricated abutment ........................... Custom abutment .................................... Abutment supported crown ...................... Abutment supported mtl crown ................ Abutment supported mtl crown ................ Abutment supported mtl crown ................ Abutment supported mtl crown ................ Abutment supported mtl crown ................ Abutment supported mtl crown ................ Implant supported crown ......................... Implant supported mtl crown ................... Implant supported mtl crown ................... Abutment supported retainer ................... Abutment supported retainer ................... Abutment supported retainer ................... Abutment supported retainer ................... Abutment supported retainer ................... Abutment supported retainer ................... Abutment supported retainer ................... Implant supported retainer ....................... Implant supported retainer ....................... Implant supported retainer ....................... Implnt/abut suprtd fixd dent ..................... Implnt/abut suprtd fixd dent ..................... Implant maintenance ............................... Repair implant .......................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 0330 0330 .................... 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 7.1756 7.1756 .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 $425.82 $425.82 .................... $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 $85.16 $85.16 .................... $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00163 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50842 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D6094 D6095 D6100 D6190 D6194 D6199 D6205 D6210 D6211 D6212 D6214 D6240 D6241 D6242 D6245 D6250 D6251 D6252 D6253 D6545 D6548 D6600 D6601 D6602 D6603 D6604 D6605 D6606 D6607 D6608 D6609 D6610 D6611 D6612 D6613 D6614 D6615 D6624 D6634 D6710 D6720 D6721 D6722 D6740 D6750 D6751 D6752 D6780 D6781 D6782 D6783 D6790 D6791 D6792 D6793 D6794 D6920 D6930 D6940 D6950 D6970 D6971 D6972 D6973 D6975 D6976 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI 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 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 E E S E E E E E E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Abut support crown titanium .................... Odontics repr abutment ........................... Removal of implant .................................. Radio/surgical implant index .................... Abut support retainer titani ...................... Implant procedure .................................... Pontic-indirect resin based ...................... Prosthodont high noble metal .................. Bridge base metal cast ............................ Bridge noble metal cast ........................... Pontic titanium ......................................... Bridge porcelain high noble ..................... Bridge porcelain base metal .................... Bridge porcelain nobel metal ................... Bridge porcelain/ceramic ......................... Bridge resin w/high noble ........................ Bridge resin base metal ........................... Bridge resin w/noble metal ...................... Provisional pontic ..................................... Dental retainr cast metl ........................... Porcelain/ceramic retainer ....................... Porcelain/ceramic inlay 2srf ..................... Porc/ceram inlay >= 3 surfac .................. Cst hgh nble mtl inlay 2 srf ..................... Cst hgh nble mtl inlay >=3sr ................... Cst bse mtl inlay 2 surfaces .................... Cst bse mtl inlay >= 3 surfa .................... Cast noble metal inlay 2 sur .................... Cst noble mtl inlay >=3 surf .................... Onlay porc/crmc 2 surfaces ..................... Onlay porc/crmc >=3 surfaces ................ Onlay cst hgh nbl mtl 2 srfc .................... Onlay cst hgh nbl mtl >=3srf ................... Onlay cst base mtl 2 surface ................... Onlay cst base mtl >=3 surfa .................. Onlay cst nbl mtl 2 surfaces .................... Onlay cst nbl mtl >=3 surfac ................... Inlay titanium ............................................ Onlay titanium .......................................... Crown-indirect resin based ...................... Retain crown resin w hi nble ................... Crown resin w/base metal ....................... Crown resin w/noble metal ...................... Crown porcelain/ceramic ......................... Crown porcelain high noble ..................... Crown porcelain base metal .................... Crown porcelain noble metal ................... Crown 3/4 high noble metal .................... Crown 3/4 cast based metal .................... Crown 3/4 cast noble metal ..................... Crown 3/4 porcelain/ceramic ................... Crown full high noble metal ..................... Crown full base metal cast ...................... Crown full noble metal cast ..................... Provisional retainer crown ....................... Crown titanium ......................................... Dental connector bar ............................... Dental recement bridge ........................... Stress breaker ......................................... Precision attachment ............................... Post & core plus retainer ......................... Cast post bridge retainer ......................... Prefab post & core plus reta ................... Core build up for retainer ........................ Coping metal ............................................ Each addtnl cast post .............................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00164 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50843 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D6977 D6980 D6985 D6999 D7111 D7140 D7210 D7220 D7230 D7240 D7241 D7250 D7260 D7261 D7270 D7272 D7280 D7282 D7283 D7285 D7286 D7287 D7288 D7290 D7291 D7310 D7311 D7320 D7321 D7340 D7350 D7410 D7411 D7412 D7413 D7414 D7415 D7440 D7441 D7450 D7451 D7460 D7461 D7465 D7471 D7472 D7473 D7485 D7490 D7510 D7511 D7520 D7521 D7530 D7540 D7550 D7560 D7610 D7620 D7630 D7640 D7650 D7660 D7670 D7671 D7680 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI E E E E S S S S S S S S S S E E E E B E E E B E S E E E B E E E E E E E E E E E E E E E E E E E E E B E B E E E E E E E E E E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Each addtl prefab post ............................ Bridge repair ............................................ Pediatric partial denture fx ....................... Fixed prosthodontic proc ......................... Coronal remnants deciduous t ................ 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 ....................... Tooth reimplantation ................................ Tooth transplantation ............................... Exposure impact tooth orthod ................. Mobilize erupted/malpos toot ................... Place device impacted tooth ................... Biopsy of oral tissue hard ........................ Biopsy of oral tissue soft ......................... Cytology sample collection ...................... Brush biopsy ............................................ Repositioning of teeth .............................. Transseptal fiberotomy ............................ Alveoplasty w/ extraction ......................... Alveoloplasty w/extract 1-3 ...................... Alveoplasty w/o extraction ....................... Alveoloplasty not w/extracts .................... Vestibuloplasty ridge extens .................... Vestibuloplasty exten graft ...................... Rad exc lesion up to 1.25 cm ................. Excision benign lesion>1.25c .................. Excision benign lesion compl .................. Excision malig lesion < =1.25c ................ Excision malig lesion > 1.25cm ............... Excision malig les complicat .................... Malig tumor exc to 1.25 cm ..................... Malig tumor > 1.25 cm ............................. Rem odontogen cyst to 1.25cm .............. Rem odontogen cyst > 1.25 cm .............. Rem nonodonto cyst to 1.25cm .............. Rem nonodonto cyst > 1.25 cm .............. Lesion destruction .................................... Rem exostosis any site ........................... Removal of torus palatinus ...................... Remove torus mandibularis ..................... Surg reduct osseoustuberosit .................. Mandible resection ................................... I&d absc intraoral soft tiss ....................... Incision/drain abscess intra ..................... I&d abscess extraoral .............................. Incision/drain abscess extra .................... Removal fb skin/areolar tiss .................... Removal of fb reaction ............................ Removal of sloughed off bone ................ Maxillary sinusotomy ............................... Maxilla open reduct simple ...................... Clsd reduct simpl maxilla fx ..................... Open red simpl mandible fx .................... Clsd red simpl mandible fx ...................... Open red simp malar/zygom fx ............... Clsd red simp malar/zygom fx ................. Closd rductn splint alveolus ..................... Alveolus open reduction .......................... Reduct simple facial bone fx ................... .................... .................... .................... .................... 0330 0330 0330 0330 0330 0330 0330 0330 0330 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00165 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50844 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D7710 D7720 D7730 D7740 D7750 D7760 D7770 D7771 D7780 D7810 D7820 D7830 D7840 D7850 D7852 D7854 D7856 D7858 D7860 D7865 D7870 D7871 D7872 D7873 D7874 D7875 D7876 D7877 D7880 D7899 D7910 D7911 D7912 D7920 D7940 D7941 D7943 D7944 D7945 D7946 D7947 D7948 D7949 D7950 D7953 D7955 D7960 D7963 D7970 D7971 D7972 D7980 D7981 D7982 D7983 D7990 D7991 D7995 D7996 D7997 D7999 D8010 D8020 D8030 D8040 D8050 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI 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 E E E E E E E S 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 E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Maxilla open reduct compound ............... Clsd reduct compd maxilla fx .................. Open reduct compd mandble fx .............. Clsd reduct compd mandble fx ................ Open red comp malar/zygma fx .............. Clsd red comp malar/zygma fx ................ Open reduc compd alveolus fx ................ Alveolus clsd reduc stblz te ..................... Reduct compnd facial bone fx ................. Tmj open reduct-dislocation .................... Closed tmp manipulation ......................... Tmj manipulation under anest ................. Removal of tmj condyle ........................... Tmj meniscectomy ................................... Tmj repair of joint disc ............................. Tmj excisn of joint membrane ................. Tmj cutting of a muscle ........................... Tmj reconstruction ................................... Tmj cutting into joint ................................ Tmj reshaping components ..................... Tmj aspiration joint fluid ........................... Lysis + lavage w catheters ...................... Tmj diagnostic arthroscopy ...................... Tmj arthroscopy lysis adhesn .................. Tmj arthroscopy disc reposit ................... Tmj arthroscopy synovectomy ................. Tmj arthroscopy discectomy .................... Tmj arthroscopy debridement .................. Occlusal orthotic appliance ...................... Tmj unspecified therapy .......................... Dent sutur recent wnd to 5cm ................. Dental suture wound to 5 cm .................. Suture complicate wnd > 5 cm ................ Dental skin graft ....................................... Reshaping bone orthognathic .................. Bone cutting ramus closed ...................... Cutting ramus open w/graft ..................... Bone cutting segmented .......................... Bone cutting body mandible .................... Reconstruction maxilla total ..................... Reconstruct maxilla segment .................. Reconstruct midface no graft .................. Reconstruct midface w/graft .................... Mandible graft .......................................... Bone replacement graft ........................... Repair maxillofacial defects ..................... Frenulectomy/frenulotomy ....................... Frenuloplasty ........................................... Excision hyperplastic tissue ..................... Excision pericoronal gingiva .................... Surg redct fibrous tuberosit ..................... Sialolithotomy ........................................... Excision of salivary gland ........................ Sialodochoplasty ...................................... Closure of salivary fistula ........................ Emergency tracheotomy .......................... Dental coronoidectomy ............................ Synthetic graft facial bones ..................... Implant mandible for augment ................. Appliance removal ................................... Oral surgery procedure ............................ Limited dental tx primary ......................... Limited dental tx transition ....................... Limited dental tx adolescent .................... Limited dental tx adult ............................. Intercep dental tx primary ........................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00166 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50845 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS D8060 D8070 D8080 D8090 D8210 D8220 D8660 D8670 D8680 D8690 D8691 D8692 D8999 D9110 D9210 D9211 D9212 D9215 D9220 D9221 D9230 D9241 D9242 D9248 D9310 D9410 D9420 D9430 D9440 D9450 D9610 D9630 D9910 D9911 D9920 D9930 D9940 D9941 D9942 D9950 D9951 D9952 D9970 D9971 D9972 D9973 D9974 D9999 E0100 E0105 E0110 E0111 E0112 E0113 E0114 E0116 E0117 E0118 E0130 E0135 E0140 E0141 E0143 E0144 E0147 E0148 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI E E E E E E E E E E E E E N E E E E E E N E E N E E E E E E E S E E E S S E E S S S E E E E E E Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Intercep dental tx transitn ........................ Compre dental tx transition ..................... Compre dental tx adolescent ................... Compre dental tx adult ............................ Orthodontic rem appliance tx .................. Fixed appliance therapy habt .................. Preorthodontic tx visit .............................. Periodic orthodontc tx visit ...................... Orthodontic retention ............................... Orthodontic treatment .............................. Repair ortho appliance ............................ Replacement retainer .............................. Orthodontic procedure ............................. Tx dental pain minor proc ........................ Dent anesthesia w/o surgery ................... Regional block anesthesia ....................... Trigeminal block anesthesia .................... Local anesthesia ...................................... General anesthesia .................................. General anesthesia ea ad 15m ............... Analgesia ................................................. Intravenous sedation ............................... IV sedation ea ad 30 m ........................... Sedation (non-iv) ..................................... Dental consultation .................................. Dental house call ..................................... Hospital call ............................................. Office visit during hours ........................... Office visit after hours .............................. Case presentation tx plan ........................ Dent therapeutic drug inject .................... Other drugs/medicaments ....................... Dent appl desensitizing med ................... Appl desensitizing resin ........................... Behavior management ............................. Treatment of complications ..................... Dental occlusal guard .............................. Fabrication athletic guard ........................ Repair/reline occlusal guard .................... Occlusion analysis ................................... Limited occlusal adjustment .................... Complete occlusal adjustment ................. Enamel microabrasion ............................. Odontoplasty 1-2 teeth ............................ Extrnl bleaching per arch ......................... Extrnl bleaching per tooth ........................ Intrnl bleaching per tooth ......................... Adjunctive procedure ............................... Cane adjust/fixed with tip ........................ Cane adjust/fixed quad/3 pro .................. Crutch forearm pair .................................. Crutch forearm each ................................ Crutch underarm pair wood ..................... Crutch underarm each wood ................... Crutch underarm pair no wood ................ Crutch underarm each no wood .............. Underarm springassist crutch .................. Crutch substitute ...................................... Walker rigid adjust/fixed ht ...................... Walker folding adjust/fixed ....................... Walker w trunk support ............................ Rigid wheeled walker adj/fix .................... Walker folding wheeled w/o s .................. Enclosed walker w rear seat ................... Walker variable wheel resist .................... Heavyduty walker no wheels ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0330 .................... .................... .................... 0330 0330 .................... .................... 0330 0330 0330 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 7.1756 .................... .................... .................... 7.1756 7.1756 .................... .................... 7.1756 7.1756 7.1756 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $425.82 .................... .................... .................... $425.82 $425.82 .................... .................... $425.82 $425.82 $425.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $85.16 .................... .................... .................... $85.16 $85.16 .................... .................... $85.16 $85.16 $85.16 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00167 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50846 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E0149 E0153 E0154 E0155 E0156 E0157 E0158 E0159 E0160 E0161 E0162 E0163 E0164 E0166 E0167 E0168 E0169 E0175 E0180 E0181 E0182 E0184 E0185 E0186 E0187 E0188 E0189 E0190 E0191 E0193 E0194 E0196 E0197 E0198 E0199 E0200 E0202 E0203 E0205 E0210 E0215 E0217 E0218 E0220 E0221 E0225 E0230 E0231 E0232 E0235 E0236 E0238 E0239 E0240 E0241 E0242 E0243 E0244 E0245 E0246 E0247 E0248 E0249 E0250 E0251 E0255 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y E Y Y E E Y Y Y Y E E E E E E E E E Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Heavy duty wheeled walker ..................... Forearm crutch platform atta ................... Walker platform attachment ..................... Walker wheel attachment,pair ................. Walker seat attachment ........................... Walker crutch attachment ........................ Walker leg extenders set of4 ................... Brake for wheeled walker ........................ Sitz type bath or equipment .................... Sitz bath/equipment w/faucet .................. Sitz bath chair .......................................... Commode chair stationry fxd ................... Commode chair mobile fixed a ................ Commode chair mobile detach ................ Commode chair pail or pan ..................... Heavyduty/wide commode chair .............. Seatlift incorp commodechair .................. Commode chair foot rest ......................... Press pad alternating w pump ................. Press pad alternating w/ pum .................. Pressure pad alternating pum ................. Dry pressure mattress ............................. Gel pressure mattress pad ...................... Air pressure mattress .............................. Water pressure mattress ......................... Synthetic sheepskin pad .......................... Lambswool sheepskin pad ...................... Positioning cushion .................................. Protector heel or elbow ........................... Powered air flotation bed ......................... Air fluidized bed ....................................... Gel pressure mattress ............................. Air pressure pad for mattres .................... Water pressure pad for mattr .................. Dry pressure pad for mattres .................. Heat lamp without stand .......................... Phototherapy light w/ photom .................. Therapeutic lightbox tabletp .................... Heat lamp with stand ............................... Electric heat pad standard ....................... Electric heat pad moist ............................ Water circ heat pad w pump ................... Water circ cold pad w pump .................... Hot water bottle ....................................... Infrared heating pad system .................... Hydrocollator unit ..................................... Ice cap or collar ....................................... Wound warming device ........................... Warming card for NWT ............................ Paraffin bath unit portable ....................... Pump for water circulating p .................... Heat pad non-electric moist ..................... Hydrocollator unit portable ....................... Bath/shower chair .................................... Bath tub wall rail ...................................... Bath tub rail floor ..................................... Toilet rail .................................................. Toilet seat raised ..................................... Tub stool or bench ................................... Transfer tub rail attachment .................... Trans bench w/wo comm open ............... HDtrans bench w/wo comm open ........... Pad water circulating heat u .................... Hosp bed fixed ht w/ mattres .................. Hosp bed fixd ht w/o mattres .................. Hospital bed var ht w/ mattr .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00168 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50847 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E0256 E0260 E0261 E0265 E0266 E0270 E0271 E0272 E0273 E0274 E0275 E0276 E0277 E0280 E0290 E0291 E0292 E0293 E0294 E0295 E0296 E0297 E0300 E0301 E0302 E0303 E0304 E0305 E0310 E0315 E0316 E0325 E0326 E0350 E0352 E0370 E0371 E0372 E0373 E0424 E0425 E0430 E0431 E0434 E0435 E0439 E0440 E0441 E0442 E0443 E0444 E0445 E0450 E0455 E0457 E0459 E0460 E0461 E0462 E0463 E0464 E0470 E0471 E0472 E0480 E0481 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y E Y Y E E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E Y Y Y E E E Y Y Y Y E E Y Y E Y E Y Y Y Y A Y Y Y Y Y Y Y Y Y Y Y Y Y E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Hospital bed var ht w/o matt ................... Hosp bed semi-electr w/ matt .................. Hosp bed semi-electr w/o mat ................. Hosp bed total electr w/ mat ................... Hosp bed total elec w/o matt ................... Hospital bed institutional t ....................... Mattress innerspring ................................ Mattress foam rubber .............................. Bed board ................................................ Over-bed table ......................................... Bed pan standard .................................... Bed pan fracture ...................................... Powered pres-redu air mattrs .................. Bed cradle ................................................ Hosp bed fx ht w/o rails w/m ................... Hosp bed fx ht w/o rail w/o ...................... Hosp bed var ht w/o rail w/o ................... Hosp bed var ht w/o rail w/ ..................... Hosp bed semi-elect w/ mattr .................. Hosp bed semi-elect w/o matt ................. Hosp bed total elect w/ matt .................... Hosp bed total elect w/o mat ................... Enclosed ped crib hosp grade ................. HD hosp bed, 350-600 lbs ...................... Ex hd hosp bed > 600 lbs ....................... Hosp bed hvy dty xtra wide ..................... Hosp bed xtra hvy dty × wide .................. Rails bed side half length ........................ Rails bed side full length ......................... Bed accessory brd/tbl/supprt ................... Bed safety enclosure ............................... Urinal male jug-type ................................. Urinal female jug-type .............................. Control unit bowel system ....................... Disposable pack w/bowel syst ................. Air elevator for heel ................................. Nonpower mattress overlay ..................... Powered air mattress overlay .................. Nonpowered pressure mattress .............. Stationary compressed gas 02 ................ Gas system stationary compre ................ Oxygen system gas portable ................... Portable gaseous 02 ................................ Portable liquid 02 ..................................... Oxygen system liquid portabl .................. Stationary liquid 02 .................................. Oxygen system liquid station ................... Oxygen contents, gaseous ...................... Oxygen contents, liquid ........................... Portable 02 contents, gas ........................ Portable 02 contents, liquid ..................... Oximeter non-invasive ............................. Volume vent stationary/porta ................... Oxygen tent excl croup/ped t .................. Chest shell ............................................... Chest wrap ............................................... Neg press vent portabl/statn ................... Vol vent noninvasive interfa .................... Rocking bed w/ or w/o side r ................... Press supp vent invasive int .................... Press supp vent noninv int ...................... RAD w/o backup non-inv intfc ................. RAD w/backup non inv intrfc ................... RAD w backup invasive intrfc .................. Percussor elect/pneum home m .............. Intrpulmnry percuss vent sys ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00169 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50848 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E0482 E0483 E0484 E0500 E0550 E0555 E0560 E0561 E0562 E0565 E0570 E0571 E0572 E0574 E0575 E0580 E0585 E0590 E0600 E0601 E0602 E0603 E0604 E0605 E0606 E0607 E0610 E0615 E0616 E0617 E0618 E0619 E0620 E0621 E0625 E0627 E0628 E0629 E0630 E0635 E0636 E0637 E0638 E0639 E0640 E0650 E0651 E0652 E0655 E0660 E0665 E0666 E0667 E0668 E0669 E0671 E0672 E0673 E0675 E0691 E0692 E0693 E0694 E0700 E0701 E0710 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A A Y Y Y Y Y N Y A A Y Y E Y Y Y Y Y Y E E E E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E Y E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Cough stimulating device ........................ Chest compression gen system .............. Non-elec oscillatory pep dvc ................... Ippb all types ........................................... Humidif extens supple w ippb ................. Humidifier for use w/ regula .................... Humidifier supplemental w/ i ................... Humidifier nonheated w PAP .................. Humidifier heated used w PAP ............... Compressor air power source ................. Nebulizer with compression ..................... Aerosol compressor for svneb ................. Aerosol compressor adjust pr .................. Ultrasonic generator w svneb .................. Nebulizer ultrasonic ................................. Nebulizer for use w/ regulat .................... Nebulizer w/ compressor & he ................ Dispensing fee dme neb drug ................. Suction pump portab hom modl .............. Cont airway pressure device ................... Manual breast pump ................................ Electric breast pump ................................ Hosp grade elec breast pump ................. Vaporizer room type ................................ Drainage board postural .......................... Blood glucose monitor home ................... Pacemaker monitr audible/vis ................. Pacemaker monitr digital/vis .................... Cardiac event recorder ............................ Automatic ext defibrillator ........................ Apnea monitor ......................................... Apnea monitor w recorder ....................... Cap bld skin piercing laser ...................... Patient lift sling or seat ............................ Patient lift bathroom or toi ....................... Seat lift incorp lift-chair ............................ Seat lift for pt furn-electr .......................... Seat lift for pt furn-non-el ......................... Patient lift hydraulic ................................. Patient lift electric .................................... PT support & positioning sys ................... Sit-stand w seatlift wheeled ..................... Standing frame sys wheeled ................... Moveable patient lift system .................... Fixed patient lift system ........................... Pneuma compresor non-segment ........... Pneum compressor segmental ................ Pneum compres w/cal pressure .............. Pneumatic appliance half arm ................. Pneumatic appliance full leg .................... Pneumatic appliance full arm .................. Pneumatic appliance half leg .................. Seg pneumatic appl full leg ..................... Seg pneumatic appl full arm .................... Seg pneumatic appli half leg ................... Pressure pneum appl full leg ................... Pressure pneum appl full arm ................. Pressure pneum appl half leg ................. Pneumatic compression device ............... Uvl pnl 2 sq ft or less .............................. Uvl sys panel 4 ft ..................................... Uvl sys panel 6 ft ..................................... Uvl md cabinet sys 6 ft ............................ Safety equipment ..................................... Helmet w face guard prefab .................... Restraints any type .................................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00170 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50849 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E0720 E0730 E0731 E0740 E0744 E0745 E0746 E0747 E0748 E0749 E0752 E0754 E0755 E0756 E0757 E0758 E0759 E0760 E0761 E0765 E0769 E0776 E0779 E0780 E0781 E0782 E0783 E0784 E0785 E0786 E0791 E0830 E0840 E0849 E0850 E0855 E0860 E0870 E0880 E0890 E0900 E0910 E0920 E0930 E0935 E0940 E0941 E0942 E0944 E0945 E0946 E0947 E0948 E0950 E0951 E0952 E0953 E0954 E0955 E0956 E0957 E0958 E0959 E0960 E0961 E0966 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y Y E Y Y N B A E B N A A Y E Y B Y Y Y Y N N Y N N Y N Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E E E E E Y Y Y A B Y B B ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Tens two lead .......................................... Tens four lead .......................................... Conductive garment for tens/ .................. Incontinence treatment systm .................. Neuromuscular stim for scoli ................... Neuromuscular stim for shock ................. Electromyograph biofeedback ................. Elec osteogen stim not spine .................. Elec osteogen stim spinal ........................ Elec osteogen stim implanted ................. Neurostimulator electrode ........................ Pulsegenerator pt programmer ................ Electronic salivary reflex s ....................... Implantable pulse generator .................... Implantable RF receiver .......................... External RF transmitter ............................ Replace rdfrquncy transmittr ................... Osteogen ultrasound stimltor ................... Nontherm electromgntc device ................ Nerve stimulator for tx n&v ...................... Electric wound treatment dev .................. Iv pole ...................................................... Amb infusion pump mechanical .............. Mech amb infusion pump <8hrs .............. External ambulatory infus pu ................... Non-programble infusion pump ............... Programmable infusion pump .................. Ext amb infusn pump insulin ................... Replacement impl pump cathet ............... Implantable pump replacement ............... Parenteral infusion pump sta ................... Ambulatory traction device ...................... Tract frame attach headboard ................. Cervical pneum trac equip ....................... Traction stand free standing .................... Cervical traction equipment ..................... Tract equip cervical tract ......................... Tract frame attach footboard ................... Trac stand free stand extrem .................. Traction frame attach pelvic .................... Trac stand free stand pelvic .................... Trapeze bar attached to bed ................... Fracture frame attached to b ................... Fracture frame free standing ................... Exercise device passive moti .................. Trapeze bar free standing ....................... Gravity assisted traction de ..................... Cervical head harness/halter ................... Pelvic belt/harness/boot ........................... Belt/harness extremity ............................. Fracture frame dual w cross .................... Fracture frame attachmnts pe ................. Fracture frame attachmnts ce ................. Tray .......................................................... Loop heel ................................................. Toe loop/holder, each .............................. Pneumatic tire .......................................... Wheelchair semi-pneumatic ca ............... Cushioned headrest ................................. W/c lateral trunk/hip suppor ..................... W/c medial thigh support ......................... Whlchr att- conv 1 arm drive ................... Amputee adapter ..................................... W/c shoulder harness/straps ................... Wheelchair brake extension .................... Wheelchair head rest extensi .................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00171 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50850 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E0967 E0968 E0969 E0970 E0971 E0972 E0973 E0974 E0977 E0978 E0980 E0981 E0982 E0983 E0984 E0985 E0986 E0990 E0992 E0994 E0995 E0996 E0997 E0998 E0999 E1000 E1001 E1002 E1003 E1004 E1005 E1006 E1007 E1008 E1009 E1010 E1011 E1014 E1015 E1016 E1017 E1018 E1019 E1020 E1021 E1025 E1026 E1027 E1028 E1029 E1030 E1031 E1035 E1037 E1038 E1039 E1050 E1060 E1070 E1083 E1084 E1085 E1086 E1087 E1088 E1089 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y B B A B B Y B Y Y Y Y Y Y Y B B Y B B Y Y Y B Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E Y E E E E Y Y Y Y Y Y Y Y A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Wheelchair hand rims .............................. Wheelchair commode seat ...................... Wheelchair narrowing device .................. Wheelchair no. 2 footplates ..................... Wheelchair anti-tipping devi .................... Transfer board or device ......................... W/Ch access det adj armrest .................. W/Ch access anti-rollback ....................... Wheelchair wedge cushion ...................... W/C acc,saf belt pelv strap ..................... Wheelchair safety vest ............................ Seat upholstery, replacement .................. Back upholstery, replacement ................. Add pwr joystick ....................................... Add pwr tiller ............................................ W/c seat lift mechanism .......................... Man w/c push-rim pow assist .................. Whellchair elevating leg res .................... Wheelchair solid seat insert .................... Wheelchair arm rest ................................ Wheelchair calf rest ................................. Wheelchair tire solid ................................ Wheelchair caster w/ a fork ..................... Wheelchair caster w/o a fork ................... Wheelchr pneumatic tire w/wh ................ Wheelchair tire pneumatic ca .................. Wheelchair wheel .................................... Pwr seat tilt .............................................. Pwr seat recline ....................................... Pwr seat recline mech ............................. Pwr seat recline pwr ................................ Pwr seat combo w/o shear ...................... Pwr seat combo w/shear ......................... Pwr seat combo pwr shear ...................... Add mech leg elevation ........................... Add pwr leg elevation .............................. Ped wc modify width adjustm .................. Reclining back add ped w/c .................... Shock absorber for man w/c ................... Shock absorber for power w/c ................. HD shck absrbr for hd man wc ................ HD shck absrber for hd powwc ............... HD feature power seat ............................ Residual limb support system ................. Ex hd feature power seat ........................ Pedwc lat/thor sup nocontour .................. Pedwc contoured lat/thor sup .................. Ped wc lat/ant support ............................. W/c manual swingaway ........................... W/c vent tray fixed ................................... W/c vent tray gimbaled ............................ Rollabout chair with casters .................... Patient transfer system ............................ Transport chair, ped size ......................... Transport chair, adult size ....................... Transport chair pt wt>=250lb ................... Whelchr fxd full length arms .................... Wheelchair detachable arms ................... Wheelchair detachable foot r ................... Hemi-wheelchair fixed arms .................... Hemi-wheelchair detachable a ................ Hemi-wheelchair fixed arms .................... Hemi-wheelchair detachable a ................ Wheelchair lightwt fixed arm ................... Wheelchair lightweight det a ................... Wheelchair lightwt fixed arm ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00172 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50851 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E1090 E1092 E1093 E1100 E1110 E1130 E1140 E1150 E1160 E1161 E1170 E1171 E1172 E1180 E1190 E1195 E1200 E1210 E1211 E1212 E1213 E1220 E1221 E1222 E1223 E1224 E1225 E1226 E1227 E1228 E1229 E1230 E1231 E1232 E1233 E1234 E1235 E1236 E1237 E1238 E1239 E1240 E1250 E1260 E1270 E1280 E1285 E1290 E1295 E1296 E1297 E1298 E1300 E1310 E1340 E1353 E1355 E1372 E1390 E1391 E1399 E1405 E1406 E1500 E1510 E1520 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A A A A A A A Y A A A A A A A A A Y Y A A A A A A A Y B Y Y Y Y Y Y Y Y Y Y Y Y Y A A A A A A A A Y Y Y E Y Y Y Y Y Y Y N Y Y A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Wheelchair lightweight det a ................... Wheelchair wide w/ leg rests ................... Wheelchair wide w/ foot rest ................... Whchr s-recl fxd arm leg res ................... Wheelchair semi-recl detach ................... Whlchr stand fxd arm ft rest .................... Wheelchair standard detach a ................. Wheelchair standard w/ leg r ................... Wheelchair fixed arms ............................. Manual adult wc w tiltinspac .................... Whlchr ampu fxd arm leg rest ................. Wheelchair amputee w/o leg r ................. Wheelchair amputee detach ar ............... Wheelchair amputee w/ foot r ................. Wheelchair amputee w/ leg re ................. Wheelchair amputee heavy dut ............... Wheelchair amputee fixed arm ................ Whlchr moto ful arm leg rest ................... Wheelchair motorized w/ det ................... Wheelchair motorized w full .................... Wheelchair motorized w/ det ................... Whlchr special size/constrc ..................... Wheelchair spec size w foot .................... Wheelchair spec size w/ leg .................... Wheelchair spec size w foot .................... Wheelchair spec size w/ leg .................... Wheelchair spec sz semi-recl .................. W/C access fully reclineback ................... Wheelchair spec sz spec ht a ................. Wheelchair spec sz spec ht b ................. Pediatric wheelchair NOS ........................ Power operated vehicle ........................... Rigid ped w/c tilt-in-space ....................... Folding ped wc tilt-in-space ..................... Rig ped wc tltnspc w/o seat .................... Fld ped wc tltnspc w/o seat ..................... Rigid ped wc adjustable .......................... Folding ped wc adjustable ....................... Rgd ped wc adjstabl w/o seat ................. Fld ped wc adjstabl w/o seat ................... Ped power wheelchair NOS .................... Whchr litwt det arm leg rest ..................... Wheelchair lightwt fixed arm ................... Wheelchair lightwt foot rest ..................... Wheelchair lightweight leg r .................... Whchr h-duty det arm leg res .................. Wheelchair heavy duty fixed ................... Wheelchair hvy duty detach a ................. Wheelchair heavy duty fixed ................... Wheelchair special seat heig ................... Wheelchair special seat dept .................. Wheelchair spec seat depth/w ................ Whirlpool portable .................................... Whirlpool non-portable ............................. Repair for DME, per 15 min .................... Oxygen supplies regulator ....................... Oxygen supplies stand/rack .................... Oxy suppl heater for nebuliz ................... Oxygen concentrator ............................... Oxygen concentrator, dual ...................... Durable medical equipment mi ................ O2/water vapor enrich w/heat ................. O2/water vapor enrich w/o he ................. Centrifuge ................................................ Kidney dialysate delivry sys .................... Heparin infusion pump ............................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00173 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50852 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E1530 E1540 E1550 E1560 E1570 E1575 E1580 E1590 E1592 E1594 E1600 E1610 E1615 E1620 E1625 E1630 E1632 E1634 E1635 E1636 E1637 E1639 E1699 E1700 E1701 E1702 E1800 E1801 E1802 E1805 E1806 E1810 E1811 E1815 E1816 E1818 E1820 E1821 E1825 E1830 E1840 E1841 E1902 E2000 E2100 E2101 E2120 E2201 E2202 E2203 E2204 E2205 E2206 E2291 E2292 E2293 E2294 E2300 E2301 E2310 E2311 E2320 E2321 E2322 E2323 E2324 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A A A A A A A A A A A A A A A A A B A A A A A Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A Y Y Y Y Y Y Y Y Y Y E E E E Y Y Y Y Y Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Replacement air bubble detec ................. Replacement pressure alarm .................. Bath conductivity meter ........................... Replace blood leak detector .................... Adjustable chair for esrd pt ..................... Transducer protect/fld bar ....................... Unipuncture control system ..................... Hemodialysis machine ............................. Auto interm peritoneal dialy ..................... Cycler dialysis machine ........................... Deli/install chrg hemo equip .................... Reverse osmosis h2o puri sys ................ Deionizer H2O puri system ..................... Replacement blood pump ........................ Water softening system ........................... Reciprocating peritoneal dia .................... Wearable artificial kidney ......................... Peritoneal dialysis clamp ......................... Compact travel hemodialyzer .................. Sorbent cartridges per 10 ........................ Hemostats for dialysis, each ................... Dialysis scale ........................................... Dialysis equipment noc ............................ Jaw motion rehab system ........................ Repl cushions for jaw motion .................. Repl measr scales jaw motion ................ Adjust elbow ext/flex device .................... SPS elbow device .................................... Adjst forearm pro/sup device ................... Adjust wrist ext/flex device ...................... SPS wrist device ...................................... Adjust knee ext/flex device ...................... SPS knee device ..................................... Adjust ankle ext/flex device ..................... SPS ankle device .................................... SPS forearm device ................................. Soft interface material .............................. Replacement interface SPSD .................. Adjust finger ext/flex devc ....................... Adjust toe ext/flex device ......................... Adj shoulder ext/flex device ..................... Static str shldr dev rom adj ..................... AAC non-electronic board ....................... Gastric suction pump hme mdl ................ Bld glucose monitor w voice .................... Bld glucose monitor w lance ................... Pulse gen sys tx endolymp fl .................. Man w/ch acc seat w>=20÷<24÷ ............. Seat width 24-27 in .................................. Frame depth less than 22 in ................... Frame depth 22 to 25 in .......................... Manual wc accessory, handrim ............... Complete wheel lock assembly ............... Planar back for ped size wc .................... Planar seat for ped size wc ..................... Contour back for ped size wc .................. Contour seat for ped size wc .................. Pwr seat elevation sys ............................. Pwr standing ............................................ Electro connect btw control ..................... Electro connect btw 2 sys ....................... Hand chin control ..................................... Hand interface joystick ............................ Mult mech switches ................................. Special joystick handle ............................ Chin cup interface .................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00174 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50853 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS E2325 E2326 E2327 E2328 E2329 E2330 E2331 E2340 E2341 E2342 E2343 E2351 E2360 E2361 E2362 E2363 E2364 E2365 E2366 E2367 E2368 E2369 E2370 E2399 E2402 E2500 E2502 E2504 E2506 E2508 E2510 E2511 E2512 E2599 E2601 E2602 E2603 E2604 E2605 E2606 E2607 E2608 E2609 E2610 E2611 E2612 E2613 E2614 E2615 E2616 E2617 E2618 E2619 E2620 E2621 E8000 E8001 E8002 G0008 G0009 G0010 G0027 G0101 G0102 G0103 G0104 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y B Y Y Y Y Y Y Y Y Y Y Y E E E X X B A V N A S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Sip and puff interface .............................. Breath tube kit ......................................... Head control interface mech ................... Head/extremity control inter ..................... Head control nonproportional .................. Head control proximity switc .................... Attendant control ...................................... W/c wdth 20-23 in seat frame ................. W/c wdth 24-27 in seat frame ................. W/c dpth 20-21 in seat frame .................. W/c dpth 22-25 in seat frame .................. Electronic SGD interface ......................... 22nf nonsealed leadacid .......................... 22nf sealed leadacid battery ................... Gr24 nonsealed leadacid ......................... Gr24 sealed leadacid battery .................. U1nonsealed leadacid battery ................. U1 sealed leadacid battery ...................... Battery charger, single mode .................. Battery charger, dual mode ..................... Power wc motor replacement .................. Pwr wc gear box replacement ................. Pwr wc motor/gear box combo ................ Noc interface ............................................ Neg press wound therapy pump ............. SGD digitized pre-rec <=8min ................. SGD prerec msg >8min <=20min ............ SGD prerec msg>20min <=40min ........... SGD prerec msg > 40 min ...................... SGD spelling phys contact ...................... SGD w multi methods msg/accs ............. SGD sftwre prgrm for PC/PDA ................ SGD accessory, mounting sys ................ SGD accessory noc ................................. Gen w/c cushion wdth < 22 in ................. Gen w/c cushion wdth >=22 in ................ Skin protect wc cus wd <22in .................. Skin protect wc cus wd>=22in ................. Position wc cush wdth <22 in .................. Position wc cush wdth>=22 in ................. Skin pro/pos wc cus wd <22in ................. Skin pro/pos wc cus wd>=22in ................ Custom fabricate w/c cushion ................. Powered w/c cushion ............................... Gen use back cush wdth <22in ............... Gen use back cush wdth>=22in .............. Position back cush wd <22in ................... Position back cush wd>=22in .................. Pos back post/lat wdth <22in .................. Pos back post/lat wdth>=22in ................. Custom fab w/c back cushion ................. Wc acc solid seat supp base .................. Replace cover w/c seat cush .................. WC planar back cush wd <22in .............. WC planar back cush wd>=22in ............. Posterior gait trainer ................................ Upright gait trainer ................................... Anterior gait trainer .................................. Admin influenza virus vac ........................ Admin pneumococcal vaccine ................. Admin hepatitis b vaccine ........................ Semen analysis ....................................... CA screen pelvic/breast exam ................. Prostate ca screening dre ....................... Psa, total screening ................................. CA screen flexi sigmoidscope ................. .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0350 0350 .................... .................... 0600 .................... .................... 0159 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.3954 0.3954 .................... .................... 0.8688 .................... .................... 3.1455 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $23.46 $23.46 .................... .................... $51.56 .................... .................... $186.66 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.00 $0.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.00 $0.00 .................... .................... $10.31 .................... .................... $46.67 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00175 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50854 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS G0105 G0106 G0107 G0108 G0109 G0110 G0111 G0112 G0113 G0114 G0115 G0116 G0117 G0118 G0120 G0121 G0122 G0123 G0124 G0127 G0128 G0129 G0130 G0141 G0143 G0144 G0145 G0147 G0148 G0151 G0152 G0153 G0154 G0155 G0156 G0166 G0168 G0173 G0175 G0176 G0177 G0179 G0180 G0181 G0182 G0186 G0202 G0204 G0206 G0219 G0235 G0237 G0238 G0239 G0243 G0244 G0245 G0246 G0247 G0248 G0249 G0250 G0251 G0252 G0255 G0257 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI T S A A A A A A A A A A S S S T E A A T B P X E A A A A A B B B B B B T N S V P P E E E E T A A A E E S S S S B V V T S S E S E E S ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Colorectal scrn hi risk ind ........................ Colon CA screen barium enema ............. CA screen fecal blood test ...................... 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 not hi rsk ind .................... Colon ca scrn barium enema .................. Screen cerv/vag thin layer ....................... Screen c/v thin layer by MD .................... Trim nail(s) ............................................... CORF skilled nursing service .................. Partial hosp prog service ......................... Single energy x-ray study ........................ Scr c/v cyto,autosys and md ................... Scr c/v cyto,thinlayer,rescr ...................... Scr c/v cyto,thinlayer,rescr ...................... Scr c/v cyto,thinlayer,rescr ...................... Scr c/v cyto, automated sys .................... Scr c/v cyto, autosys, rescr ..................... HHCP-serv of pt,ea 15 min ..................... HHCP-serv of ot,ea 15 min ..................... HHCP-svs of s/l path,ea 15mn ................ HHCP-svs of rn,ea 15 min ...................... HHCP-svs of csw,ea 15 min ................... HHCP-svs of aide,ea 15 min ................... Extrnl counterpulse, per tx ....................... Wound closure by adhesive .................... Linear acc stereo radsur com .................. OPPS Service,sched team conf .............. OPPS/PHP activity therapy ..................... OPPS/PHP train & educ serv .................. MD recertification HHA PT ...................... MD certification HHA patient ................... Home health care supervision ................. Hospice care supervision ........................ Dstry eye lesn,fdr vssl tech ..................... Screeningmammographydigital ............... Diagnosticmammographydigital ............... Diagnosticmammographydigital ............... PET img whbd ring noncov ind ............... PET not otherwise specified .................... Therapeutic procd strg endur .................. Oth resp proc, indiv ................................. Oth resp proc, group ............................... Multisour photon stero treat ..................... Observ care by facility topt ...................... Initial Foot Exam PTLOPS ...................... 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 .............................. Current percep threshold tst .................... Unsched dialysis ESRD pt hos ............... 0158 0157 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0230 0230 0157 0158 .................... .................... .................... 0009 .................... 0033 0260 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0678 .................... 1528 0602 0033 0033 .................... .................... .................... .................... 0235 .................... .................... .................... .................... .................... 0411 0411 0411 1528 .................... 0600 0600 0009 1503 1503 .................... 1513 .................... .................... 0170 7.6588 2.2904 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.7858 0.7858 2.2904 7.6588 .................... .................... .................... 0.668 .................... 4.0708 0.7555 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.7276 .................... .................... 1.4284 4.0708 4.0708 .................... .................... .................... .................... 4.6593 .................... .................... .................... .................... .................... 0.3869 0.3869 0.3869 .................... .................... 0.8688 0.8688 0.668 .................... .................... .................... .................... .................... .................... 5.8994 $454.50 $135.92 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $46.63 $46.63 $135.92 $454.50 .................... .................... .................... $39.64 .................... $241.57 $44.83 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $102.52 .................... $5,250.00 $84.77 $241.57 $241.57 .................... .................... .................... .................... $276.50 .................... .................... .................... .................... .................... $22.96 $22.96 $22.96 $5,250.00 .................... $51.56 $51.56 $39.64 $150.00 $150.00 .................... $1,150.00 .................... .................... $350.09 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.97 $14.97 .................... .................... .................... .................... .................... $8.34 .................... .................... $17.93 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $67.40 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $8.34 .................... .................... .................... .................... .................... .................... .................... $113.63 $27.18 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.33 $9.33 $27.18 $113.63 .................... .................... .................... $7.93 .................... $48.31 $8.97 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $20.50 .................... $1,050.00 $16.95 $48.31 $48.31 .................... .................... .................... .................... $55.30 .................... .................... .................... .................... .................... $4.59 $4.59 $4.59 $1,050.00 .................... $10.31 $10.31 $7.93 $30.00 $30.00 .................... $230.00 .................... .................... $70.02 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00176 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50855 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS G0258 G0259 G0260 G0263 G0264 G0265 G0266 G0267 G0268 G0269 G0270 G0271 G0275 G0278 G0279 G0280 G0281 G0282 G0283 G0288 G0289 G0290 G0291 G0293 G0294 G0295 G0297 G0298 G0299 G0300 G0302 G0303 G0304 G0305 G0306 G0307 G0308 G0309 G0310 G0311 G0312 G0313 G0314 G0315 G0316 G0317 G0318 G0319 G0320 G0321 G0322 G0323 G0324 G0325 G0326 G0327 G0328 G0329 G0337 G0339 G0340 G0341 G0342 G0343 G0344 G0345 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI X N T B B A A S X N A A N N A A A E A S N T T S S E T T T T S S S S A A A A A A A A A A A A A A A A A A A A A A A A A S S C C C V M ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... IV infusion during obs stay ...................... Inject for sacroiliac joint ........................... Inj for sacroiliac jt anesth ......................... Adm with CHF, CP, asthma .................... Assmt otr CHF, CP, asthma .................... Cryopresevation Freeze+stora ................ Thawing + expansion froz cel .................. Bone marrow or psc harvest ................... 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 pre & post su ................. Arthro, loose body + chondro .................. Drug-eluting stents, single ....................... Drug-eluting stents,each add ................... Non-cov surg proc,clin trial ...................... Non-cov proc, clinical trial ....................... Electromagnetic therapy onc ................... Insert single chamber/cd ......................... Insert dual chamber/cd ............................ Inser/repos single icd+leads .................... Insert reposit lead dual+gen .................... Pre-op service LVRS complete ............... Pre-op service LVRS 10-15dos ............... Pre-op service LVRS 1-9 dos .................. Post op service LVRS min 6 ................... CBC/diffwbc w/o platelet .......................... CBC without platelet ................................ ESRD related svc 4+mo<2yrs ................. ESRD related svc 2-3mo<2yrs ................ ESRD related svc 1vst<2yr ..................... ESRD related svs 4+mo 2-11yr ............... ESRD relate svs 2-3 mo 2-11y ............... ESRD related svs 1 mon 2-11y ............... ESRD relate svs 4+mo 12-19 .................. ESRD related svs 2-3 mo 12-1 ............... ESRD related svs 1 vis/12-19 ................. ESRD related svs 4+mo 20+yrs .............. ESRD related svs 2-3 mo 20+y ............... ESRD related svs 1visit 20+y .................. ESRD related svs home under ................ ESRDrelatedsvs home mo 2-11y ............ ESRD related svs home mo 12-1 ........... ESRD related svs home mo 20+ ............. ESRD related svs home/dy/2y ................ ESRD relate home/dy 2-11yr .................. ESRD relate home/dy 12-19y .................. ESRD relate home/dy 20+yrs .................. Fecal blood scrn immunoassay ............... Electromagntic tx for ulcers ..................... Hospice evaluation preelecti .................... Robot lin-radsurg com, first ..................... Robt lin-radsurg fractx 2-5 ....................... Percutaneous islet celltrans ..................... Laparoscopy Islet cell Trans .................... Laparotomy Islet cell tranp ...................... Initial preventive exam ............................. IV infuse hydration initial ......................... 0340 .................... 0206 .................... .................... .................... .................... 0110 0340 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0417 .................... 0656 0656 1505 1502 .................... 0107 0107 0108 0108 1509 507 1504 1504 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1528 1525 .................... .................... .................... 0601 .................... 0.6384 .................... 5.492 .................... .................... .................... .................... 3.6594 0.6384 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 4.075 .................... 109.9237 109.9237 .................... .................... .................... 260.0295 260.0295 349.1681 349.1681 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.0038 .................... $37.88 .................... $325.91 .................... .................... .................... .................... $217.16 $37.88 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $241.82 .................... $6,523.20 $6,523.20 $350.00 $75.00 .................... $15,430.93 $15,430.93 $20,720.68 $20,720.68 $750.00 $550.00 $250.00 $250.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $5,250.00 $3,750.00 .................... .................... .................... $59.57 .................... .................... .................... $75.55 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3,103.22 $3,103.22 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $7.58 .................... $65.18 .................... .................... .................... .................... $43.43 $7.58 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $48.36 .................... $1,304.64 $1,304.64 $70.00 $15.00 .................... $3,086.19 $3,086.19 $4,144.14 $4,144.14 $150.00 $110.00 $50.00 $50.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,050.00 $750.00 .................... .................... .................... $11.91 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00177 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50856 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS G0346 G0347 G0348 G0349 G0350 G0351 G0353 G0354 G0355 G0356 G0357 G0358 G0359 G0360 G0361 G0362 G0363 G0364 G0365 G0366 G0367 G0368 G0369 G0370 G0371 G0374 G0375 G0376 G3001 G9001 G9002 G9003 G9004 G9005 G9006 G9007 G9008 G9009 G9010 G9011 G9012 G9013 G9014 G9016 G9017 G9018 G9019 G9020 G9021 G9022 G9023 G9024 G9025 G9026 G9027 G9028 G9029 G9030 G9031 G9032 G9033 G9034 G9035 G9036 G9041 G9042 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI M M M M M M M M M M M M M M M M M X S B S M M M M M S S S B B B B B B B B E E E E E E E A A A A M M M M M M M M M M M M A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Each additional infuse hours ................... 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 administrate 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 & biops ................ Vessel mapping hemo access ................. EKG for initial prevent exam ................... EKG tracing for initial prev ...................... EKG interpret & report preve ................... Pharm fee 1st month transpla ................. Pharmacy fee oral cancer etc ................. Pharm dispense inhalation 30 ................. Pharm dispense inhalation 90 ................. Smoke/Tobacco counseling 3-1 .............. Smoke/Tobacco counseling >10 ............. Admin + supply, tositumomab ................. MCCD, initial rate .................................... MCCD,maintenance rate ......................... MCCD, risk adj hi, initial .......................... MCCD, risk adj lo, initial .......................... MCCD, risk adj, maintenance .................. MCCD, Home monitoring ........................ MCCD, sch team conf ............................. Mccd,phys coor-care ovrsght .................. MCCD, risk adj, level 3 ............................ MCCD, risk adj, level 4 ............................ MCCD, risk adj, level 5 ............................ Other Specified Case Mgmt .................... ESRD demo bundle level I ...................... ESRD demo bundle-level II ..................... Demo-smoking cessation coun ............... Amantadine HCL,oral .............................. Zanamivir, inh pwdr ................................. Oseltamivir phosp .................................... Rimantadine HCL .................................... Chemo assess nausea vomit L1 ............. Chemo assess nausea vomit L2 ............. Chemo assess nausea vomit L3 ............. Chemo assess nausea vomit L4 ............. Chemo assessment pain level1 .............. Chemo assessment pain level2 .............. Chemo assessment pain level3 .............. Chemo assessment pain level4 .............. Chemo assess for fatigue L1 .................. Chemo assess for fatigue L2 .................. Chemo assess for fatigue L3 .................. Chemo assess for fatigue L4 .................. Amantadine HCL, oral, brand .................. Zanamivir, inh pwdr, brand ...................... Oseltamivir phosp, brand ......................... Rimantadine HCL, brand ......................... Low vision serv occupational ................... Low vision orient/mobility ......................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0342 0267 .................... 0099 .................... .................... .................... .................... .................... 1491 1491 1522 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.156 2.6327 .................... 0.3821 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $9.26 $156.23 .................... $22.67 .................... .................... .................... .................... .................... $5.00 $5.00 $2,250.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.70 $62.18 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1.85 $31.25 .................... $4.53 .................... .................... .................... .................... .................... $1.00 $1.00 $450.00 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00178 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50857 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS G9043 ...... G9044 ...... J0120 ....... J0128 ....... J0130 ....... J0135 ....... J0150 ....... J0152 ....... J0170 ....... J0180 ....... J0190 ....... J0200 ....... J0205 ....... J0207 ....... J0210 ....... J0215 ....... J0256 ....... J0270 ....... J0275 ....... J0280 ....... J0282 ....... J0285 ....... J0287 ....... J0288 ....... J0289 ....... J0290 ....... J0295 ....... J0300 ....... J0330 ....... J0350 ....... J0360 ....... J0380 ....... J0390 ....... J0395 ....... J0456 ....... J0460 ....... J0470 ....... J0475 ....... J0476 ....... J0500 ....... J0515 ....... J0520 ....... J0530 ....... J0540 ....... J0550 ....... J0560 ....... J0570 ....... J0580 ....... J0583 ....... J0585 ....... J0587 ....... J0592 ....... J0595 ....... J0600 ....... J0610 ....... J0620 ....... J0630 ....... J0636 ....... J0637 ....... J0640 ....... J0670 ....... J0690 ....... J0692 ....... J0694 ....... J0696 ....... J0697 ....... SI A A N G K K K K N K N N K K K B K B B N N K K K K N N N N N N N N K N N N K B N N N N N N N N K N K K N N K N N K N K N N N N N N N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Low vision rehab therapist ....................... Low vision rehab teacher ........................ Tetracyclin injection ................................. Abarelix injection ...................................... Abciximab injection .................................. Adalimumab injection ............................... Injection adenosine 6 MG ........................ Adenosine injection .................................. Adrenalin epinephrin inject ...................... Agalsidase beta injection ......................... Inj biperiden lactate/5 mg ........................ Alatrofloxacin mesylate ............................ Alglucerase injection ................................ Amifostine ................................................ Methyldopate hcl injection ....................... Alefacept .................................................. Alpha 1 proteinase inhibitor ..................... Alprostadil for injection ............................ Alprostadil urethral suppos ...................... Aminophyllin 250 MG inj .......................... Amiodarone HCl ...................................... Amphotericin B ........................................ Amphotericin b lipid complex ................... Ampho b cholesteryl sulfate .................... Amphotericin b liposome inj .................... Ampicillin 500 MG inj ............................... Ampicillin sodium per 1.5 gm .................. Amobarbital 125 MG inj ........................... Succinycholine chloride inj ...................... Injection anistreplase 30 u ....................... Hydralazine hcl injection .......................... Inj metaraminol bitartrate ......................... Chloroquine injection ............................... Arbutamine HCl injection ......................... Azithromycin ............................................ Atropine sulfate injection ......................... Dimecaprol injection ................................ Baclofen 10 MG injection ........................ Baclofen intrathecal trial .......................... Dicyclomine injection ............................... Inj benztropine mesylate .......................... Bethanechol chloride inject ...................... Penicillin g benzathine inj ........................ Penicillin g benzathine inj ........................ Penicillin g benzathine inj ........................ Penicillin g benzathine inj ........................ Penicillin g benzathine inj ........................ Penicillin g benzathine inj ........................ Bivalirudin ................................................ Botulinum toxin a per unit ........................ Botulinum toxin type B ............................. Buprenorphine hydrochloride ................... Butorphanol tartrate 1 mg ........................ Edetate calcium disodium inj ................... Calcium gluconate injection ..................... Calcium glycer & lact/10 ML .................... Calcitonin salmon injection ...................... Inj calcitriol per 0.1 mcg .......................... Caspofungin acetate ................................ Leucovorin calcium injection .................... Inj mepivacaine HCL/10 ml ..................... Cefazolin sodium injection ....................... Cefepime HCl for injection ....................... Cefoxitin sodium injection ........................ Ceftriaxone sodium injection ................... Sterile cefuroxime injection ...................... .................... .................... .................... 9216 1605 1083 0379 0917 .................... 9208 .................... .................... 0900 7000 2210 .................... 0901 .................... .................... .................... .................... 9030 9024 0735 0736 .................... .................... .................... .................... .................... .................... .................... .................... 9031 .................... .................... .................... 9032 .................... .................... .................... .................... .................... .................... .................... .................... .................... 0880 .................... 0902 9018 .................... .................... 0892 .................... .................... 0893 .................... 9019 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $66.96 $450.60 $300.10 $33.45 $71.53 .................... $123.35 .................... .................... $39.94 $436.01 $9.58 .................... $3.30 .................... .................... .................... .................... $30.70 $11.95 $12.24 $21.91 .................... .................... .................... .................... .................... .................... .................... .................... $163.15 .................... .................... .................... $188.01 .................... .................... .................... .................... .................... .................... .................... .................... .................... $72.26 .................... $4.80 $7.89 .................... .................... $40.34 .................... .................... $35.68 .................... $32.35 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $13.39 $90.12 $60.02 $6.69 $14.31 .................... $24.67 .................... .................... $7.99 $87.20 $1.92 .................... $0.66 .................... .................... .................... .................... $6.14 $2.39 $2.45 $4.38 .................... .................... .................... .................... .................... .................... .................... .................... $32.63 .................... .................... .................... $37.60 .................... .................... .................... .................... .................... .................... .................... .................... .................... $14.45 .................... $0.96 $1.58 .................... .................... $8.07 .................... .................... $7.14 .................... $6.47 .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00179 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50858 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J0698 J0702 J0704 J0706 J0710 J0713 J0715 J0720 J0725 J0735 J0740 J0743 J0744 J0745 J0760 J0770 J0780 J0800 J0835 J0850 J0878 J0880 J0895 J0900 J0945 J0970 J1000 J1020 J1030 J1040 J1051 J1055 J1056 J1060 J1070 J1080 J1094 J1100 J1110 J1120 J1160 J1165 J1170 J1180 J1190 J1200 J1205 J1212 J1230 J1240 J1245 J1250 J1260 J1270 J1320 J1325 J1327 J1330 J1335 J1364 J1380 J1390 J1410 J1435 J1436 J1438 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N N N K N N N N N K K N N N N N N K K K G E K N N N N N N N N E E N N N N N K N N N N K K N N N N N N N K N N N K K N N N N K N K K ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Cefotaxime sodium injection .................... Betamethasone acet&sod phosp ............. Betamethasone sod phosp/4 MG ............ Caffeine citrate injection .......................... Cephapirin sodium injection .................... Inj ceftazidime per 500 mg ...................... Ceftizoxime sodium / 500 MG ................. Chloramphenicol sodium injec ................. Chorionic gonadotropin/1000u ................. Clonidine hydrochloride ........................... Cidofovir injection .................................... Cilastatin sodium injection ....................... Ciprofloxacin iv ........................................ Inj codeine phosphate /30 MG ................ Colchicine injection .................................. Colistimethate sodium inj ......................... Prochlorperazine injection ....................... Corticotropin injection .............................. Inj cosyntropin per 0.25 MG .................... Cytomegalovirus imm IV /vial .................. Daptomycin injection ................................ Darbepoetin alfa injection ........................ Deferoxamine mesylate inj ...................... Testosterone enanthate inj ...................... Brompheniramine maleate inj .................. Estradiol valerate injection ....................... Depo-estradiol cypionate inj .................... Methylprednisolone 20 MG inj ................. Methylprednisolone 40 MG inj ................. Methylprednisolone 80 MG inj ................. Medroxyprogesterone inj ......................... Medrxyprogester acetate inj .................... MA/EC contraceptiveinjection .................. Testosterone cypionate 1 ML .................. Testosterone cypionat 100 MG ............... Testosterone cypionat 200 MG ............... Inj dexamethasone acetate ..................... Dexamethasone sodium phos ................. Inj dihydroergotamine mesylt ................... Acetazolamid sodium injectio .................. Digoxin injection ....................................... Phenytoin sodium injection ...................... Hydromorphone injection ......................... Dyphylline injection .................................. Dexrazoxane HCl injection ...................... Diphenhydramine hcl injectio ................... Chlorothiazide sodium inj ........................ Dimethyl sulfoxide 50% 50 ML ................ Methadone injection ................................. Dimenhydrinate injection ......................... Dipyridamole injection .............................. Inj dobutamine HCL/250 mg .................... Dolasetron mesylate ................................ Injection, doxercalciferol .......................... Amitriptyline injection ............................... Epoprostenol injection ............................. Eptifibatide injection ................................. Ergonovine maleate injection .................. Ertapenem injection ................................. Erythro lactobionate /500 MG .................. Estradiol valerate 10 MG inj .................... Estradiol valerate 20 MG inj .................... Inj estrogen conjugate 25 MG ................. Injection estrone per 1 MG ...................... Etidronate disodium inj ............................ Etanercept injection ................................. .................... .................... .................... 0876 .................... .................... .................... .................... .................... 0935 9033 .................... .................... .................... .................... .................... .................... 1280 0835 0903 9124 .................... 0895 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1210 .................... .................... .................... .................... 9166 0726 .................... .................... .................... .................... .................... .................... .................... 0750 .................... .................... .................... 1607 1330 .................... .................... .................... .................... 9038 .................... 1436 1608 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0.5263 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.34 .................... .................... .................... .................... .................... $57.47 $782.98 .................... .................... .................... .................... .................... .................... $95.44 $69.27 $683.07 $0.30 .................... $14.91 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $27.82 .................... .................... .................... .................... $7.74 $216.39 .................... .................... .................... .................... .................... .................... .................... $6.55 .................... .................... .................... $12.73 $31.23 .................... .................... .................... .................... $57.77 .................... $68.69 $152.11 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.67 .................... .................... .................... .................... .................... $11.49 $156.60 .................... .................... .................... .................... .................... .................... $19.09 $13.85 $136.61 $0.06 .................... $2.98 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $5.56 .................... .................... .................... .................... $1.55 $43.28 .................... .................... .................... .................... .................... .................... .................... $1.31 .................... .................... .................... $2.55 $6.25 .................... .................... .................... .................... $11.55 .................... $13.74 $30.42 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00180 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50859 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J1440 J1441 J1450 J1452 J1455 J1457 J1460 J1470 J1480 J1490 J1500 J1510 J1520 J1530 J1540 J1550 J1560 J1563 J1564 J1565 J1570 J1580 J1590 J1595 J1600 J1610 J1620 J1626 J1630 J1631 J1642 J1644 J1645 J1650 J1652 J1655 J1670 J1700 J1710 J1720 J1730 J1742 J1745 J1750 J1756 J1785 J1790 J1800 J1810 J1815 J1817 J1825 J1830 J1835 J1840 J1850 J1885 J1890 J1931 J1940 J1950 J1955 J1956 J1960 J1980 J1990 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI K K N K N K N B B B B B B B B B B E E K N N N N N K K K N N N N N N N K K N N N K K K K K K N N E N N E K K N N N N K N K B N N N N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Filgrastim 300 mcg injection .................... Filgrastim 480 mcg injection .................... Fluconazole .............................................. Intraocular Fomivirsen na ........................ Foscarnet sodium injection ...................... Gallium nitrate injection ........................... Gamma globulin 1 CC inj ........................ Gamma globulin 2 CC inj ........................ Gamma globulin 3 CC inj ........................ Gamma globulin 4 CC inj ........................ Gamma globulin 5 CC inj ........................ Gamma globulin 6 CC inj ........................ Gamma globulin 7 CC inj ........................ Gamma globulin 8 CC inj ........................ Gamma globulin 9 CC inj ........................ Gamma globulin 10 CC inj ...................... Gamma globulin > 10 CC inj ................... IV immune globulin .................................. Immune globulin 10 mg ........................... RSV-ivig ................................................... Ganciclovir sodium injection .................... Garamycin gentamicin inj ........................ Gatifloxacin injection ................................ Injection glatiramer acetate ..................... Gold sodium thiomaleate inj .................... Glucagon hydrochloride/1 MG ................. Gonadorelin hydroch/ 100 mcg ............... Granisetron HCl injection ......................... Haloperidol injection ................................ Haloperidol decanoate inj ........................ Inj heparin sodium per 10 u .................... Inj heparin sodium per 1000u .................. Dalteparin sodium .................................... Inj enoxaparin sodium ............................. Fondaparinux sodium .............................. Tinzaparin sodium injection ..................... Tetanus immune globulin inj .................... Hydrocortisone acetate inj ....................... Hydrocortisone sodium ph inj .................. Hydrocortisone sodium succ i ................. Diazoxide injection ................................... Ibutilide fumarate injection ....................... Infliximab injection ................................... Iron dextran .............................................. Iron sucrose injection ............................... Injection imiglucerase /unit ...................... Droperidol injection .................................. Propranolol injection ................................ Droperidol/fentanyl inj .............................. Insulin injection ........................................ Insulin for insulin pump use ..................... Interferon beta-1a .................................... Interferon beta-1b / .25 MG ..................... Itraconazole injection ............................... Kanamycin sulfate 500 MG inj ................ Kanamycin sulfate 75 MG inj .................. Ketorolac tromethamine inj ...................... Cephalothin sodium injection ................... Laronidase injection ................................. Furosemide injection ................................ Leuprolide acetate /3.75 MG ................... Inj levocarnitine per 1 gm ........................ Levofloxacin injection ............................... Levorphanol tartrate inj ............................ Hyoscyamine sulfate inj ........................... Chlordiazepoxide injection ....................... 0728 7049 .................... 9040 .................... 1085 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0906 .................... .................... .................... .................... .................... 9042 7005 0764 .................... .................... .................... .................... .................... .................... .................... 1655 1670 .................... .................... .................... 1740 9044 7043 9045 9046 0916 .................... .................... .................... .................... .................... .................... 0910 9047 .................... .................... .................... .................... 9209 .................... 0800 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $178.39 $282.29 .................... $203.93 .................... $1.30 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.56 .................... .................... .................... .................... .................... $62.16 $173.44 $7.24 .................... .................... .................... .................... .................... .................... .................... $2.53 $76.90 .................... .................... .................... $113.86 $243.34 $54.20 $11.43 $0.38 $3.98 .................... .................... .................... .................... .................... .................... $81.95 $36.93 .................... .................... .................... .................... $23.16 .................... $441.78 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $35.68 $56.46 .................... $40.79 .................... $0.26 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $3.11 .................... .................... .................... .................... .................... $12.43 $34.69 $1.45 .................... .................... .................... .................... .................... .................... .................... $0.51 $15.38 .................... .................... .................... $22.77 $48.67 $10.84 $2.29 $0.08 $0.80 .................... .................... .................... .................... .................... .................... $16.39 $7.39 .................... .................... .................... .................... $4.63 .................... $88.36 .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00181 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50860 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J2001 J2010 J2020 J2060 J2150 J2175 J2180 J2185 J2210 J2250 J2260 J2270 J2271 J2275 J2280 J2300 J2310 J2320 J2321 J2322 J2324 J2353 J2354 J2355 J2357 J2360 J2370 J2400 J2405 J2410 J2430 J2440 J2460 J2469 J2501 J2505 J2510 J2515 J2540 J2543 J2545 J2550 J2560 J2590 J2597 J2650 J2670 J2675 J2680 J2690 J2700 J2710 J2720 J2725 J2730 J2760 J2765 J2770 J2780 J2783 J2788 J2790 J2792 J2794 J2795 J2800 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N N K N N N N N N N N N N N N N N N N N K K N K G N N N K N K N N K N K N N N N Y N N N N N N N N N N N N N K N N K N G K K K G N N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Lidocaine injection ................................... Lincomycin injection ................................. Linezolid injection .................................... Lorazepam injection ................................. Mannitol injection ..................................... Meperidine hydrochl /100 MG ................. Meperidine/promethazine inj .................... Meropenem .............................................. Methylergonovin maleate inj .................... Inj midazolam hydrochloride .................... Inj milrinone lactate / 5 MG ..................... Morphine sulfate injection ........................ Morphine so4 injection 100mg ................ Morphine sulfate injection ........................ Inj, moxifloxacin 100 mg .......................... Inj nalbuphine hydrochloride .................... Inj naloxone hydrochloride ....................... Nandrolone decanoate 50 MG ................ Nandrolone decanoate 100 MG .............. Nandrolone decanoate 200 MG .............. Nesiritide .................................................. Octreotide injection, depot ....................... Octreotide inj, non-depot ......................... Oprelvekin injection ................................. Omalizumab injection .............................. Orphenadrine injection ............................. Phenylephrine hcl injection ...................... Chloroprocaine hcl injection .................... Ondansetron hcl injection ........................ Oxymorphone hcl injection ...................... Pamidronate disodium /30 MG ................ Papaverin hcl injection ............................. Oxytetracycline injection .......................... Palonosetron HCl ..................................... Paricalcitol ................................................ Injection, pegfilgrastim 6mg ..................... Penicillin g procaine inj ............................ Pentobarbital sodium inj .......................... Penicillin g potassium inj ......................... Piperacillin/tazobactam ............................ Pentamidine isethionte/300mg ................ Promethazine hcl injection ....................... Phenobarbital sodium inj ......................... Oxytocin injection ..................................... Inj desmopressin acetate ......................... Prednisolone acetate inj .......................... Totazoline hcl injection ............................ Inj progesterone per 50 MG .................... Fluphenazine decanoate 25 MG ............. Procainamide hcl injection ....................... Oxacillin sodium injeciton ........................ Neostigmine methylslfte inj ...................... Inj protamine sulfate/10 MG .................... Inj protirelin per 250 mcg ......................... Pralidoxime chloride inj ............................ Phentolaine mesylate inj .......................... Metoclopramide hcl injection ................... Quinupristin/dalfopristin ........................... Ranitidine hydrochloride inj ..................... Rasburicase ............................................. Rho d immune globulin 50 mcg .............. Rho d immune globulin inj ....................... Rho(D) immune globulin h, sd ................. Risperidone, long acting .......................... Ropivacaine HCl injection ........................ Methocarbamol injection .......................... .................... .................... 9001 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 9114 1207 .................... 7011 9300 .................... .................... .................... 0768 .................... 0730 .................... .................... 9210 .................... 9119 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 2730 .................... .................... 2770 .................... 0738 9023 0884 1609 9125 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $24.15 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $75.19 $87.40 .................... $249.06 $15.98 .................... .................... .................... $3.80 .................... $58.42 .................... .................... $18.42 .................... $2,178.28 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $76.68 .................... .................... $105.48 .................... $109.18 $25.08 $113.91 $12.04 $4.71 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $4.83 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.04 $17.48 .................... $49.81 $3.20 .................... .................... .................... $0.76 .................... $11.68 .................... .................... $3.68 .................... $435.66 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $15.34 .................... .................... $21.10 .................... $21.84 $5.02 $22.78 $2.41 $0.94 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00182 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50861 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J2810 J2820 J2910 J2912 J2916 J2920 J2930 J2940 J2941 J2950 J2993 J2995 J2997 J3000 J3010 J3030 J3070 J3100 J3105 J3110 J3120 J3130 J3140 J3150 J3230 J3240 J3246 J3250 J3260 J3265 J3280 J3301 J3302 J3303 J3305 J3310 J3315 J3320 J3350 J3360 J3364 J3365 J3370 J3396 J3400 J3410 J3411 J3415 J3420 J3430 J3465 J3470 J3475 J3480 J3485 J3486 J3487 J3490 J3520 J3530 J3535 J3570 J3590 J7030 J7040 J7042 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N K N N N N N K K N K K K N N K N K N B N N N N N K K N N N N N N N K N K N K N N K N K N N N N N N K N N N N N K N E N E E N N N N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Inj theophylline per 40 MG ...................... Sargramostim injection ............................ Aurothioglucose injeciton ......................... Sodium chloride injection ......................... Na ferric gluconate complex .................... Methylprednisolone injection ................... Methylprednisolone injection ................... Somatrem injection .................................. Somatropin injection ................................ Promazine hcl injection ............................ Reteplase injection .................................. Inj streptokinase /250000 IU .................... Alteplase recombinant ............................. Streptomycin injection .............................. Fentanyl citrate injeciton .......................... Sumatriptan succinate / 6 MG ................. Pentazocine hcl injection ......................... Tenecteplase injection ............................. Terbutaline sulfate inj .............................. Teriparatide injection ............................... Testosterone enanthate inj ...................... Testosterone enanthate inj ...................... Testosterone suspension inj .................... Testosteron propionate inj ....................... Chlorpromazine hcl injection ................... Thyrotropin injection ................................ Tirofiban HCl ............................................ Trimethobenzamide hcl inj ....................... Tobramycin sulfate injection .................... Injection torsemide 10 mg/ml .................. Thiethylperazine maleate inj .................... Triamcinolone acetonide inj ..................... Triamcinolone diacetate inj ...................... Triamcinolone hexacetonl inj ................... Inj trimetrexate glucoronate ..................... Perphenazine injeciton ............................ Triptorelin pamoate .................................. Spectinomycn di-hcl inj ............................ Urea injection ........................................... Diazepam injection .................................. Urokinase 5000 IU injection .................... Urokinase 250,000 IU inj ......................... Vancomycin hcl injection ......................... Verteporfin injection ................................. Triflupromazine hcl inj .............................. Hydroxyzine hcl injection ......................... Thiamine hcl 100 mg ............................... Pyridoxine hcl 100 mg ............................. Vitamin b12 injection ............................... Vitamin k phytonadione inj ...................... Injection, voriconazole ............................. Hyaluronidase injection ............................ Inj magnesium sulfate .............................. Inj potassium chloride .............................. Zidovudine ............................................... Ziprasidone mesylate ............................... Zoledronic acid ........................................ Drugs unclassified injection ..................... Edetate disodium per 150 mg ................. Nasal vaccine inhalation .......................... Metered dose inhaler drug ...................... Laetrile amygdalin vit B17 ....................... Unclassified biologics .............................. Normal saline solution infus .................... Normal saline solution infus .................... 5% dextrose/normal saline ...................... .................... 0731 .................... .................... .................... .................... .................... 2940 7034 .................... 9005 0911 7048 .................... .................... 3030 .................... 9002 .................... .................... .................... .................... .................... .................... .................... 9108 7041 .................... .................... .................... .................... .................... .................... .................... 7045 .................... 9122 .................... 9051 .................... .................... 7036 .................... 1203 .................... .................... .................... .................... .................... .................... 1052 .................... .................... .................... .................... .................... 9115 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.0454 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $21.11 .................... .................... .................... .................... .................... $43.14 $42.93 .................... $898.81 $83.36 $30.65 .................... .................... $51.03 .................... $2,052.77 .................... .................... .................... .................... .................... .................... .................... $712.58 $7.89 .................... .................... .................... .................... .................... .................... .................... $139.85 .................... $369.98 .................... $62.04 .................... .................... $415.69 .................... $9.16 .................... .................... .................... .................... .................... .................... $4.63 .................... .................... .................... .................... .................... $202.41 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $4.22 .................... .................... .................... .................... .................... $8.63 $8.59 .................... $179.76 $16.67 $6.13 .................... .................... $10.21 .................... $410.55 .................... .................... .................... .................... .................... .................... .................... $142.52 $1.58 .................... .................... .................... .................... .................... .................... .................... $27.97 .................... $74.00 .................... $12.41 .................... .................... $83.14 .................... $1.83 .................... .................... .................... .................... .................... .................... $0.93 .................... .................... .................... .................... .................... $40.48 .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00183 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50862 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J7050 J7051 J7060 J7070 J7100 J7110 J7120 J7130 J7190 J7191 J7192 J7193 J7194 J7195 J7197 J7198 J7199 J7300 J7302 J7303 J7304 J7308 J7310 J7317 J7320 J7330 J7340 J7342 J7343 J7344 J7350 J7500 J7501 J7502 J7504 J7505 J7506 J7507 J7509 J7510 J7511 J7513 J7515 J7516 J7517 J7518 J7520 J7525 J7599 J7608 J7611 J7612 J7613 J7614 J7616 J7617 J7622 J7624 J7626 J7628 J7629 J7631 J7633 J7635 J7636 J7637 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI N N N N N N N N K K K K K K N K B E E E E K K K K B E K B K K N K K K K N K N N K K K N K G K K N Y Y Y Y Y Y Y A A A Y Y Y N Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Normal saline solution infus .................... Sterile saline/water .................................. 5% dextrose/water ................................... D5w infusion ............................................ Dextran 40 infusion .................................. Dextran 75 infusion .................................. Ringers lactate infusion ........................... Hypertonic saline solution ........................ Factor viii ................................................. Factor VIII (porcine) ................................. Factor viii recombinant ............................ Factor IX non-recombinant ...................... Factor ix complex .................................... Factor IX recombinant ............................. Antithrombin iii injection ........................... Anti-inhibitor ............................................. Hemophilia clot factor noc ....................... Intraut copper contraceptive .................... Levonorgestrel iu contracept ................... Contraceptive vaginal ring ....................... Contraceptive hormone patch ................. Aminolevulinic acid hcl top ...................... Ganciclovir long act implant .................... Sodium hyaluronate injection .................. Hylan G-F 20 injection ............................. Cultured chondrocytes implnt .................. Metabolic active D/E tissue ..................... Metabolically active tissue ....................... Nonmetabolic act d/e tissue .................... Nonmetabolic active tissue ...................... Injectable human tissue ........................... Azathioprine oral 50mg ............................ Azathioprine parenteral ............................ Cyclosporine oral 100 mg ........................ Lymphocyte immune globulin .................. Monoclonal antibodies ............................. Prednisone oral ........................................ Tacrolimus oral per 1 MG ........................ Methylprednisolone oral ........................... Prednisolone oral per 5 mg ..................... Antithymocyte globuln rabbit ................... Daclizumab, parenteral ............................ Cyclosporine oral 25 mg .......................... Cyclosporin parenteral 250mg ................. Mycophenolate mofetil oral ...................... Mycophenolic acid ................................... Sirolimus, oral .......................................... Tacrolimus injection ................................. Immunosuppressive drug noc ................. Acetylcysteine inh sol u d ........................ Albuterol concentrated form .................... Levalbuterol concentrated ....................... Albuterol unit dose ................................... Levalbuterol unit dose ............................. Albuterol compound solution ................... Levalbuterol compounded sol .................. Beclomethasone inhalatn sol ................... Betamethasone inhalation sol ................. Budesonide inhalation sol ........................ Bitolterol mes inhal sol con ..................... Bitolterol mes inh sol u d ......................... Cromolyn sodium inh sol u d ................... Budesonide concentrated sol .................. Atropine inhal sol con .............................. Atropine inhal sol unit dose ..................... Dexamethasone inhal sol con ................. .................... .................... .................... .................... .................... .................... .................... .................... 0925 0926 0927 0931 0928 0932 .................... 0929 .................... .................... .................... .................... .................... 7308 0913 7316 1611 .................... .................... 9054 .................... 9156 9055 .................... 0887 0888 0890 7038 .................... 0891 .................... .................... 9104 1612 7515 .................... 9015 9219 9020 9006 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.51 $1.75 $0.94 $0.75 $0.52 $0.86 .................... $1.12 .................... .................... .................... .................... .................... $96.79 $4,318.68 $110.65 $203.15 .................... .................... $15.69 .................... $53.76 $3.54 .................... $47.40 $3.94 $290.30 $885.36 .................... $3.37 .................... .................... $299.47 $381.48 $1.00 .................... $2.50 $2.47 $6.85 $126.61 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.10 $0.35 $0.19 $0.15 $0.10 $0.17 .................... $0.22 .................... .................... .................... .................... .................... $19.36 $863.74 $22.13 $40.63 .................... .................... $3.14 .................... $10.75 $0.71 .................... $9.48 $0.79 $58.06 77.07 .................... $0.67 .................... .................... $59.89 $76.30 $0.20 .................... $0.50 $0.49 $1.37 $25.32 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00184 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50863 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J7638 J7639 J7641 J7642 J7643 J7644 J7648 J7649 J7658 J7659 J7668 J7669 J7674 J7680 J7681 J7682 J7683 J7684 J7699 J7799 J8499 J8501 J8510 J8520 J8521 J8530 J8560 J8565 J8600 J8610 J8700 J8999 J9000 J9001 J9010 J9015 J9017 J9020 J9031 J9035 J9040 J9041 J9045 J9050 J9055 J9060 J9062 J9065 J9070 J9080 J9090 J9091 J9092 J9093 J9094 J9095 J9096 J9097 J9098 J9100 J9110 J9120 J9130 J9140 J9150 J9151 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI Y Y A Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y E G K K E N K E N N K B N K K K K K K G K K K K G N B K N B B B B N B B B B K N B N K B K K ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Dexamethasone inhal sol u d .................. Dornase alpha inhal sol u d .................... Flunisolide, inhalation sol ........................ Glycopyrrolate inhal sol con .................... Glycopyrrolate inhal sol u d ..................... Ipratropium brom inh sol u d ................... Isoetharine hcl inh sol con ....................... Isoetharine hcl inh sol u d ....................... Isoproterenolhcl inh sol con ..................... Isoproterenol hcl inh sol ud ..................... Metaproterenol inh sol con ...................... Metaproterenol inh sol u d ....................... Methacholine chloride, neb ...................... Terbutaline so4 inh sol con ..................... Terbutaline so4 inh sol u d ...................... Tobramycin inhalation sol ........................ Triamcinolone inh sol con ........................ Triamcinolone inh sol u d ........................ Inhalation solution for DME ..................... Non-inhalation drug for DME ................... Oral prescrip drug non chemo ................. Oral aprepitant ......................................... Oral busulfan ........................................... Capecitabine, oral, 150 mg ..................... Capecitabine, oral, 500 mg ..................... Cyclophosphamide oral 25 MG ............... Etoposide oral 50 MG .............................. Gefitinib oral ............................................. Melphalan oral 2 MG ............................... Methotrexate oral 2.5 MG ........................ Temozolomide ......................................... Oral prescription drug chemo .................. Doxorubic hcl 10 MG vl chemo ............... Doxorubicin hcl liposome inj .................... Alemtuzumab injection ............................. Aldesleukin/single use vial ....................... Arsenic trioxide ........................................ Asparaginase injection ............................. Bcg live intravesical vac .......................... Bevacizumab injection ............................. Bleomycin sulfate injection ...................... Bortezomib injection ................................ Carboplatin injection ................................ Carmus bischl nitro inj ............................. Cetuximab injection ................................. Cisplatin 10 MG injection ......................... Cisplatin 50 MG injection ......................... Inj cladribine per 1 MG ............................ Cyclophosphamide 100 MG inj ............... Cyclophosphamide 200 MG inj ............... Cyclophosphamide 500 MG inj ............... Cyclophosphamide 1.0 grm inj ................ Cyclophosphamide 2.0 grm inj ................ Cyclophosphamide lyophilized ................ Cyclophosphamide lyophilized ................ Cyclophosphamide lyophilized ................ Cyclophosphamide lyophilized ................ Cyclophosphamide lyophilized ................ Cytarabine liposome ................................ Cytarabine hcl 100 MG inj ....................... Cytarabine hcl 500 MG inj ....................... Dactinomycin actinomycin d .................... Dacarbazine 100 mg inj ........................... Dacarbazine 200 MG inj .......................... Daunorubicin ............................................ Daunorubicin citrate liposom ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0868 7015 7042 .................... .................... 0802 .................... .................... .................... 1086 .................... .................... 7046 9110 0807 9012 0814 0809 9214 0857 9207 0811 0812 9215 .................... .................... 0858 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1166 .................... .................... .................... 0819 .................... 0820 0821 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $4.75 $1.98 $3.30 .................... .................... $41.12 .................... .................... .................... $7.28 .................... .................... $365.64 $516.87 $701.76 $33.76 $55.42 $121.74 $58.17 $54.18 $28.90 $77.16 $141.29 $50.59 .................... .................... $39.37 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $366.43 .................... .................... .................... $6.20 .................... $35.28 $57.56 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $0.95 $0.40 $0.66 .................... .................... $8.22 .................... .................... .................... $1.46 .................... .................... $73.13 $103.37 $140.35 $6.75 $11.08 $24.35 $11.63 $10.84 $5.78 $15.43 $28.26 $10.12 .................... .................... $7.87 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $73.29 .................... .................... .................... $1.24 .................... $7.06 $11.51 —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00185 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50864 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS J9160 ....... J9165 ....... J9170 ....... J9178 ....... J9181 ....... J9182 ....... J9185 ....... J9190 ....... J9200 ....... J9201 ....... J9202 ....... J9206 ....... J9208 ....... J9209 ....... J9211 ....... J9212 ....... J9213 ....... J9214 ....... J9215 ....... J9216 ....... J9217 ....... J9218 ....... J9219 ....... J9230 ....... J9245 ....... J9250 ....... J9260 ....... J9263 ....... J9265 ....... J9266 ....... J9268 ....... J9270 ....... J9280 ....... J9290 ....... J9291 ....... J9293 ....... J9300 ....... J9305 ....... J9310 ....... J9320 ....... J9340 ....... J9350 ....... J9355 ....... J9357 ....... J9360 ....... J9370 ....... J9375 ....... J9380 ....... J9390 ....... J9395 ....... J9600 ....... J9999 ....... K0001 ...... K0002 ...... K0003 ...... K0004 ...... K0005 ...... K0006 ...... K0007 ...... K0009 ...... K0010 ...... K0011 ...... K0012 ...... K0014 ...... K0015 ...... K0017 ...... SI K N K K N B K N K K K K K K K K K K K K K K K N K N B B K K K K K B B K K G K K K K K K N N B B K K K N Y Y Y Y Y Y Y Y Y Y Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Denileukin diftitox, 300 mcg .................... Diethylstilbestrol injection ........................ Docetaxel ................................................. Inj, epirubicin hcl, 2 mg ........................... Etoposide 10 MG inj ................................ Etoposide 100 MG inj .............................. Fludarabine phosphate inj ....................... Fluorouracil injection ................................ Floxuridine injection ................................. Gemcitabine HCl ...................................... Goserelin acetate implant ........................ Irinotecan injection ................................... Ifosfomide injection .................................. Mesna injection ........................................ Idarubicin hcl injection ............................. Interferon alfacon-1 .................................. Interferon alfa-2a inj ................................. Interferon alfa-2b inj ................................. Interferon alfa-n3 inj ................................. Interferon gamma 1-b inj ......................... Leuprolide acetate suspnsion .................. Leuprolide acetate injeciton ..................... Leuprolide acetate implant ...................... Mechlorethamine hcl inj ........................... Inj melphalan hydrochl 50 MG ................ Methotrexate sodium inj .......................... Methotrexate sodium inj .......................... Oxaliplatin ................................................ Paclitaxel injection ................................... Pegaspargase/singl dose vial .................. Pentostatin injection ................................. Plicamycin (mithramycin) inj .................... Mitomycin 5 MG inj .................................. Mitomycin 20 MG inj ................................ Mitomycin 40 MG inj ................................ Mitoxantrone hydrochl / 5 MG ................. Gemtuzumab ozogamicin ........................ Pemetrexed injection ............................... Rituximab cancer treatment ..................... Streptozocin injection ............................... Thiotepa injection ..................................... Topotecan ................................................ Trastuzumab ............................................ Valrubicin, 200 mg ................................... Vinblastine sulfate inj ............................... Vincristine sulfate 1 MG inj ...................... Vincristine sulfate 2 MG inj ...................... Vincristine sulfate 5 MG inj ...................... Vinorelbine tartrate/10 mg ....................... Injection, Fulvestrant ................................ Porfimer sodium ....................................... Chemotherapy drug ................................. Standard wheelchair ................................ Stnd hemi (low seat) whlchr .................... Lightweight wheelchair ............................ High strength ltwt whlchr ......................... Ultralightweight wheelchair ...................... Heavy duty wheelchair ............................ Extra heavy duty wheelchair ................... Other manual wheelchair/base ................ Stnd wt frame power whlchr .................... Stnd wt pwr whlchr w control .................. Ltwt portbl power whlchr .......................... Other power whlchr base ........................ Detach non-adjus hght armrst ................. Detach adjust armrest base .................... 1084 .................... 0823 1167 .................... .................... 0842 .................... 0827 0828 0810 0830 0831 0732 0832 0912 0834 0836 0865 0838 9217 0861 7051 .................... 0840 .................... .................... .................... 0863 0843 0844 0860 0862 .................... .................... 0864 9004 9213 0849 0850 0851 0852 1613 9167 .................... .................... .................... .................... 0855 9120 0856 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $1,235.33 .................... $301.17 $25.15 .................... .................... $262.41 .................... $60.17 $117.45 $196.25 $129.08 $53.54 $13.68 $314.00 $3.91 $31.75 $13.22 $8.77 $277.79 $230.87 $10.96 $2,262.19 .................... $523.22 .................... .................... .................... $19.11 $1,528.80 $1,868.91 $80.54 $26.36 .................... .................... $329.69 $2,245.04 $41.29 $447.97 $153.33 $44.55 $755.51 $53.98 $376.87 .................... .................... .................... .................... $62.85 $82.90 $2,457.97 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $247.07 .................... $60.23 $5.03 .................... .................... $52.48 .................... $12.03 $23.49 $39.25 $25.82 $10.71 $2.74 $62.80 $0.78 $6.35 $2.64 $1.75 $55.56 $46.17 $2.19 $452.44 .................... $104.64 .................... .................... .................... $3.82 $305.76 $373.78 $16.11 $5.27 .................... .................... $65.94 $449.01 $8.26 $89.59 $30.67 $8.91 $151.10 $10.80 $75.37 .................... .................... .................... .................... $12.57 $16.58 $491.59 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00186 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50865 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS K0018 K0019 K0020 K0037 K0038 K0039 K0040 K0041 K0042 K0043 K0044 K0045 K0046 K0047 K0050 K0051 K0052 K0053 K0056 K0064 K0065 K0066 K0067 K0068 K0069 K0070 K0071 K0072 K0073 K0074 K0075 K0076 K0077 K0078 K0090 K0091 K0092 K0093 K0094 K0095 K0096 K0097 K0098 K0099 K0102 K0104 K0105 K0106 K0108 K0195 K0415 K0416 K0452 K0455 K0462 K0552 K0600 K0601 K0602 K0603 K0604 K0605 K0606 K0607 K0608 K0609 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y B B Y Y Y Y Y Y Y Y Y Y Y Y Y Y ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Detach adjust armrst upper ..................... Arm pad each .......................................... Fixed adjust armrest pair ......................... High mount flip-up footrest ...................... Leg strap each ......................................... Leg strap h style each ............................. Adjustable angle footplate ....................... Large size footplate each ........................ Standard size footplate each ................... Ftrst lower extension tube ....................... Ftrst upper hanger bracket ...................... Footrest complete assembly .................... Elevat legrst low extension ...................... Elevat legrst up hangr brack ................... Ratchet assembly .................................... Cam relese assem ftrst/lgrst .................... Swingaway detach footrest ...................... Elevate footrest articulate ........................ Seat ht <17 or >=21 ltwt wc .................... Zero pressure tube flat free ..................... Spoke protectors ...................................... Solid tire any size each ........................... Pneumatic tire any size each .................. Pneumatic tire tube each ......................... Rear whl complete solid tire .................... Rear whl compl pneum tire ..................... Front castr compl pneum tire .................. Frnt cstr cmpl sem-pneum tir ................... Caster pin lock each ................................ Pneumatic caster tire each ...................... Semi-pneumatic caster tire ...................... Solid caster tire each ............................... Front caster assem complete .................. Pneumatic caster tire tube ....................... Rear tire power wheelchair ...................... Rear tire tube power whlchr .................... Rear assem cmplt powr whlchr ............... Rear zero pressure tire tube ................... Wheel tire for power base ....................... Wheel tire tube each base ...................... Wheel assem powr base complt ............. Wheel zero presure tire tube ................... Drive belt power wheelchair .................... Pwr wheelchair front caster ..................... Crutch and cane holder ........................... Cylinder tank carrier ................................ Iv hanger .................................................. Arm trough each ...................................... W/c component-accessory NOS ............. Elevating whlchair leg rests ..................... RX antiemetic drg, oral NOS ................... Rx antiemetic drg,rectal NOS .................. Wheelchair bearings ................................ Pump uninterrupted infusion .................... Temporary replacement eqpmnt ............. Supply/Ext inf pump syr type ................... Functional neuromuscularstim ................. Repl batt silver oxide 1.5 v ...................... Repl batt silver oxide 3 v ......................... Repl batt alkaline 1.5 v ............................ Repl batt lithium 3.6 v .............................. Repl batt lithium 4.5 v .............................. AED garment w/elec analysis .................. Repl batt for AED .................................... Repl garment for AED ............................. Repl electrode for AED ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00187 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50866 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS K0618 ...... K0619 ...... K0620 ...... K0628 ...... K0629 ...... K0630 ...... K0631 ...... K0632 ...... K0633 ...... K0634 ...... K0635 ...... K0636 ...... K0637 ...... K0638 ...... K0639 ...... K0640 ...... K0641 ...... K0642 ...... K0643 ...... K0644 ...... K0645 ...... K0646 ...... K0647 ...... K0648 ...... K0649 ...... K0669 ...... K0670 ...... K0671 ...... L0100 ....... L0110 ....... L0112 ....... L0120 ....... L0130 ....... L0140 ....... L0150 ....... L0160 ....... L0170 ....... L0172 ....... L0174 ....... L0180 ....... L0190 ....... L0200 ....... L0210 ....... L0220 ....... L0430 ....... L0450 ....... L0452 ....... L0454 ....... L0456 ....... L0458 ....... L0460 ....... L0462 ....... L0464 ....... L0466 ....... L0468 ....... L0470 ....... L0472 ....... L0480 ....... L0482 ....... L0484 ....... L0486 ....... L0488 ....... L0490 ....... L0700 ....... L0710 ....... L0810 ....... SI A A A Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A Y A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... TLSO 2 piece rigid shell .......................... TLSO 3 piece rigid shell .......................... Tubular elastic dressing ........................... Mult dens insert direct form ..................... Mult dens insert custom mold ................. SIO flex pelvisacral prefab ...................... SIO flex pelvisacral custom ..................... SIO panel prefab ..................................... SIO panel custom .................................... LO flexibl L1 - below L5 pre .................... LO sag stays/panels pre-fab ................... LO sagitt rigid panel prefab ..................... LO flex w/o rigid stays pre ....................... LSO flex w/rigid stays cust ...................... LSO post rigid panel pre ......................... LSO sag-coro rigid frame pre .................. LSO sag-cor rigid frame cust .................. LSO flexion control prefab ....................... LSO flexion control custom ..................... LSO sagit rigid panel prefab .................... LSO sagittal rigid panel cus .................... LSO sag-coronal panel prefab ................ LSO sag-coronal panel custom ............... LSO s/c shell/panel prefab ...................... LSO s/c shell/panel custom ..................... W/c seat/back no CVR SADMERC ......... Stance phase only ................................... Portable oxygen concentrator .................. Cranial orthosis/helmet mold ................... Cranial orthosis/helmet nonm .................. Cranial cervical orthosis .......................... Cerv flexible non-adjustable .................... Flex thermoplastic collar mo .................... Cervical semi-rigid adjustab .................... Cerv semi-rig adj molded chn ................. Cerv semi-rig wire occ/mand ................... Cervical collar molded to pt ..................... Cerv col thermplas foam 2 pi .................. Cerv col foam 2 piece w thor .................. Cer post col occ/man sup adj .................. Cerv collar supp adj cerv ba ................... Cerv col supp adj bar & thor ................... Thoracic rib belt ....................................... Thor rib belt custom fabrica ..................... Dewall posture protector .......................... TLSO flex prefab thoracic ........................ tlso flex custom fab thoraci ...................... TLSO flex prefab sacrococ-T9 ................ TLSO flex prefab ..................................... TLSO 2Mod symphis-xipho pre ............... TLSO2Mod symphysis-stern pre ............. TLSO 3Mod sacro-scap pre .................... TLSO 4Mod sacro-scap pre .................... TLSO rigid frame pre soft ap ................... TLSO rigid frame prefab pelv .................. TLSO rigid frame pre subclav ................. TLSO rigid frame hyperex pre ................. TLSO rigid plastic custom fa ................... TLSO rigid lined custom fab .................... TLSO rigid plastic cust fab ...................... TLSO rigidlined cust fab two ................... TLSO rigid lined pre one pie ................... TLSO rigid plastic pre one ....................... Ctlso a-p-l control molded ....................... Ctlso a-p-l control w/ inter ....................... Halo cervical into jckt vest ....................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00188 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50867 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L0820 L0830 L0860 L0861 L0960 L0970 L0972 L0974 L0976 L0978 L0980 L0982 L0984 L0999 L1000 L1005 L1010 L1020 L1025 L1030 L1040 L1050 L1060 L1070 L1080 L1085 L1090 L1100 L1110 L1120 L1200 L1210 L1220 L1230 L1240 L1250 L1260 L1270 L1280 L1290 L1300 L1310 L1499 L1500 L1510 L1520 L1600 L1610 L1620 L1630 L1640 L1650 L1652 L1660 L1680 L1685 L1686 L1690 L1700 L1710 L1720 L1730 L1750 L1755 L1800 L1810 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Halo cervical into body jack ..................... Halo cerv into milwaukee typ .................. Magnetic resonanc image comp ............. Halo repl liner/interface ............................ Post surgical support pads ...................... Tlso corset front ....................................... Lso corset front ........................................ Tlso full corset ......................................... Lso full corset .......................................... Axillary crutch extension .......................... Peroneal straps pair ................................ Stocking supp grips set of f ..................... Protective body sock each ...................... Add to spinal orthosis NOS ..................... Ctlso milwauke initial model .................... Tension based scoliosis orth ................... Ctlso axilla sling ....................................... Kyphosis pad ........................................... Kyphosis pad floating .............................. Lumbar bolster pad .................................. Lumbar or lumbar rib pad ........................ Sternal pad .............................................. Thoracic pad ............................................ Trapezius sling ......................................... Outrigger .................................................. Outrigger bil w/ vert extens ..................... Lumbar sling ............................................ Ring flange plastic/leather ....................... Ring flange plas/leather mol .................... Covers for upright each ........................... Furnsh initial orthosis only ....................... Lateral thoracic extension ........................ Anterior thoracic extension ...................... Milwaukee type superstructur .................. Lumbar derotation pad ............................ Anterior asis pad ...................................... Anterior thoracic derotation ..................... Abdominal pad ......................................... Rib gusset (elastic) each ......................... Lateral trochanteric pad ........................... Body jacket mold to patient ..................... Post-operative body jacket ...................... Spinal orthosis NOS ................................ Thkao mobility frame ............................... Thkao standing frame .............................. Thkao swivel walker ................................ Abduct hip flex frejka w cvr ..................... Abduct hip flex frejka covr ....................... Abduct hip flex pavlik harne .................... Abduct control hip semi-flex .................... Pelv band/spread bar thigh c .................. HO abduction hip adjustable ................... HO bi thighcuffs w sprdr bar ................... HO abduction static plastic ...................... Pelvic & hip control thigh c ...................... Post-op hip abduct custom fa .................. HO post-op hip abduction ........................ Combination bilateral HO ........................ Leg perthes orth toronto typ .................... Legg perthes orth newington ................... Legg perthes orthosis trilat ...................... Legg perthes orth scottish r ..................... Legg perthes sling ................................... Legg perthes patten bottom t .................. Knee orthoses elas w stays .................... Ko elastic with joints ................................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00189 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50868 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L1815 L1820 L1825 L1830 L1831 L1832 L1834 L1836 L1840 L1843 L1844 L1845 L1846 L1847 L1850 L1855 L1858 L1860 L1870 L1880 L1900 L1901 L1902 L1904 L1906 L1907 L1910 L1920 L1930 L1932 L1940 L1945 L1950 L1951 L1960 L1970 L1971 L1980 L1990 L2000 L2005 L2010 L2020 L2030 L2035 L2036 L2037 L2038 L2039 L2040 L2050 L2060 L2070 L2080 L2090 L2106 L2108 L2112 L2114 L2116 L2126 L2128 L2132 L2134 L2136 L2180 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Elastic with condylar pads ....................... Ko elas w/ condyle pads & jo .................. Ko elastic knee cap ................................. Ko immobilizer canvas longit ................... Knee orth pos locking joint ...................... KO adj jnt pos rigid support ..................... Ko w/0 joint rigid molded to ..................... Rigid KO wo joints ................................... Ko derot ant cruciate custom .................. KO single upright custom fit .................... Ko w/adj jt rot cntrl molded ...................... Ko w/ adj flex/ext rotat cus ...................... Ko w adj flex/ext rotat mold ..................... KO adjustable w air chambers ................ Ko swedish type ...................................... Ko plas doub upright jnt mol ................... Ko polycentric pneumatic pad ................. Ko supracondylar socket mold ................ Ko doub upright lacers molde ................. Ko doub upright cuffs/lacers .................... Afo sprng wir drsflx calf bd ...................... Prefab ankle orthosis ............................... Afo ankle gauntlet .................................... Afo molded ankle gauntlet ....................... Afo multiligamentus ankle su ................... AFO supramalleolar custom .................... Afo sing bar clasp attach sh .................... Afo sing upright w/ adjust s ..................... Afo plastic ................................................ Afo rig ant tib prefab TCF/= ..................... Afo molded to patient plasti ..................... Afo molded plas rig ant tib ...................... Afo spiral molded to pt plas ..................... AFO spiral prefabricated .......................... Afo pos solid ank plastic mo ................... Afo plastic molded w/ankle j .................... AFO w/ankle joint, prefab ........................ Afo sing solid stirrup calf ......................... Afo doub solid stirrup calf ........................ Kafo sing fre stirr thi/calf .......................... KAFO sng/dbl mechanical act ................. Kafo sng solid stirrup w/o j ...................... Kafo dbl solid stirrup band/ ...................... Kafo dbl solid stirrup w/o j ....................... KAFO plastic pediatric size ..................... Kafo plas doub free knee mol ................. Kafo plas sing free knee mol ................... Kafo w/o joint multi-axis an ..................... KAFO,plstic,medlat rotat con ................... Hkafo torsion bil rot straps ...................... Hkafo torsion cable hip pelv .................... Hkafo torsion ball bearing j ...................... Hkafo torsion unilat rot str ....................... Hkafo unilat torsion cable ........................ Hkafo unilat torsion ball br ....................... Afo tib fx cast plaster mold ...................... Afo tib fx cast molded to pt ..................... Afo tibial fracture soft ............................... Afo tib fx semi-rigid .................................. Afo tibial fracture rigid .............................. Kafo fem fx cast thermoplas .................... Kafo fem fx cast molded to p .................. Kafo femoral fx cast soft .......................... Kafo fem fx cast semi-rigid ...................... Kafo femoral fx cast rigid ......................... Plas shoe insert w ank joint .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00190 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50869 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L2182 L2184 L2186 L2188 L2190 L2192 L2200 L2210 L2220 L2230 L2232 L2240 L2250 L2260 L2265 L2270 L2275 L2280 L2300 L2310 L2320 L2330 L2335 L2340 L2350 L2360 L2370 L2375 L2380 L2385 L2390 L2395 L2397 L2405 L2415 L2425 L2430 L2492 L2500 L2510 L2520 L2525 L2526 L2530 L2540 L2550 L2570 L2580 L2600 L2610 L2620 L2622 L2624 L2627 L2628 L2630 L2640 L2650 L2660 L2670 L2680 L2750 L2755 L2760 L2768 L2770 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Drop lock knee ......................................... Limited motion knee joint ......................... Adj motion knee jnt lerman t ................... Quadrilateral brim .................................... Waist belt ................................................. Pelvic band & belt thigh fla ...................... Limited ankle motion ea jnt ..................... Dorsiflexion assist each joi ...................... Dorsi & plantar flex ass/res ..................... Split flat caliper stirr & p .......................... Rocker bottom, contact AFO ................... Round caliper and plate atta ................... Foot plate molded stirrup at .................... Reinforced solid stirrup ............................ Long tongue stirrup .................................. Varus/valgus strap padded/li ................... Plastic mod low ext pad/line .................... Molded inner boot .................................... Abduction bar jointed adjust .................... Abduction bar-straight .............................. Non-molded lacer .................................... Lacer molded to patient mode ................. Anterior swing band ................................. Pre-tibial shell molded to p ...................... Prosthetic type socket molde .................. Extended steel shank .............................. Patten bottom .......................................... Torsion ank & half solid sti ...................... Torsion straight knee joint ....................... Straight knee joint heavy du .................... Offset knee joint each .............................. Offset knee joint heavy duty .................... Suspension sleeve lower ext ................... Knee joint drop lock ea jnt ....................... Knee joint cam lock each joi ................... Knee disc/dial lock/adj flex ...................... Knee jnt ratchet lock ea jnt ...................... Knee lift loop drop lock rin ....................... Thi/glut/ischia wgt bearing ....................... Th/wght bear quad-lat brim m ................. Th/wght bear quad-lat brim c .................. Th/wght bear nar m-l brim mo ................. Th/wght bear nar m-l brim cu .................. Thigh/wght bear lacer non-mo ................. Thigh/wght bear lacer molded ................. Thigh/wght bear high roll cu .................... Hip clevis type 2 posit jnt ........................ Pelvic control pelvic sling ........................ Hip clevis/thrust bearing fr ....................... Hip clevis/thrust bearing lo ...................... Pelvic control hip heavy dut .................... Hip joint adjustable flexion ....................... Hip adj flex ext abduct cont ..................... Plastic mold recipro hip & c ..................... Metal frame recipro hip & ca ................... Pelvic control band & belt u .................... Pelvic control band & belt b .................... Pelv & thor control gluteal ....................... Thoracic control thoracic ba .................... Thorac cont paraspinal uprig ................... Thorac cont lat support upri .................... Plating chrome/nickel pr bar .................... Carbon graphite lamination ..................... Extension per extension per .................... Ortho sidebar disconnect ......................... Low ext orthosis per bar/jnt ..................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00191 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50870 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L2780 L2785 L2795 L2800 L2810 L2820 L2830 L2840 L2850 L2860 L2999 L3000 L3001 L3002 L3003 L3010 L3020 L3030 L3031 L3040 L3050 L3060 L3070 L3080 L3090 L3100 L3140 L3150 L3160 L3170 L3201 L3202 L3203 L3204 L3206 L3207 L3208 L3209 L3211 L3212 L3213 L3214 L3215 L3216 L3217 L3219 L3221 L3222 L3224 L3225 L3230 L3250 L3251 L3252 L3253 L3254 L3255 L3257 L3260 L3265 L3300 L3310 L3320 L3330 L3332 L3334 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A B B B B B B B E B B B B B B B B B B B B B B B B B B B B B B B B B B B B B A A B B B B B B B B B B B B B B B B ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Non-corrosive finish ................................. Drop lock retainer each ........................... Knee control full kneecap ........................ Knee cap medial or lateral p ................... Knee control condylar pad ....................... Soft interface below knee se ................... Soft interface above knee se ................... Tibial length sock fx or equ ..................... Femoral lgth sock fx or equa ................... Torsion mechanism knee/ankle ............... Lower extremity orthosis NOS ................. Ft insert ucb berkeley shell ..................... Foot insert remov molded spe ................. Foot insert plastazote or eq ..................... Foot insert silicone gel eac ...................... Foot longitudinal arch suppo ................... Foot longitud/metatarsal sup ................... Foot arch support remov prem ................ Foot lamin/prepreg composite ................. Ft arch suprt premold longit .................... Foot arch supp premold metat ................ Foot arch supp longitud/meta .................. Arch suprt att to sho longit ...................... Arch supp att to shoe metata .................. Arch supp att to shoe long/m .................. Hallus-valgus nght dynamic s .................. Abduction rotation bar shoe .................... Abduct rotation bar w/o shoe .................. Shoe styled positioning dev ..................... Foot plastic heel stabilizer ....................... Oxford w supinat/pronat inf ..................... Oxford w/ supinat/pronator c ................... Oxford w/ supinator/pronator ................... Hightop w/ supp/pronator inf ................... Hightop w/ supp/pronator chi ................... Hightop w/ supp/pronator jun .................. Surgical boot each infant ......................... Surgical boot each child .......................... Surgical boot each junior ......................... Benesch boot pair infant .......................... Benesch boot pair child ........................... Benesch boot pair junior .......................... Orthopedic ftwear ladies oxf .................... Orthoped ladies shoes dpth i .................. Ladies shoes hightop depth i .................. Orthopedic mens shoes oxford ............... Orthopedic mens shoes dpth i ................ Mens shoes hightop depth inl ................. Womans shoe oxford brace .................... Mans shoe oxford brace .......................... Custom shoes depth inlay ....................... Custom mold shoe remov prost .............. Shoe molded to pt silicone s ................... Shoe molded plastazote cust .................. Shoe molded plastazote cust .................. Orth foot non-stndard size/w ................... Orth foot non-standard size/ .................... Orth foot add charge split s ..................... Ambulatory surgical boot eac .................. Plastazote sandal each ........................... Sho lift taper to metatarsal ...................... Shoe lift elev heel/sole neo ..................... Shoe lift elev heel/sole cor ...................... Lifts elevation metal extens ..................... Shoe lifts tapered to one-ha .................... Shoe lifts elevation heel /i ....................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00192 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50871 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L3340 L3350 L3360 L3370 L3380 L3390 L3400 L3410 L3420 L3430 L3440 L3450 L3455 L3460 L3465 L3470 L3480 L3485 L3500 L3510 L3520 L3530 L3540 L3550 L3560 L3570 L3580 L3590 L3595 L3600 L3610 L3620 L3630 L3640 L3649 L3650 L3651 L3652 L3660 L3670 L3675 L3677 L3700 L3701 L3710 L3720 L3730 L3740 L3760 L3762 L3800 L3805 L3807 L3810 L3815 L3820 L3825 L3830 L3835 L3840 L3845 L3850 L3855 L3860 L3890 L3900 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B A A A A A A E A A A A A A A A A A A A A A A A A A A A A A B A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Shoe wedge sach .................................... Shoe heel wedge ..................................... Shoe sole wedge outside sole ................ Shoe sole wedge between sole .............. Shoe clubfoot wedge ............................... Shoe outflare wedge ................................ Shoe metatarsal bar wedge ro ................ Shoe metatarsal bar between ................. Full sole/heel wedge btween ................... Sho heel count plast reinfor .................... Heel leather reinforced ............................ Shoe heel sach cushion type .................. Shoe heel new leather standa ................. Shoe heel new rubber standar ................ Shoe heel thomas with wedge ................ Shoe heel thomas extend to b ................ Shoe heel pad & depress for .................. Shoe heel pad removable for .................. Ortho shoe add leather insol ................... Orthopedic shoe add rub insl .................. O shoe add felt w leath insl ..................... Ortho shoe add half sole ......................... Ortho shoe add full sole .......................... O shoe add standard toe tap .................. O shoe add horseshoe toe tap ................ O shoe add instep extension ................... O shoe add instep velcro clo ................... O shoe convert to sof counte .................. Ortho shoe add march bar ...................... Trans shoe calip plate exist ..................... Trans shoe caliper plate new .................. Trans shoe solid stirrup exi ..................... Trans shoe solid stirrup new ................... Shoe dennis browne splint bo ................. Orthopedic shoe modifica NOS ............... Shlder fig 8 abduct restrain ..................... Prefab shoulder orthosis .......................... Prefab dbl shoulder orthosis .................... Abduct restrainer canvas&web ................ Acromio/clavicular canvas&we ................ Canvas vest SO ....................................... SO hard plastic stabilizer ......................... Elbow orthoses elas w stays ................... Prefab elbow orthosis .............................. Elbow elastic with metal joi ..................... Forearm/arm cuffs free motio .................. Forearm/arm cuffs ext/flex a .................... Cuffs adj lock w/ active con ..................... EO withjoint, Prefabricated ...................... Rigid EO wo joints ................................... Whfo short opponen no attach ................ Whfo long opponens no attach ............... WHFO,no joint, prefabricated .................. Whfo thumb abduction bar ...................... Whfo second m.p. abduction a ................ Whfo ip ext asst w/ mp ext s ................... Whfo m.p. extension stop ........................ Whfo m.p. extension assist ..................... Whfo m.p. spring extension a .................. Whfo spring swivel thumb ....................... Whfo thumb ip ext ass w/ mp .................. Action wrist w/ dorsiflex as ...................... Whfo adj m.p. flexion contro .................... Whfo adj m.p. flex ctrl & i ........................ Torsion mechanism wrist/elbo ................. Hinge extension/flex wrist/f ...................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00193 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50872 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L3901 L3902 L3904 L3906 L3907 L3908 L3909 L3910 L3911 L3912 L3914 L3916 L3917 L3918 L3920 L3922 L3923 L3924 L3926 L3928 L3930 L3932 L3934 L3936 L3938 L3940 L3942 L3944 L3946 L3948 L3950 L3952 L3954 L3956 L3960 L3962 L3963 L3964 L3965 L3966 L3968 L3969 L3970 L3972 L3974 L3980 L3982 L3984 L3985 L3986 L3995 L3999 L4000 L4002 L4010 L4020 L4030 L4040 L4045 L4050 L4055 L4060 L4070 L4080 L4090 L4100 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Y Y Y Y Y Y Y Y A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Hinge ext/flex wrist finger ........................ Whfo ext power compress gas ................ Whfo electric custom fitted ...................... Wrist gauntlet molded to pt ..................... Whfo wrst gauntlt thmb spica .................. Wrist cock-up non-molded ....................... Prefab wrist orthosis ................................ Whfo swanson design ............................. Prefab hand finger orthosis ..................... Flex glove w/elastic finger ....................... WHO wrist extension cock-up ................. Whfo wrist extens w/ outrigg ................... Prefab metacarpl fx orthosis .................... HFO knuckle bender ................................ Knuckle bender with outrigge .................. Knuckle bend 2 seg to flex j .................... HFO, no joint, prefabricated .................... Oppenheimer ........................................... Thomas suspension ................................. Finger extension w/ clock sp ................... Finger extension with wrist ...................... Safety pin spring wire .............................. Safety pin modified .................................. Palmer ...................................................... Dorsal wrist .............................................. Dorsal wrist w/ outrigger at ...................... Reverse knuckle bender .......................... Reverse knuckle bend w/ outr ................. HFO composite elastic ............................ Finger knuckle bender ............................. Oppenheimer w/ knuckle bend ................ Oppenheimer w/ rev knuckle 2 ................ Spreading hand ....................................... Add joint upper ext orthosis ..................... Sewho airplan desig abdu pos ................ Sewho erbs palsey design abd ............... Molded w/ articulating elbow ................... Seo mobile arm sup att to wc ................. Arm supp att to wc rancho ty .................. Mobile arm supports reclinin ................... Friction dampening arm supp .................. Monosuspension arm/hand supp ............ Elevat proximal arm support .................... Offset/lat rocker arm w/ ela ..................... Mobile arm support supinator .................. Upp ext fx orthosis humeral .................... Upper ext fx orthosis rad/ul ..................... Upper ext fx orthosis wrist ....................... Forearm hand fx orth w/ wr h .................. Humeral rad/ulna wrist fx or .................... Sock fracture or equal each .................... Upper limb orthosis NOS ......................... Repl girdle milwaukee orth ...................... Replace strap, any orthosis ..................... Replace trilateral socket br ...................... Replace quadlat socket brim ................... Replace socket brim cust fit .................... Replace molded thigh lacer ..................... Replace non-molded thigh lac ................. Replace molded calf lacer ....................... Replace non-molded calf lace ................. Replace high roll cuff ............................... Replace prox & dist upright ..................... Repl met band kafo-afo prox ................... Repl met band kafo-afo calf/ ................... Repl leath cuff kafo prox th ..................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00194 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50873 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L4110 L4130 L4205 L4210 L4350 L4360 L4370 L4380 L4386 L4392 L4394 L4396 L4398 L5000 L5010 L5020 L5050 L5060 L5100 L5105 L5150 L5160 L5200 L5210 L5220 L5230 L5250 L5270 L5280 L5301 L5311 L5321 L5331 L5341 L5400 L5410 L5420 L5430 L5450 L5460 L5500 L5505 L5510 L5520 L5530 L5535 L5540 L5560 L5570 L5580 L5585 L5590 L5595 L5600 L5610 L5611 L5613 L5614 L5616 L5617 L5618 L5620 L5622 L5624 L5626 L5628 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Repl leath cuff kafo-afo cal ...................... Replace pretibial shell ............................. Ortho dvc repair per 15 min .................... Orth dev repair/repl minor p .................... Ankle control orthosi prefab ..................... Pneumati walking boot prefab ................. Pneumatic full leg splint ........................... Pneumatic knee splint ............................. Non-pneum walk boot prefab .................. Replace AFO soft interface ..................... Replace foot drop spint ........................... Static AFO ............................................... Foot drop splint recumbent ...................... Sho insert w arch toe filler ....................... Mold socket ank hgt w/ toe f ................... Tibial tubercle hgt w/ toe f ....................... Ank symes mold sckt sach ft ................... Symes met fr leath socket ar .................. Molded socket shin sach foot .................. Plast socket jts/thgh lacer ........................ Mold sckt ext knee shin sach .................. Mold socket bent knee shin s .................. Kne sing axis fric shin sach ..................... No knee/ankle joints w/ ft b ..................... No knee joint with artic ali ....................... Fem focal defic constant fri ..................... Hip canad sing axi cons fric .................... Tilt table locking hip sing ......................... Hemipelvect canad sing axis ................... BK mold socket SACH ft endo ................ Knee disart, SACH ft, endo ..................... AK open end SACH ................................. Hip disart canadian SACH ft ................... Hemipelvectomy canadian SACH ........... Postop dress & 1 cast chg bk ................. Postop dsg bk ea add cast ch ................. Postop dsg & 1 cast chg ak/d ................. Postop dsg ak ea add cast ch ................. Postop app non-wgt bear dsg ................. Postop app non-wgt bear dsg ................. Init bk ptb plaster direct ........................... Init ak ischal plstr direct ........................... Prep BK ptb plaster molded .................... Perp BK ptb thermopls direct .................. Prep BK ptb thermopls molded ............... Prep BK ptb open end socket ................. Prep BK ptb laminated socket ................. Prep AK ischial plast molded .................. Prep AK ischial direct form ...................... Prep AK ischial thermo mold ................... Prep AK ischial open end ........................ Prep AK ischial laminated ....................... Hip disartic sach thermopls ..................... Hip disart sach laminat mold ................... Above knee hydracadence ...................... Ak 4 bar link w/fric swing ......................... Ak 4 bar ling w/hydraul swig ................... 4-bar link above knee w/swng ................. Ak univ multiplex sys frict ........................ AK/BK self-aligning unit ea ...................... Test socket symes ................................... Test socket below knee ........................... Test socket knee disarticula .................... Test socket above knee .......................... Test socket hip disarticulat ...................... Test socket hemipelvectomy ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00195 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50874 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L5629 L5630 L5631 L5632 L5634 L5636 L5637 L5638 L5639 L5640 L5642 L5643 L5644 L5645 L5646 L5647 L5648 L5649 L5650 L5651 L5652 L5653 L5654 L5655 L5656 L5658 L5661 L5665 L5666 L5668 L5670 L5671 L5672 L5673 L5676 L5677 L5678 L5679 L5680 L5681 L5682 L5683 L5684 L5685 L5686 L5688 L5690 L5692 L5694 L5695 L5696 L5697 L5698 L5699 L5700 L5701 L5702 L5704 L5705 L5706 L5707 L5710 L5711 L5712 L5714 L5716 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Below knee acrylic socket ....................... Syme typ expandabl wall sckt ................. Ak/knee disartic acrylic soc ..................... Symes type ptb brim design s ................. Symes type poster opening so ................ Symes type medial opening so ............... Below knee total contact ......................... Below knee leather socket ...................... Below knee wood socket ......................... Knee disarticulat leather so ..................... Above knee leather socket ...................... Hip flex inner socket ext fr ....................... Above knee wood socket ........................ Bk flex inner socket ext fra ...................... Below knee cushion socket ..................... Below knee suction socket ...................... Above knee cushion socket ..................... Isch containmt/narrow m-l so .................. Tot contact ak/knee disart s .................... Ak flex inner socket ext fra ...................... Suction susp ak/knee disart .................... Knee disart expand wall sock .................. Socket insert symes ................................ Socket insert below knee ........................ Socket insert knee articulat ..................... Socket insert above knee ........................ Multi-durometer symes ............................ Multi-durometer below knee .................... Below knee cuff suspension .................... Socket insert w/o lock lower .................... Bk molded supracondylar susp ............... BK/AK locking mechanism ...................... Bk removable medial brim sus ................ Socket insert w lock mech ....................... Bk knee joints single axis p ..................... Bk knee joints polycentric p ..................... Bk joint covers pair .................................. Socket insert w/o lock mech .................... Bk thigh lacer non-molded ....................... Intl custm cong/latyp insert ...................... Bk thigh lacer glut/ischia m ..................... Initial custom socket insert ...................... Bk fork strap ............................................ Below knee sus/seal sleeve .................... Bk back check ......................................... Bk waist belt webbing .............................. Bk waist belt padded and lin ................... Ak pelvic control belt light ........................ Ak pelvic control belt pad/l ...................... Ak sleeve susp neoprene/equa ............... Ak/knee disartic pelvic join ...................... Ak/knee disartic pelvic band .................... Ak/knee disartic silesian ba ..................... Shoulder harness ..................................... Replace socket below knee ..................... Replace socket above knee .................... Replace socket hip .................................. Custom shape cover BK .......................... Custom shape cover AK .......................... Custom shape cvr knee disart ................. Custom shape cvr hip disart .................... Kne-shin exo sng axi mnl loc .................. Knee-shin exo mnl lock ultra ................... Knee-shin exo frict swg & st .................... Knee-shin exo variable frict ..................... Knee-shin exo mech stance ph ............... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00196 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50875 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L5718 L5722 L5724 L5726 L5728 L5780 L5781 L5782 L5785 L5790 L5795 L5810 L5811 L5812 L5814 L5816 L5818 L5822 L5824 L5826 L5828 L5830 L5840 L5845 L5848 L5850 L5855 L5856 L5857 L5910 L5920 L5925 L5930 L5940 L5950 L5960 L5962 L5964 L5966 L5968 L5970 L5972 L5974 L5975 L5976 L5978 L5979 L5980 L5981 L5982 L5984 L5985 L5986 L5987 L5988 L5990 L5995 L5999 L6000 L6010 L6020 L6025 L6050 L6055 L6100 L6110 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Knee-shin exo frct swg & sta .................. Knee-shin pneum swg frct exo ................ Knee-shin exo fluid swing ph .................. Knee-shin ext jnts fld swg e .................... Knee-shin fluid swg & stance .................. Knee-shin pneum/hydra pneum .............. Lower limb pros vacuum pump ............... HD low limb pros vacuum pump ............. Exoskeletal bk ultralt mater ..................... Exoskeletal ak ultra-light m ..................... Exoskel hip ultra-light mate ..................... Endoskel knee-shin mnl lock ................... Endo knee-shin mnl lck ultra ................... Endo knee-shin frct swg & st .................. Endo knee-shin hydral swg ph ................ Endo knee-shin polyc mch sta ................ Endo knee-shin frct swg & st .................. Endo knee-shin pneum swg frc ............... Endo knee-shin fluid swing p .................. Miniature knee joint ................................. Endo knee-shin fluid swg/sta ................... Endo knee-shin pneum/swg pha ............. Multi-axial knee/shin system .................... Knee-shin sys stance flexion ................... Knee-shin sys hydraul stance ................. Endo ak/hip knee extens assi ................. Mech hip extension assist ....................... Elec knee-shin swing/stance ................... Elec knee-shin swing only ....................... Endo below knee alignable sy ................. Endo ak/hip alignable system .................. Above knee manual lock ......................... High activity knee frame .......................... Endo bk ultra-light material ...................... Endo ak ultra-light material ...................... Endo hip ultra-light materia ..................... Below knee flex cover system ................. Above knee flex cover system ................ Hip flexible cover system ......................... Multiaxial ankle w dorsiflex ...................... Foot external keel sach foot .................... Flexible keel foot ...................................... Foot single axis ankle/foot ....................... Combo ankle/foot prosthesis ................... Energy storing foot .................................. Ft prosth multiaxial ankl/ft ........................ Multi-axial ankle/ft prosth ......................... Flex foot system ...................................... Flex-walk sys low ext prosth ................... Exoskeletal axial rotation u ...................... Endoskeletal axial rotation ....................... Lwr ext dynamic prosth pylon .................. Multi-axial rotation unit ............................. Shank ft w vert load pylon ....................... Vertical shock reducing pylo .................... User adjustable heel height ..................... Lower ext pros heavyduty fea ................. Lowr extremity prosthes NOS ................. Par hand robin-aids thum rem ................. Hand robin-aids little/ring ......................... Part hand robin-aids no fing .................... Part hand disart myoelectric .................... Wrst MLd sck flx hng tri pad ................... Wrst mold sock w/exp interfa .................. Elb mold sock flex hinge pad .................. Elbow mold sock suspension t ................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00197 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50876 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L6120 L6130 L6200 L6205 L6250 L6300 L6310 L6320 L6350 L6360 L6370 L6380 L6382 L6384 L6386 L6388 L6400 L6450 L6500 L6550 L6570 L6580 L6582 L6584 L6586 L6588 L6590 L6600 L6605 L6610 L6615 L6616 L6620 L6623 L6625 L6628 L6629 L6630 L6632 L6635 L6637 L6638 L6640 L6641 L6642 L6645 L6646 L6647 L6648 L6650 L6655 L6660 L6665 L6670 L6672 L6675 L6676 L6680 L6682 L6684 L6686 L6687 L6688 L6689 L6690 L6691 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Elbow mold doub splt soc ste ................. Elbow stump activated lock h .................. Elbow mold outsid lock hinge .................. Elbow molded w/ expand inter ................ Elbow inter loc elbow forarm ................... Shlder disart int lock elbow ..................... Shoulder passive restor comp ................. Shoulder passive restor cap .................... Thoracic intern lock elbow ....................... Thoracic passive restor comp ................. Thoracic passive restor cap .................... Postop dsg cast chg wrst/elb .................. Postop dsg cast chg elb dis/ ................... Postop dsg cast chg shlder/t ................... Postop ea cast chg & realign .................. Postop applicat rigid dsg on .................... Below elbow prosth tiss shap .................. Elb disart prosth tiss shap ....................... Above elbow prosth tiss shap ................. Shldr disar prosth tiss shap ..................... Scap thorac prosth tiss shap ................... Wrist/elbow bowden cable mol ................ Wrist/elbow bowden cbl dir f ................... Elbow fair lead cable molded .................. Elbow fair lead cable dir fo ...................... Shdr fair lead cable molded .................... Shdr fair lead cable direct ....................... Polycentric hinge pair .............................. Single pivot hinge pair ............................. Flexible metal hinge pair ......................... Disconnect locking wrist uni .................... Disconnect insert locking wr .................... Flexion/extension wrist unit ..................... Spring-ass rot wrst w/ latch ..................... Rotation wrst w/ cable lock ...................... Quick disconn hook adapter o ................. Lamination collar w/ couplin .................... Stainless steel any wrist .......................... Latex suspension sleeve each ................ Lift assist for elbow .................................. Nudge control elbow lock ........................ Elec lock on manual pw elbow ................ Shoulder abduction joint pai .................... Excursion amplifier pulley t ...................... Excursion amplifier lever ty ..................... Shoulder flexion-abduction j .................... Multipo locking shoulder jnt ..................... Shoulder lock actuator ............................. Ext pwrd shlder lock/unlock ..................... Shoulder universal joint ........................... Standard control cable extra ................... Heavy duty control cable ......................... Teflon or equal cable lining ..................... Hook to hand cable adapter .................... Harness chest/shlder saddle ................... Harness figure of 8 sing con ................... Harness figure of 8 dual con ................... Test sock wrist disart/bel e ...................... Test sock elbw disart/above .................... Test socket shldr disart/tho ..................... Suction socket ......................................... Frame typ socket bel elbow/w ................. Frame typ sock above elb/dis ................. Frame typ socket shoulder di .................. Frame typ sock interscap-tho .................. Removable insert each ............................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00198 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50877 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L6692 L6693 L6694 L6695 L6696 L6697 L6698 L6700 L6705 L6710 L6715 L6720 L6725 L6730 L6735 L6740 L6745 L6750 L6755 L6765 L6770 L6775 L6780 L6790 L6795 L6800 L6805 L6806 L6807 L6808 L6809 L6810 L6825 L6830 L6835 L6840 L6845 L6850 L6855 L6860 L6865 L6867 L6868 L6870 L6872 L6873 L6875 L6880 L6881 L6882 L6890 L6895 L6900 L6905 L6910 L6915 L6920 L6925 L6930 L6935 L6940 L6945 L6950 L6955 L6960 L6965 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Silicone gel insert or equal ...................... Lockingelbow forearm cntrbal .................. Elbow socket ins use w/lock .................... Elbow socket ins use w/o lck .................. Cus elbo skt in for con/atyp ..................... Cus elbo skt in not con/atyp .................... Below/above elbow lock mech ................ Terminal device model #3 ....................... Terminal device model #5 ....................... Terminal device model #5x ..................... Terminal device model #5xa ................... Terminal device model #6 ....................... Terminal device model #7 ....................... Terminal device model #7lo .................... Terminal device model #8 ....................... Terminal device model #8x ..................... Terminal device model #88x ................... Terminal device model #10p ................... Terminal device model #10x ................... Terminal device model #12p ................... Terminal device model #99x ................... Terminal device model #555 ................... Terminal device model #ss555 ................ Hooks-accu hook or equal ....................... Hooks-2 load or equal ............................. Hooks-aprl vc or equal ............................ Modifier wrist flexion unit ......................... Trs grip vc or equal ................................. Term device grip1/2 or equal .................. Term device infant or child ...................... Trs super sport passive ........................... Pincher tool otto bock or eq .................... Hands dorrance vo .................................. Hand aprl vc ............................................ Hand sierra vo ......................................... Hand becker imperial ............................... Hand becker lock grip .............................. Term dvc-hand becker plylite .................. Hand robin-aids vo .................................. Hand robin-aids vo soft ........................... Hand passive hand .................................. Hand detroit infant hand .......................... Passive inf hand steeper/hos .................. Hand child mitt ......................................... Hand nyu child hand ................................ Hand mech inf steeper or equ ................. Hand bock vc ........................................... Hand bock vo ........................................... Autograsp feature ul term dv ................... Microprocessor control uplmb ................. Production glove ...................................... Custom glove ........................................... Hand restorat thumb/1 finger ................... Hand restoration multiple fi ...................... Hand restoration no fingers ..................... Hand restoration replacmnt g .................. Wrist disarticul switch ctrl ........................ Wrist disart myoelectronic c .................... Below elbow switch control ..................... Below elbow myoelectronic ct ................. Elbow disarticulation switch ..................... Elbow disart myoelectronic c ................... Above elbow switch control ..................... Above elbow myoelectronic ct ................. Shldr disartic switch contro ...................... Shldr disartic myoelectronic ..................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00199 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50878 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L6970 L6975 L7010 L7015 L7020 L7025 L7030 L7035 L7040 L7045 L7170 L7180 L7181 L7185 L7186 L7190 L7191 L7260 L7261 L7266 L7272 L7274 L7360 L7362 L7364 L7366 L7367 L7368 L7499 L7500 L7510 L7520 L7900 L8000 L8001 L8002 L8010 L8015 L8020 L8030 L8035 L8039 L8040 L8041 L8042 L8043 L8044 L8045 L8046 L8047 L8048 L8049 L8100 L8110 L8120 L8130 L8140 L8150 L8160 L8170 L8180 L8190 L8195 L8200 L8210 L8220 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E A A E E E E E E E E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Interscapular-thor switch ct ...................... Interscap-thor myoelectronic ................... Hand otto back steeper/eq sw ................. Hand sys teknik village swit .................... Electronic greifer switch ct ....................... Electron hand myoelectronic ................... Hand sys teknik vill myoelec ................... Electron greifer myoelectro ...................... Prehensile actuator hosmer s .................. Electron hook child michigan ................... Electronic elbow hosmer swit .................. Electronic elbow utah myoele .................. Electronic elbo simultaneous ................... Electron elbow adolescent sw ................. Electron elbow child switch ..................... Elbow adolescent myoelectron ................ Elbow child myoelectronic ct ................... Electron wrist rotator otto ........................ Electron wrist rotator utah ....................... Servo control steeper or equ ................... Analogue control unb or equa ................. Proportional ctl 12 volt uta ....................... Six volt bat otto bock/eq ea ..................... Battery chrgr six volt otto ......................... Twelve volt battery utah/equ ................... Battery chrgr 12 volt utah/e ..................... Replacemnt lithium ionbatter ................... Lithium ion battery charger ...................... Upper extremity prosthes NOS ............... Prosthetic dvc repair hourly ..................... Prosthetic device repair rep ..................... Repair prosthesis per 15 min .................. Male vacuum erection system ................. Mastectomy bra ....................................... Breast prosthesis bra & form ................... Brst prsth bra & bilat form ....................... Mastectomy sleeve .................................. Ext breastprosthesis garment .................. Mastectomy form ..................................... Breast prosthesis silicone/e ..................... Custom breast prosthesis ........................ Breast prosthesis NOS ............................ Nasal prosthesis ...................................... Midfacial prosthesis ................................. Orbital prosthesis ..................................... Upper facial prosthesis ............................ Hemi-facial prosthesis ............................. Auricular prosthesis ................................. Partial facial prosthesis ............................ Nasal septal prosthesis ........................... Unspec maxillofacial prosth ..................... Repair maxillofacial prosth ...................... Compression stocking BK18-30 .............. Compression stocking BK30-40 .............. Compression stocking BK40-50 .............. Gc stocking thighlngth 18-30 ................... Gc stocking thighlngth 30-40 ................... Gc stocking thighlngth 40-50 ................... Gc stocking full lngth 18-30 ..................... Gc stocking full lngth 30-40 ..................... Gc stocking full lngth 40-50 ..................... Gc stocking waistlngth 18-30 .................. Gc stocking waistlngth 30-40 .................. Gc stocking waistlngth 40-50 .................. Gc stocking custom made ....................... Gc stocking lymphedema ........................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 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.................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00200 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50879 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS L8230 ....... L8239 ....... L8300 ....... L8310 ....... L8320 ....... L8330 ....... L8400 ....... L8410 ....... L8415 ....... L8417 ....... L8420 ....... L8430 ....... L8435 ....... L8440 ....... L8460 ....... L8465 ....... L8470 ....... L8480 ....... L8485 ....... L8499 ....... L8500 ....... L8501 ....... L8505 ....... L8507 ....... L8509 ....... L8510 ....... L8511 ....... L8512 ....... L8513 ....... L8514 ....... L8515 ....... L8600 ....... L8603 ....... L8606 ....... L8610 ....... L8612 ....... L8613 ....... L8614 ....... L8615 ....... L8616 ....... L8617 ....... L8618 ....... L8619 ....... L8620 ....... L8621 ....... L8622 ....... L8630 ....... L8631 ....... L8641 ....... L8642 ....... L8658 ....... L8659 ....... L8670 ....... L8699 ....... L9900 ....... M0064 ...... M0075 ...... M0076 ...... M0100 ...... M0300 ...... M0301 ...... P2028 ...... P2029 ...... P2031 ...... P2033 ...... P2038 ...... SI E E A A A A A 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 N N N N A A A A A A A A N N N N N N N N A X E E E E E A A E A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Gc stocking garter belt ............................ G compression stocking NOS ................. Truss single w/ standard pad .................. Truss double w/ standard pad ................. Truss addition to std pad wa ................... Truss add to std pad scrotal .................... Sheath below knee .................................. Sheath above knee .................................. Sheath upper limb ................................... Pros sheath/sock w gel cushn ................. Prosthetic sock multi ply BK .................... Prosthetic sock multi ply AK .................... Pros sock multi ply upper lm ................... Shrinker below knee ................................ Shrinker above knee ................................ Shrinker upper limb ................................. Pros sock single ply BK ........................... Pros sock single ply AK ........................... Pros sock single ply upper l .................... Unlisted misc prosthetic ser .................... Artificial larynx .......................................... Tracheostomy speaking valve ................. Artificial larynx, accessory ....................... Trach-esoph voice pros pt in ................... Trach-esoph voice pros md in ................. Voice amplifier ......................................... Indwelling trach insert .............................. Gel cap for trach voice pros .................... Trach pros cleaning device ..................... Repl trach puncture dilator ...................... Gel cap app device for trach ................... Implant breast silicone/eq ........................ Collagen imp urinary 2.5 ml .................... Synthetic implnt urinary 1ml .................... Ocular implant .......................................... Aqueous shunt prosthesis ....................... Ossicular implant ..................................... Cochlear device/system ........................... Coch implant headset replace ................. Coch implant microphone repl ................. Coch implant trans coil repl ..................... Coch implant tran cable repl ................... Replace cochlear processor .................... Repl lithium ion battery ............................ Repl zinc air battery ................................. Repl alkaline battery ................................ Metacarpophalangeal implant .................. MCP joint repl 2 pc or more .................... Metatarsal joint implant ............................ Hallux implant .......................................... Interphalangeal joint spacer .................... Interphalangeal joint repl ......................... Vascular graft, synthetic .......................... Prosthetic implant NOS ........................... O&P supply/accessory/service ................ Visit for drug monitoring .......................... Cellular therapy ........................................ Prolotherapy ............................................. Intragastric hypothermia .......................... IV chelationtherapy .................................. Fabric wrapping of aneurysm .................. Cephalin floculation test .......................... Congo red blood test ............................... Hair analysis ............................................ Blood thymol turbidity .............................. Blood mucoprotein ................................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0374 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1.0414 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $61.80 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $12.36 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00201 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50880 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS P3000 P3001 P7001 P9010 P9011 P9012 P9016 P9017 P9019 P9020 P9021 P9022 P9023 P9031 P9032 P9033 P9034 P9035 P9036 P9037 P9038 P9039 P9040 P9041 P9043 P9044 P9045 P9046 P9047 P9048 P9050 P9051 P9052 P9053 P9054 P9055 P9056 P9057 P9058 P9059 P9060 P9603 P9604 P9612 P9615 Q0035 Q0081 Q0083 Q0084 Q0085 Q0091 Q0092 Q0111 Q0112 Q0113 Q0114 Q0115 Q0136 Q0137 Q0144 Q0163 Q0164 Q0165 Q0166 Q0167 Q0168 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A B E K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K A A N N X B B B B T N A A A A A K K E N N B K N B ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Screen pap by tech w md supv ............... Screening pap smear by phys ................. Culture bacterial urine ............................. Whole blood for transfusion ..................... Blood split unit ......................................... Cryoprecipitate each unit ......................... RBC leukocytes reduced ......................... Plasma 1 donor frz w/in 8 hr ................... Platelets, each unit .................................. Plaelet rich plasma unit ........................... Red blood cells unit ................................. Washed red blood cells unit .................... Frozen plasma, pooled, sd ...................... Platelets leukocytes reduced ................... Platelets, irradiated .................................. Platelets leukoreduced irrad .................... Platelets, pheresis ................................... Platelet pheres leukoreduced .................. Platelet pheresis irradiated ...................... Plate pheres leukoredu irrad ................... RBC irradiated ......................................... RBC deglycerolized ................................. RBC leukoreduced irradiated .................. Albumin (human),5%, 50ml ..................... Plasma protein fract,5%,50ml .................. Cryoprecipitatereducedplasma ................ Albumin (human), 5%, 250 ml ................. Albumin (human), 25%, 20 ml ................. Albumin (human), 25%, 50ml .................. Plasmaprotein fract,5%,250ml ................. Granulocytes, pheresis unit ..................... Blood, l/r, cmv-neg ................................... Platelets, hla-m, l/r, unit ........................... Plt, pher, l/r cmv-neg, irr .......................... Blood, l/r, froz/degly/wash ....................... Plt, aph/pher, l/r, cmv-neg ....................... Blood, l/r, irradiated ................................. RBC, frz/deg/wsh, l/r, irrad ...................... RBC, l/r, cmv-neg, irrad ........................... Plasma, frz between 8-24hour ................ Fr frz plasma donor retested ................... One-way allow prorated miles ................. One-way allow prorated trip .................... Catheterize for urine spec ....................... Urine specimen collect mult .................... Cardiokymography ................................... Infusion ther other than che .................... Chemo by other than infusion ................. Chemotherapy by infusion ....................... Chemo by both infusion and o ................ Obtaining screen pap smear ................... Set up port xray equipment ..................... Wet mounts/ w preparations .................... Potassium hydroxide preps ..................... Pinworm examinations ............................. Fern test ................................................... Post-coital mucous exam ........................ Non esrd epoetin alpha inj ...................... Darbepoetin alfa, non esrd ...................... Azithromycin dihydrate, oral .................... Diphenhydramine HCl 50mg ................... Prochlorperazine maleate 5mg ................ Prochlorperazine maleate10mg ............... Granisetron HCl 1 mg oral ...................... Dronabinol 2.5mg oral ............................. Dronabinol 5mg oral ................................ .................... .................... .................... 0950 0967 0952 0954 9508 0957 0958 0959 0960 0949 1013 9500 0968 9507 9501 9502 1019 9505 9504 0969 0961 0956 1009 0963 0964 0965 0966 9506 1010 1011 1020 1016 1017 1018 1021 1022 0955 9503 .................... .................... .................... .................... 0100 .................... .................... .................... .................... 0191 .................... .................... .................... .................... .................... .................... 0733 0734 .................... .................... .................... .................... 0765 .................... .................... .................... .................... .................... 2.0123 1.2698 0.7395 2.7370 1.2038 0.8317 5.1815 2.0301 2.9707 1.1956 1.6023 1.3589 2.3639 6.8988 8.1495 5.1895 9.5131 2.3876 6.4314 3.6451 0.5119 1.1226 1.3062 1.3869 0.4878 1.1117 4.9564 15.6155 2.9692 10.9690 10.1551 5.2631 8.5998 2.8004 4.8787 4.2901 1.2934 1.6241 .................... .................... .................... .................... 2.4968 .................... .................... .................... .................... 0.167 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $119.42 $75.35 $43.88 $162.42 $71.44 $49.36 $307.49 $120.47 $176.29 $70.95 $95.09 $80.64 $140.28 $409.40 $483.62 $307.96 $564.54 $141.69 $381.66 $216.31 $30.38 $66.62 $77.51 $82.30 $28.95 $65.97 $294.13 $926.67 $176.20 $650.93 $602.63 $312.33 $510.34 $166.18 $289.52 $254.59 $76.75 $96.38 .................... .................... .................... .................... $148.17 .................... .................... .................... .................... $9.91 .................... .................... .................... .................... .................... .................... $9.99 $3.28 .................... .................... .................... .................... $33.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $41.44 .................... .................... .................... .................... $2.78 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $23.88 $15.07 $8.78 $32.48 $14.29 $9.87 $61.50 $24.09 $35.26 $14.19 $19.02 $16.13 $28.06 $81.88 $96.72 $61.59 $112.91 $28.34 $76.33 $43.26 $6.08 $13.32 $15.50 $16.46 $5.79 $13.19 $58.83 $185.33 $35.24 $130.19 $120.53 $62.47 $102.07 $33.24 $57.90 $50.92 $15.35 $19.28 .................... .................... .................... .................... $29.63 .................... .................... .................... .................... $1.98 .................... .................... .................... .................... .................... .................... $2.00 $0.66 .................... .................... .................... .................... $6.70 .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00202 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50881 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued SI CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment N ..... B ..... Na ... B ..... N ..... N ..... N ..... B ..... N ..... B ..... K ..... K ..... E ..... K ..... N ..... N ..... N ..... N ..... N ..... E ..... N ..... K ..... N ..... K ..... K ..... K ..... K ..... K ..... K ..... K ..... K ..... N ..... K ..... K ..... K ..... E ..... K ..... K ..... H ..... B ..... H ..... H ..... N ..... H ..... H ..... H ..... H ..... N ..... H ..... H ..... N ..... A ..... A ..... A ..... K ..... E ..... N ..... B ..... B ..... B ..... B ..... B ..... B ..... B ..... B ..... B ..... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Promethazine HCl 12.5mg oral ............... Promethazine HCl 25 mg oral ................. Chlorpromazine HCl 10mg oral ............... Chlorpromazine HCl 25mg oral ............... Trimethobenzamide HCl 250mg .............. Thiethylperazine maleate10mg ................ Perphenazine 4mg oral ........................... Perphenazine 8mg oral ........................... Hydroxyzine pamoate 25mg .................... Hydroxyzine pamoate 50mg .................... Ondansetron HCl 8mg oral ...................... Dolasetron mesylate oral ......................... Unspecified oral anti-emetic .................... Factor viia recombinant ........................... Ntiol category 1 ........................................ Ntiol category 2 ........................................ Ntiol category 3 ........................................ Ntiol category 4 ........................................ Ntiol category 5 ........................................ Oral cabergoline 0.5 mg .......................... Elliotts b solution per ml .......................... Aprotinin, 10,000 kiu ................................ Bladder calculi irrig sol ............................ Corticorelin ovine triflutat ......................... Digoxin immune fab (ovine) ..................... Ethanolamine oleate 100 mg ................... Fomepizole, 15 mg .................................. Fosphenytoin, 50 mg ............................... Hemin, per 1 mg ...................................... Pegademase bovine, 25 iu ...................... Pentastarch 10% solution ........................ Sermorelin acetate, 0.5 mg ..................... Teniposide, 50 mg ................................... Urofollitropin, 75 iu ................................... Basiliximab ............................................... Histrelin acetate ....................................... Lepirudin .................................................. VonWillebrandFactrCmplxperIU .............. Rubidium-Rb-82 ....................................... Brachytherapy Radioelements ................. 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 tc99m labeledrbcs ................ Chromic phosphate p32 .......................... Cyanocobalamin cobalt co57 .................. Telehealth facility fee ............................... ALS emer trans no ALS serv .................. ALS nonemer trans no ALS se ............... IM inj interferon beta 1-a ......................... Subc inj interferon beta-1a ...................... Collagen skin test .................................... Cast sup body cast plaster ...................... Cast sup body cast fiberglas ................... Cast sup shoulder cast plstr .................... Cast sup shoulder cast fbrgl .................... Cast sup long arm adult plst ................... Cast sup long arm adult fbrg ................... Cast sup long arm ped plster .................. Cast sup long arm ped fbrgls .................. Cast sup sht arm adult plstr .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 0769 0763 .................... 1409 .................... .................... .................... .................... .................... .................... .................... 7019 .................... 7024 7025 7026 7027 7028 7030 9168 7040 .................... 7035 7037 1615 .................... 9057 1618 9025 .................... 1619 1620 .................... 1622 9154 1624 1625 .................... 9155 1628 .................... .................... .................... .................... 9022 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $32.02 $48.54 .................... $1,080.11 .................... .................... .................... .................... .................... .................... .................... $2.20 .................... $386.53 $552.18 $64.53 $12.31 $5.19 $6.51 $161.16 $12.45 .................... $266.23 $44.74 $1,473.57 .................... $128.17 $0.74 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $89.10 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $6.40 $9.71 .................... $216.02 .................... .................... .................... .................... .................... .................... .................... $0.44 .................... $77.31 $110.44 $12.91 $2.46 $1.04 $1.30 $32.23 $2.49 .................... $53.25 $8.95 $294.71 .................... $25.63 $0.15 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $17.82 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... CPT/ HCPCS Q0169 Q0170 Q0171 Q0172 Q0173 Q0174 Q0175 Q0176 Q0177 Q0178 Q0179 Q0180 Q0181 Q0187 Q1001 Q1002 Q1003 Q1004 Q1005 Q2001 Q2002 Q2003 Q2004 Q2005 Q2006 Q2007 Q2008 Q2009 Q2011 Q2012 Q2013 Q2014 Q2017 Q2018 Q2019 Q2020 Q2021 Q2022 Q3000 Q3001 Q3002 Q3003 Q3004 Q3005 Q3006 Q3007 Q3008 Q3009 Q3010 Q3011 Q3012 Q3014 Q3019 Q3020 Q3025 Q3026 Q3031 Q4001 Q4002 Q4003 Q4004 Q4005 Q4006 Q4007 Q4008 Q4009 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00203 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50882 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS Q4010 ...... Q4011 ...... 012 Q4013 ...... Q4014 ...... Q4015 ...... Q4016 ...... Q4017 ...... Q4018 ...... Q4019 ...... Q4020 ...... Q4021 ...... Q4022 ...... Q4023 ...... Q4024 ...... Q4025 ...... Q4026 ...... Q4027 ...... Q4028 ...... Q4029 ...... Q4030 ...... Q4031 ...... Q4032 ...... Q4033 ...... Q4034 ...... Q4035 ...... Q4036 ...... Q4037 ...... Q4038 ...... Q4039 ...... Q4040 ...... Q4041 ...... Q4042 ...... Q4043 ...... Q4044 ...... Q4045 ...... Q4046 ...... Q4047 ...... Q4048 ...... Q4049 ...... Q4050 ...... Q4051 ...... Q4054 ...... Q4055 ...... Q4075 ...... Q4076 ...... Q4077 ...... Q4079 ...... Q9941 ...... Q9942 ...... Q9943 ...... Q9944 ...... Q9945 ...... Q9946 ...... Q9947 ...... Q9948 ...... Q9949 ...... Q9950 ...... Q9951 ...... Q9952 ...... Q9953 ...... Q9954 ...... Q9955 ...... Q9956 ...... Q9957 ...... R0070 ...... SI B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B A A N N K G K K K K K K K K K K K K N K K K K N ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Cast sup sht arm adult fbrgl .................... Cast sup sht arm ped plaster .................. Cast sup sht arm ped fbrglas .................. Cast sup gauntlet plaster ......................... Cast sup gauntlet fiberglass .................... Cast sup gauntlet ped plster ................... Cast sup gauntlet ped fbrgls ................... Cast sup lng arm splint plst ..................... Cast sup lng arm splint fbrg .................... Cast sup lng arm splnt ped p .................. Cast sup lng arm splnt ped f ................... Cast sup sht arm splint plst ..................... Cast sup sht arm splint fbrg .................... Cast sup sht arm splnt ped p .................. Cast sup sht arm splnt ped f ................... Cast sup hip spica plaster ....................... Cast sup hip spica fiberglas .................... Cast sup hip spica ped plstr .................... Cast sup hip spica ped fbrgl .................... Cast sup long leg plaster ......................... Cast sup long leg fiberglass .................... Cast sup lng leg ped plaster ................... Cast sup lng leg ped fbrgls ..................... Cast sup lng leg cylinder pl ..................... Cast sup lng leg cylinder fb ..................... Cast sup lngleg cylndr ped p ................... Cast sup lngleg cylndr ped f .................... Cast sup shrt leg plaster ......................... Cast sup shrt leg fiberglass ..................... Cast sup shrt leg ped plster .................... Cast sup shrt leg ped fbrgls .................... Cast sup lng leg splnt plstr ...................... Cast sup lng leg splnt fbrgl ...................... Cast sup lng leg splnt ped p ................... Cast sup lng leg splnt ped f .................... Cast sup sht leg splnt plstr ...................... Cast sup sht leg splnt fbrgl ...................... Cast sup sht leg splnt ped p ................... Cast sup sht leg splnt ped f .................... Finger splint, static ................................... Cast supplies unlisted .............................. Splint supplies misc ................................. Darbepoetin alfa, esrd use ...................... Epoetin alfa, esrd use .............................. Acyclovir, 5 mg ........................................ Dopamine hcl, 40 mg .............................. Treprostinil, 1 mg ..................................... Injection, natalizumab .............................. IVIG lyophil 1g ......................................... IVIG lyophil 10 mg ................................... IVIG non-lyophil 1g .................................. IVIG non-lyophil 10 mg ............................ LOCM <=149 mg/ml iodine, 1ml ............. LOCM 150-199mg/ml iodine,1ml ............. LOCM 200-249mg/ml iodine,1ml ............. LOCM 250-299mg/ml iodine,1ml ............. LOCM 300-349mg/ml iodine,1ml ............. LOCM 350-399mg/ml iodine,1ml ............. LOCM >= 400 mg/ml iodine,1ml ............. Inj Gad-base MR contrast, ml ................. Inj Fe-based MR contrast, ml .................. Oral MR contrast, 100 ml ........................ Inj perflexane lip micros, m ..................... Inj octafluoropropane mic,ml ................... Inj perflutren lip micros, m ....................... Transport portable x-ray .......................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 1082 9126 0869 0870 0871 0872 9157 9158 9159 9160 9161 9162 19163 9164 .................... 9165 9203 9202 9112 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $55.02 $6.51 $39.46 $0.40 $57.26 $0.57 $0.51 $2.00 $0.78 $0.66 $0.41 $0.27 $0.20 $3.01 .................... $9.01 $13.49 $41.42 $63.51 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... $11.00 $1.30 $7.89 $0.08 $11.45 $0.11 $0.10 $0.40 $0.16 $0.13 $0.08 $0.05 $0.04 $0.60 .................... $1.80 $2.70 $8.28 $12.70 .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00204 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50883 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS R0075 R0076 V2020 V2025 V2100 V2101 V2102 V2103 V2104 V2105 V2106 V2107 V2108 V2109 V2110 V2111 V2112 V2113 V2114 V2115 V2118 V2121 V2199 V2200 V2201 V2202 V2203 V2204 V2205 V2206 V2207 V2208 V2209 V2210 V2211 V2212 V2213 V2214 V2215 V2218 V2219 V2220 V2221 V2299 V2300 V2301 V2302 V2303 V2304 V2305 V2306 V2307 V2308 V2309 V2310 V2311 V2312 V2313 V2314 V2315 V2318 V2319 V2320 V2321 V2399 V2410 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI N N A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Transport port x-ray multipl ..................... Transport portable EKG ........................... Vision svcs frames purchases ................. Eyeglasses delux frames ......................... Lens spher single plano 4.00 .................. Single visn sphere 4.12-7.00 ................... Singl visn sphere 7.12-20.00 ................... Spherocylindr 4.00d/12-2.00d .................. Spherocylindr 4.00d/2.12-4d .................... Spherocylinder 4.00d/4.25-6d .................. Spherocylinder 4.00d/>6.00d ................... Spherocylinder 4.25d/12-2d ..................... Spherocylinder 4.25d/2.12-4d .................. Spherocylinder 4.25d/4.25-6d .................. Spherocylinder 4.25d/over 6d .................. Spherocylindr 7.25d/.25-2.25 ................... Spherocylindr 7.25d/2.25-4d .................... Spherocylindr 7.25d/4.25-6d .................... Spherocylinder over 12.00d ..................... Lens lenticular bifocal .............................. Lens aniseikonic single ............................ Lenticular lens, single .............................. Lens single vision not oth c ..................... Lens spher bifoc plano 4.00d .................. Lens sphere bifocal 4.12-7.0 ................... Lens sphere bifocal 7.12-20 .................... Lens sphcyl bifocal 4.00d/.1 .................... Lens sphcy bifocal 4.00d/2.1 ................... Lens sphcy bifocal 4.00d/4.2 ................... Lens sphcy bifocal 4.00d/ove .................. Lens sphcy bifocal 4.25-7d/ ..................... Lens sphcy bifocal 4.25-7/2 ..................... Lens sphcy bifocal 4.25-7/4 ..................... Lens sphcy bifocal 4.25-7/ov ................... Lens sphcy bifo 7.25-12/.25- ................... Lens sphcyl bifo 7.25-12/2.2 ................... Lens sphcyl bifo 7.25-12/4.2 ................... Lens sphcyl bifocal over 12 ..................... Lens lenticular bifocal .............................. Lens aniseikonic bifocal ........................... Lens bifocal seg width over ..................... Lens bifocal add over 3.25d .................... Lenticular lens, bifocal ............................. Lens bifocal speciality .............................. Lens sphere trifocal 4.00d ....................... Lens sphere trifocal 4.12-7 ...................... Lens sphere trifocal 7.12-20 .................... Lens sphcy trifocal 4.0/.12- ..................... Lens sphcy trifocal 4.0/2.25 ..................... Lens sphcy trifocal 4.0/4.25 ..................... Lens sphcyl trifocal 4.00/>6 ..................... Lens sphcy trifocal 4.25-7/ ...................... Lens sphc trifocal 4.25-7/2 ...................... Lens sphc trifocal 4.25-7/4 ...................... Lens sphc trifocal 4.25-7/>6 .................... Lens sphc trifo 7.25-12/.25- ..................... Lens sphc trifo 7.25-12/2.25 .................... Lens sphc trifo 7.25-12/4.25 .................... Lens sphcyl trifocal over 12 ..................... Lens lenticular trifocal .............................. Lens aniseikonic trifocal .......................... Lens trifocal seg width > 28 .................... Lens trifocal add over 3.25d .................... Lenticular lens, trifocal ............................. Lens trifocal speciality ............................. Lens variab asphericity sing .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00205 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50884 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS V2430 V2499 V2500 V2501 V2502 V2503 V2510 V2511 V2512 V2513 V2520 V2521 V2522 V2523 V2530 V2531 V2599 V2600 V2610 V2615 V2623 V2624 V2625 V2626 V2627 V2628 V2629 V2630 V2631 V2632 V2700 V2702 V2710 V2715 V2718 V2730 V2744 V2745 V2750 V2755 V2756 V2760 V2761 V2762 V2770 V2780 V2781 V2782 V2783 V2784 V2785 V2786 V2790 V2797 V2799 V5008 V5010 V5011 V5014 V5020 V5030 V5040 V5050 V5060 V5070 V5080 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI A A A 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 E A A A A A A A A E A B A A A B A A A F A N A A E E E E E E E E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Lens variable asphericity bi ..................... Variable asphericity lens .......................... Contact lens pmma spherical .................. Cntct lens pmma-toric/prism .................... Contact lens pmma bifocal ...................... Cntct lens pmma color vision .................. Cntct gas permeable sphericl .................. Cntct toric prism ballast ........................... Cntct lens gas permbl bifocl .................... Contact lens extended wear .................... Contact lens hydrophilic .......................... Cntct lens hydrophilic toric ...................... Cntct lens hydrophil bifocl ....................... Cntct lens hydrophil extend ..................... Contact lens gas impermeable ................ Contact lens gas permeable .................... Contact lens/es other type ....................... Hand held low vision aids ........................ Single lens spectacle mount .................... Telescop/othr compound lens ................. Plastic eye prosth custom ....................... Polishing artifical eye ............................... Enlargemnt of eye prosthesis .................. Reduction of eye prosthesis .................... Scleral cover shell ................................... Fabrication & fitting .................................. Prosthetic eye other type ......................... Anter chamber intraocul lens ................... Iris support intraoclr lens ......................... Post chmbr intraocular lens ..................... Balance lens ............................................ Deluxe lens feature .................................. Glass/plastic slab off prism ...................... Prism lens/es ........................................... Fresnell prism press-on lens ................... Special base curve .................................. Tint photochromatic lens/es ..................... Tint, any color/solid/grad ......................... Anti-reflective coating .............................. UV lens/es ............................................... Eye glass case ........................................ Scratch resistant coating ......................... Mirror coating ........................................... Polarization, any lens .............................. Occluder lens/es ...................................... Oversize lens/es ...................................... Progressive lens per lens ........................ Lens, 1.54-1.65 p/1.60-1.79g .................. Lens, >= 1.66 p/>=1.80 g ........................ Lens polycarb or equal ............................ Corneal tissue processing ....................... Occupational multifocal lens .................... Amniotic membrane ................................. Vis item/svc in other code ....................... Miscellaneous vision service ................... Hearing screening .................................... Assessment for hearing aid ..................... Hearing aid fitting/checking ..................... Hearing aid repair/modifying .................... Conformity evaluation .............................. Body-worn hearing aid air ....................... Body-worn hearing aid bone ................... Hearing aid monaural in ear .................... Behind ear hearing aid ............................ Glasses air conduction ............................ Glasses bone conduction ........................ .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00206 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules 50885 ADDENDUM B.—PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2006—Continued CPT/ HCPCS V5090 V5095 V5100 V5110 V5120 V5130 V5140 V5150 V5160 V5170 V5180 V5190 V5200 V5210 V5220 V5230 V5240 V5241 V5242 V5243 V5244 V5245 V5246 V5247 V5248 V5249 V5250 V5251 V5252 V5253 V5254 V5255 V5256 V5257 V5258 V5259 V5260 V5261 V5262 V5263 V5264 V5265 V5266 V5267 V5268 V5269 V5270 V5271 V5272 V5273 V5274 V5275 V5298 V5299 V5336 V5362 V5363 V5364 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... SI 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 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 B E E E E ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Hearing aid dispensing fee ...................... Implant mid ear hearing pros .................. Body-worn bilat hearing aid ..................... Hearing aid dispensing fee ...................... Body-worn binaur hearing aid ................. In ear binaural hearing aid ...................... Behind ear binaur hearing ai ................... Glasses binaural hearing aid ................... Dispensing fee binaural ........................... Within ear cros hearing aid ..................... Behind ear cros hearing aid .................... Glasses cros hearing aid ......................... Cros hearing aid dispens fee .................. In ear bicros hearing aid .......................... Behind ear bicros hearing ai ................... Glasses bicros hearing aid ...................... Dispensing fee bicros .............................. Dispensing fee, monaural ........................ Hearing aid, monaural, cic ....................... Hearing aid, monaural, itc ....................... Hearing aid, prog, mon, cic ..................... Hearing aid, prog, mon, itc ...................... Hearing aid, prog, mon, ite ...................... Hearing aid, prog, mon, bte ..................... Hearing aid, binaural, cic ......................... Hearing aid, binaural, itc .......................... Hearing aid, prog, bin, cic ....................... Hearing aid, prog, bin, itc ........................ Hearing aid, prog, bin, ite ........................ Hearing aid, prog, bin, bte ....................... Hearing id, digit, mon, cic ........................ Hearing aid, digit, mon, itc ....................... Hearing aid, digit, mon, ite ...................... Hearing aid, digit, mon, bte ..................... Hearing aid, digit, bin, cic ........................ Hearing aid, digit, bin, itc ......................... Hearing aid, digit, bin, ite ......................... Hearing aid, digit, bin, bte ....................... Hearing aid, disp, monaural .................... Hearing aid, disp, binaural ....................... Ear mold/insert ......................................... Ear mold/insert, disp ................................ Battery for hearing device ....................... Hearing aid supply/accessory .................. ALD Telephone Amplifier ......................... Alerting device, any type ......................... ALD, TV amplifier, any type .................... ALD, TV caption decoder ........................ Tdd ........................................................... ALD for cochlear implant ......................... ALD unspecified ....................................... Ear impression ......................................... Hearing aid noc ....................................... Hearing service ........................................ Repair communication device ................. Speech screening .................................... Language screening ................................ Dysphagia screening ............................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00207 Fmt 4742 Sfmt 4742 E:\FR\FM\26AUP3.SGM 26AUP3 50886 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Proposed Rules (Catalog of Federal Domestic Assistance Program No. 93.773, MedicarelHospital Insurance; and Program No. 93.774, MedicarelSupplementary Medical Insurance Program) Dated: August 17, 2005 Ann C. Agnew, Executive Secretary to the Department [FR Doc. 05–16699 Filed 8–18–05; 2:44 pm] BILLING CODE 4120–01–P VerDate Aug<18>2005 14:57 Aug 25, 2005 Jkt 205001 PO 00000 Frm 00208 Fmt 4701 Sfmt 4701 E:\FR\FM\26AUP3.SGM 26AUP3

Agencies

[Federal Register Volume 70, Number 165 (Friday, August 26, 2005)]
[Proposed Rules]
[Pages 50680-50886]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-16699]



[[Page 50679]]

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Part III

Book 2 of 2 Books

Pages 50679-50948





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 419 and 485



Medicare Program; Proposed Changes to the Hospital Outpatient 
Prospective Payment System and Calendar Year 2006 Payment Rates; 
Correction; Proposed Rule

Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / 
Proposed Rules

[[Page 50680]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 419 and 485

[CMS-1501-CN]
RIN 0938-AN46


Medicare Program; Proposed Changes to the Hospital Outpatient 
Prospective Payment System and Calendar Year 2006 Payment Rates; 
Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed rule; correction.

-----------------------------------------------------------------------

SUMMARY: This document corrects technical errors that appeared in the 
proposed rule published in the Federal Register on July 25, 2005 
entitled ``Medicare Program; Proposed Changes to the Hospital 
Outpatient Prospective Payment System and Calendar Year 2006 Payment 
Rates; Proposed Rule.''

FOR FURTHER INFORMATION CONTACT: Rebecca Kane, (410) 786-0378.

SUPPLEMENTARY INFORMATION: 

I. Background

    FR Doc. 05-14448 contains our proposed rule to update the Medicare 
Outpatient Prospective Payment System for calendar year (CY) 2006. We 
have identified a number of technical errors in the ``Summary of 
Errors'' section and are correcting them in the ``Correction of 
Errors'' section below.

II. Summary of Errors

A. Corrections Related to the Rural Adjustment Calculation

    The calendar year (CY) 2006 Outpatient Prospective Payment System 
(OPPS) proposed rule that we published in the Federal Register on July 
25, 2005 included a proposed 6.6 percent adjustment for rural sole 
community hospitals. The calculations used to develop the conversion 
factor and budget neutrality scalar inadvertently incorporated this 
adjustment as 6.4 percent. The rural adjustment is used in calculations 
that determine the scalar and conversion factor, and therefore affects 
the payment rates and copayment amounts published in the proposed rule. 
The corrected scalar is 1.003753831, and the corrected conversion 
factor is $59.343. The various changes to the preamble are specified 
under section III. of this correction notice. In addition to preamble 
text changes, we are correcting specific tables and addenda which also 
reflected the inadvertent use of a 6.4 percent rural adjustment factor, 
which we have described below.
    On page 42709, we published Table 11. We are correcting the last 
column of this table to present the corrected proposed CY 2006 payment 
amounts. In section III. of this notice, we republish Table 11 as 
corrected.
    On pages 42761-42762, we published Table 33. In section III. of 
this notice, we republish Table 33 as corrected.
    On pages 42764-42775, we published Addendum A, which provides the 
payment rates and copayment amounts for Ambulatory Payment 
Classification (APC) groups used for payment purposes under the OPPS. A 
corrected Addendum A is posted on the OPPS Web site at https://
www.cms.hhs.gov/providers/hopps/2006p/1501p.asp.
    On pages 42776-42965, we published Addendum B, which provides the 
payment rates and copayment amounts for services payable under OPPS. A 
corrected Addendum B, including additional technical errors affecting 
HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS 
Web site at https://www.cms.hhs.gov/providers/hopps/2006p/1501p.asp.
    We are posting the corrected Addendum A and Addendum B on our Web 
site rather than publishing them in this notice because of the large 
volume of data included in these addenda. Hard copies of these tables 
are available by contacting the CMS staff member identified above.
    We note that as soon as we discovered these inadvertent errors that 
affected the payment rates noted in the proposed rule, we posted the 
corrections on the CMS Web site at: https://www.cms.hhs.gov/providers/
hopps/2006p/1501p.asp.

B. Other Corrections

    We also noted other typographical, formatting, and other technical 
errors in the proposed rule.
    On page 42714, we published Table 15. The proposed ``unadjusted'' 
and ``adjusted'' CY 2006 APC median cost for APC 0085 Level II 
Electrophysiologic Evaluation contained a typographical error and 
should read $2,123.38. We are correcting this under section III. of 
this notice.
    On page 42761, column 2 includes a comparison that discusses the 
differences in copayments from CY 2005 to CY 2006. While the analysis 
of this example is correct, the example incorrectly identifies the 
comparison as being the ``minimum unadjusted copayment'' rather than 
the ``national unadjusted copayment''. We are making this correction 
under section III. of this notice to refer to the ``national unadjusted 
copayment''.
    On page 42737, we published Table 26, which inadvertently excluded 
C2636 (Brachytherapy linear source, Palladium -103, per 1 mm) which was 
accurately described in the text of page 42736 as a proposed separately 
payable brachytherapy source. In section III. of the notice we append 
the excluded row to correct table 26 as published.
    The other technical, typographical, formatting, and other errors 
that appeared on various other pages of the Federal Register are 
corrected as noted in section III. of this notice.

III. Correction of Errors

    In FR Doc. 05-14448 of July 25, 2005 (70 FR 42674), make the 
following corrections:
    1. On page 42690, in column 3, in the last paragraph, in line 20, 
the figure ``0.999207669'' is corrected to read ``1.003753831''.
    2. On page 42691, in column 1, in the second full paragraph, line 
8, the year ``2006'' is corrected to read ``2007''.
    3. On page 42694,
    a. In column 1, in the second full paragraph, in line 8, the figure 
``$240.51'' is corrected to read ``$241.57''.
    b. In column 1, in the second full paragraph, in line 8, the figure 
``$48.10'' is corrected to read ``$48.31''.
    c. In column 3, in the third full paragraph, in line 8, the figure 
``1.002015212'' is corrected to read ``1.002023412''.
    d. In column 3, in the third full paragraph, in line 18, the figure 
``0.99652023'' is corrected to read ``0.99639633''.
    e. In column 3, in the last partial paragraph, in line 5, the 
figure ``1.002015212'' is corrected to read ``1.002023412''.
    4. On page 42695,
    a. In column 1, in the first partial paragraph, in line 5, the 
figure ``0.99652023'' is corrected to read ``0.99639633''.
    b. In column 1, in the first partial paragraph, in line 7, the 
figure ``$59.350'' is corrected to read ``$59.343''.
    5. On page 42703,
    a. In column 1, in the second full paragraph, in line 5, the figure 
``$9.95'' is corrected to read ``$7.00''.
    b. In column 1, in the second full paragraph, in line 5, the figure 
``40'' is corrected to read ``28''.
    c. In column 1, in the second full paragraph, in line 6, the figure 
``$24.89'' is corrected to read ``$25.00''.
    6. On page 42709,

[[Page 50681]]

    a. In column 1, in the first full paragraph, in line 22, the figure 
``$1,297'' is corrected to read ``$1,274''.
    b. In column 1, in the first full paragraph, in line 23, the figure 
``$1,366'' is corrected to read ``$1,244''.
    c. In column 1, in the first full paragraph, in line 25, the figure 
``$1,100'' is corrected to read ``$1,025''.
    d. Table 11 is corrected to read as follows:

        Table 11.--Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006
----------------------------------------------------------------------------------------------------------------
                                                                                                       Proposed
                                     CY 2005   CY 2005 status    Proposed  Proposed CY 2006  CY 2005    CY 2006
     HCPCS           Descriptor        APC        indicator      CY 2006        status       payment    payment
                                                                   APC         indicator      amount    amount
----------------------------------------------------------------------------------------------------------------
0027T..........  Endoscopic             1547  T                      0220  T                    $850   $1,030.11
                  epidural lysis.
33225..........  L ventric pacing       1525  S                      0418  T                   3,750    6,486.45
                  lead add-on.
61623..........  Endovasc tempory       1555  T                      0081  T                   1,650    2,044.21
                  vessel occl.
92974..........  Cath place, cardio     1559  T                      0103  T                   2,250      873.18
                  brachytx.
93580..........  Transcath closure      1559  T                      0434  T                   2,250    5,387.61
                  of asd.
93581..........  Transcath closure      1559  T                      0434  T                   2,250    5,387.61
                  of vsd.
95965..........  Meg, spontaneous..     1528  S                      0430  T                   5,250      676.75
95966..........  Meg, evoked,           1516  S                      0430  T                   1,450      676.75
                  single.
95967..........  Meg, evoked, each      1511  S                      0430  T                     950      676.75
                  add'l.
C9713..........  Non-contact laser      1525  S                      0429  T                   3,750    2,511.08
                  vap prosta.
----------------------------------------------------------------------------------------------------------------

    7. On page 42710, in column 2, in the first full paragraph, in line 
19, the figure ``$93.71'' is corrected to read ``$93.37''.
    8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7, 
both occurrences of the figure ``$2,123.46'' are corrected to read 
``$2,123.38''.
    9. On page 42737, Table 26, ``Proposed Separately payable 
Brachytherapy Sources for CY 2006'' is appended with the following row:

----------------------------------------------------------------------------------------------------------------
                                                                                                    New status
    HCPCS       Long descriptor     APC                          APC title                          indicator
----------------------------------------------------------------------------------------------------------------
C2636........  Brachytherapy        2636   Brachytx linear source, P-103.......................  H
                linear source,
                Palladium-103,
                per 1mm.
----------------------------------------------------------------------------------------------------------------

    10. On page 42756, in column 1, in the first partial paragraph, in 
line 5, the figure ``1.8'' is corrected to read ``1.7''.
    11. On page 42758, in column 2, in the third full paragraph, in 
line 13, the figure ``$59.35'' is corrected to read ``$59.34''.
    12. On page 42759,
    a. In column 1, in the first partial paragraph, in line 21, the 
figure ``5.8'' is corrected to read ``5.6''.
    b. In column 1, in the first partial paragraph, in line 31, the 
figure ``1.2'' is corrected to read ``1.3''.
    c. In column 1, in the first partial paragraph, in line 31, the 
figure ``1.8'' is corrected to read ``1.7''.
    d. In column 1, in the first partial paragraph, in line 36, the 
figure ``2.6'' is corrected to read ``2.5''.
    e. In column 1, in the second partial paragraph, in line 22, the 
figure ``2.9'' is corrected to read ``2.7''.
    f. In column 1, in the second partial paragraph, in line 25, the 
figure ``0.7'' is corrected to read ``0.6''.
    g. In column 1, in the second partial paragraph, in line 30, the 
text ``West South Central'' is corrected to read ``New England''.
    h. In column 2, in the first partial paragraph, in line 2, the 
figure ``1.9'' is corrected to read ``1.7''.
    i. In column 2, in the first partial paragraph, in line 2, the 
figure ``1.8'' is corrected to read ``1.6''.
    j. In column 2, in the first full paragraph, in line 4, the figure 
``0.4'' is corrected to read ``0.3''.
    k. In column 2, in the first full paragraph, in line 5, the figure 
``0.5'' is corrected to read ``0.3''.
    l. In column 2, in the first full paragraph, in line 9, the figure 
``0.9'' is corrected to read ``1.6''.
    m. In column 2, in the first full paragraph, in line 10, the figure 
``1.4'' is corrected to read ``2.2''.
    n. In column 2, in the first full paragraph, in line 21, the 
sentence portion ``1.3 percent and voluntary and government hospitals 
will gain at least 0.1 percent.'' is corrected to read ``1.1 percent, 
voluntary hospitals would gain 0.2 percent, and government hospitals 
will see no changes as a result of changes to APC structure.''
    o. In column 3, in the second full paragraph, in line 7, the figure 
``0.997'' is corrected to read ``0.996''.
    p. In column 3, in the second full paragraph, in line 10, the 
figure ``0.3'' is corrected to read ``0.4''.
    q. In column 3, in the second full paragraph, in line 13, the 
figure ``5.2'' is corrected to read ``5.4''.
    13. On page 42760,
    a. In column 1, in the first partial paragraph, in line 6, the 
figure ``0.3'' is corrected to read ``0.4''.
    b. In column 1, in the first full paragraph, in line 19, the figure 
``5.8'' is corrected to read ``5.6''.
    c. In column 1, in the first full paragraph, in line 24, the figure 
``-2.8'' is corrected to read ``-2.4''.
    d. In column 1, in the first full paragraph, in line 32, the figure 
``1.2'' is corrected to read ``1.3''.
    e. In column 1, in the first full paragraph, in line 35, the figure 
``0.3'' is corrected to read ``0.4''.
    f. In column 1, in the first full paragraph, in line 37, the figure 
``1.5'' is corrected to read ``1.4''.
    g. In column 1, in the last paragraph, in line 7, the figure 
``8.6'' is corrected to read ``8.7''.
    h. In column 1, in the third partial paragraph, in line 12, the 
figure ``5.0'' is corrected to read ``4.7''.
    i. In column 3, in the first partial paragraph, in line 6, the 
figure ``2.6'' is corrected to read ``2.5''.
    j. In column 3, in the first partial paragraph, in line 12, the 
figure ``2.1'' is corrected to read ``1.8''.
    k. In column 3, in the first partial paragraph, in line 32, the 
figure ``3.7'' is corrected to read ``3.6''.

[[Page 50682]]

    l. In column 3, in the first full paragraph, in line 11, the figure 
``3.4'' is corrected to read ``3.5''.
    m. In column 3, in the first full paragraph, in line 13, the figure 
``6.4'' is corrected to read ``6.5''.
    n. In column 3, in the first full paragraph, in line 30, the text 
``greater than'' is corrected to read ``of at least''.
    o. In column 3, in the first full paragraph, in lines 33 and 34, 
the figure ``only 1.0'' is corrected to read ``1.4'' and the text ``and 
0.8 percent, respectively.'' is appended to the end of the sentence.
    14. On page 42761
    a. In column 1, in the first partial paragraph, in line 3, the 
figure ``1.9'' is corrected to read ``2.6''.
    b. In column 1, in the first partial paragraph, in line 6, the 
figure ``2.6'' is corrected to read ``3.4''.
    c. In column 1, in the first partial paragraph, in line 11, the 
figure ``0.8'' is corrected to read ``0.6''.
    d. In column 1, in line 12, the designation for the heading 
``Estimated Impacts of This Proposed Rule on Beneficiaries'' is 
corrected from ``G'' to read ``F''.
    e. In column 1, in the second partial paragraph, in line 12, the 
figure ``$11.86'' is corrected to read ``$11.91''.
    f. In column 2, in the first partial paragraph, in lines 4 and 6, 
the term ``minimum'' is corrected to read ``national''.
    g. In column 2, in the first partial paragraph, in line 8, the 
figure ``$223.91'' is corrected to read ``$224.91''.
    h. Table 33 is corrected to read as follows:

        Table 33.--Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
                                                                                             Cumulative
                                                                                   New adj      (Cols
                                                     Number of             New    for rural    2,3,4)
                 Hospital category                                APC      wage      sole       with       All
                                                     hospitals  changes   index   community    market    changes
                                                                                  hospitals    basket
                                                                                               update
                                                           (1)      (2)      (3)        (4)         (5)      (6)
----------------------------------------------------
ALL HOSPITALS......................................       4212      0.0      0.0        0.0         3.2      1.9
URBAN HOSPITALS....................................       2949      0.0      0.0       -0.4         2.8      1.6
    LARGE URBAN....................................       1624     -0.8      0.0       -0.4         2.0      0.8
    OTHER URBAN....................................       1325      1.0      0.0       -0.4         3.8      2.5
RURAL HOSPITALS....................................       1263     -0.1      0.1        1.8         5.0      3.5
    SOLE COMMUNITY.................................        478     -0.1      0.0        5.4         8.7      6.5
    OTHER RURAL....................................        785     -0.1      0.1       -0.4         2.8      1.6
BEDS (URBAN):
    0-99 BEDS......................................        917      0.0      0.2       -0.4         3.0      2.1
    100-199 BEDS...................................        964     -0.4      0.0       -0.4         2.5      1.5
    200-299 BEDS...................................        503      0.2      0.1       -0.4         3.2      2.4
    300-499 BEDS...................................        402     -0.1     -0.1       -0.4         2.6      1.5
    500 + BEDS.....................................        163      0.3      0.0       -0.4         3.1      1.0
BEDS (RURAL):
    0-49 BEDS......................................        551     -0.9      0.2        2.1         4.6      3.1
    50-100 BEDS....................................        419     -0.8      0.2        2.3         4.8      3.0
    101-149 BEDS...................................        180      1.4      0.0        1.1         5.8      4.7
    150-199 BEDS...................................         62     -0.2     -0.2        1.8         4.7      3.7
    200 + BEDS.....................................         51      0.1      0.0        1.7         5.1      3.1
VOLUME (URBAN):
    LT 5,000 claim lines...........................        600     -5.6      0.5       -0.4        -2.4     -1.8
    5,000-10,999...................................        180     -2.4      0.2       -0.4         0.5      0.6
    11,000-20,999..................................        299     -0.6      0.2       -0.4         2.4      2.5
    21,000-42,999..................................        575     -0.6      0.1       -0.4         2.3      1.9
    GT 42,999......................................       1295      0.2      0.0       -0.4         3.0      1.6
VOLUME (RURAL):
    LT 5,000 claim lines...........................        119     -2.7      0.0        1.4         1.7      1.4
    5,000-10,999...................................        195     -1.9      0.0        2.1         3.4      2.4
    11,000-20,999..................................        325     -0.9     -0.1        2.0         4.3      3.4
    21,000-42,999..................................        364     -0.9      0.2        1.9         4.5      3.0
    GT 42,999......................................        260      0.6      0.0        1.7         5.7      3.8
REGION (URBAN):
    NEW ENGLAND....................................        166     -1.3     -0.1       -0.4         1.4     -0.2
    MIDDLE ATLANTIC................................        393      0.6     -0.1       -0.4         3.4      2.1
    SOUTH ATLANTIC.................................        453     -0.4     -0.4       -0.4         2.0      1.0
    EAST NORTH CENT................................        466      0.4     -0.1       -0.4         3.2      1.7
    EAST SOUTH CENT................................        197      1.5      0.0       -0.4         4.4      3.4
    WEST NORTH CENT................................        184      2.5     -0.3       -0.4         5.1      3.6
    WEST SOUTH CENT................................        445     -0.3     -0.1       -0.4         2.5      1.3
    MOUNTAIN.......................................        163     -0.1     -0.2       -0.4         2.5      1.3
    PACIFIC........................................        431     -1.7      1.1       -0.4         2.2      1.4
    PUERTO RICO....................................         51      0.4     -0.3       -0.4         2.9      2.2
REGION (RURAL):
    NEW ENGLAND....................................         37     -1.1      0.9        1.2         4.2      0.8
    MIDDLE ATLANTIC................................         78      1.7     -0.4        1.4         6.0      4.1
    SOUTH ATLANTIC.................................        189     -0.4     -0.2        1.7         4.4      3.3
    EAST NORTH CENT................................        171     -0.6      0.1        1.4         4.1      2.2
    EAST SOUTH CENT................................        202     -0.7      0.5        0.5         3.5      3.0
    WEST NORTH CENT................................        188      1.6     -0.3        2.6         7.2      4.7

[[Page 50683]]

 
    WEST SOUTH CENT................................        242     -0.9     -0.2        2.2         4.4      3.7
    MOUNTAIN.......................................         95     -1.0      0.1        4.6         7.0      5.2
    PACIFIC........................................         61     -0.7      1.8        2.7         7.2      5.3
TEACHING STATUS:
    NON-TEACHING...................................       3115     -0.3      0.1        0.3         3.2      2.3
    MINOR..........................................        769      0.3      0.0       -0.2         3.3      2.3
    MAJOR..........................................        328      0.3     -0.2       -0.3         3.0      0.6
DSH PATIENT PERCENT:
    0..............................................         16      0.3      0.0       -0.4         3.1      3.1
    GT 0-0.10......................................        386      0.1     -0.2       -0.3         2.8      1.7
    0.10-0.16......................................        555      0.0      0.1        0.2         3.5      2.4
    0.16-0.23......................................        802      0.1      0.0        0.1         3.5      2.3
    0.23-0.35......................................        977      0.1     -0.1        0.0         3.2      1.9
    GE 0.35........................................        792     -0.3      0.1       -0.1         3.0      1.8
    TEFRA: DSH NOT AVAIL 1.........................        684     -1.6      0.0       -0.4         1.2     -2.6
URBAN TEACHING/DSH:
    TEACHING & DSH.................................        944      0.4     -0.1       -0.4         3.1      1.7
    NO TEACHING/DSH................................       1401     -0.3      0.1       -0.4         2.5      1.8
    NO TEACHING/NO DSH.............................         16      0.3      0.0       -0.4         3.1      3.1
    TEFRA: DSH NOT AVAIL 1.........................        588     -2.2      0.1       -0.4         0.7     -3.4
TYPE OF OWNERSHIP:
    VOLUNTARY......................................       2397      0.2      0.0        0.0         3.3      2.0
    PROPRIETARY....................................       1091     -1.1      0.0        0.0         2.1      1.6
    GOVERNMENT.....................................        724      0.0      0.1        0.2         3.6      1.7
----------------------------------------------------------------------------------------------------------------
Col (1) Total Hospitals in 2006.
Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC
  groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral
  overall).
Col (3) This column shows the adjustment for updating the wage index (budget neutral overall).
Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall).
Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket
  update.
Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes.
1 Complete DSH numbers are not available for hospitals that are not paid under IPPS.

    15. On pages 42764-42775, Addendum A is corrected to read as 
follows:

[[Page 50684]]



Addendum A.--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment
                                 Rates, and Copayment Amounts Calendar Year 2006
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
      APC               Group title                SI           Relative     Payment     unadjusted   unadjusted
                                                                 weight        rate      copayment    copayment
----------------------------------------------------------------------------------------------------------------
0001...........  Level I Photochemotherapy  S...............       0.4213       $25.00        $7.00        $5.00
0002...........  Level I Fine Needle        T...............       0.9559       $56.73  ...........       $11.35
                  Biopsy/Aspiration.
0003...........  Bone Marrow Biopsy/        T...............       2.6530      $157.44  ...........       $31.49
                  Aspiration.
0004...........  Level I Needle Biopsy/     T...............       1.7646      $104.72       $22.36       $20.94
                  Aspiration Except Bone
                  Marrow.
0005...........  Level II Needle Biopsy/    T...............       3.5994      $213.60       $71.59       $42.72
                  Aspiration Except Bone
                  Marrow.
0006...........  Level I Incision &         T...............       1.5500       $91.98       $22.28       $18.40
                  Drainage.
0007...........  Level II Incision &        T...............      11.4501      $679.48  ...........      $135.90
                  Drainage.
0008...........  Level III Incision and     T...............      16.4989      $979.09  ...........      $195.82
                  Drainage.
0009...........  Nail Procedures..........  T...............       0.6680       $39.64        $8.34        $7.93
0010...........  Level I Destruction of     T...............       0.5719       $33.94        $9.65        $6.79
                  Lesion.
0011...........  Level II Destruction of    T...............       2.0839      $123.66       $25.17       $24.73
                  Lesion.
0012...........  Level I Debridement &      T...............       0.8497       $50.42       $11.18       $10.08
                  Destruction.
0013...........  Level II Debridement &     T...............       1.1078       $65.74       $14.20       $13.15
                  Destruction.
0015...........  Level III Debridement &    T...............       1.6514       $98.00       $20.29       $19.60
                  Destruction.
0016...........  Level IV Debridement &     T...............       2.5834      $153.31       $33.57       $30.66
                  Destruction.
0017...........  Level VI Debridement &     T...............      18.4211    $1,093.16      $227.84      $218.63
                  Destruction.
0018...........  Biopsy of Skin/Puncture    T...............       1.1726       $69.59       $16.04       $13.92
                  of Lesion.
0019...........  Level I Excision/ Biopsy.  T...............       4.0547      $240.62       $71.87       $48.12
0020...........  Level II Excision/ Biopsy  T...............       6.9433      $412.04      $107.40       $82.41
0021...........  Level III Excision/        T...............      14.9776      $888.82      $219.48      $177.76
                  Biopsy.
0022...........  Level IV Excision/ Biopsy  T...............      19.6472    $1,165.92      $354.45      $233.18
0023...........  Exploration Penetrating    T...............       4.7775      $283.51  ...........       $56.70
                  Wound.
0024...........  Level I Skin Repair......  T...............       1.6084       $95.45       $31.25       $19.09
0025...........  Level II Skin Repair.....  T...............       5.4938      $326.02      $101.85       $65.20
0027...........  Level IV Skin Repair.....  T...............      18.4182    $1,092.99      $329.72      $218.60
0028...........  Level I Breast Surgery...  T...............      19.5801    $1,161.94      $303.74      $232.39
0029...........  Level II Breast Surgery..  T...............      32.0476    $1,901.80      $632.64      $380.36
0030...........  Level III Breast Surgery.  T...............      40.0825    $2,378.62      $763.55      $475.72
0033...........  Partial Hospitalization..  P...............       4.0708      $241.57  ...........       $48.31
0035...........  Venous Cutdown...........  T...............       0.7158       $42.48  ...........        $8.50
0036...........  Level II Fine Needle       T...............       2.1773      $129.21  ...........       $25.84
                  Biopsy/Aspiration.
0037...........  Level IV Needle Biopsy/    T...............       9.4751      $562.28      $224.91      $112.46
                  Aspiration Except Bone
                  Marrow.
0039...........  Level I Implantation of    S...............     181.4000   $10,764.82  ...........    $2,152.96
                  Neurostimulator.
0040...........  Level I Implantation of    S...............      55.3297    $3,283.43  ...........      $656.69
                  Neurostimulator
                  Electrodes.
0041...........  Level I Arthroscopy......  T...............      28.1318    $1,669.43  ...........      $333.89
0042...........  Level II Arthroscopy.....  T...............      43.9753    $2,609.63      $804.74      $521.93
0043...........  Closed Treatment Fracture  T...............       1.7694      $105.00  ...........       $21.00
                  Finger/Toe/Trunk.
0045...........  Bone/Joint Manipulation    T...............      14.4945      $860.15      $268.47      $172.03
                  Under Anesthesia.
0046...........  Open/Percutaneous          T...............      37.7023    $2,237.37      $535.76      $447.47
                  Treatment Fracture or
                  Dislocation.
0047...........  Arthroplasty without       T...............      31.6107    $1,875.87      $537.03      $375.17
                  Prosthesis.
0048...........  Level I Arthroplasty with  T...............      43.1288    $2,559.39      $570.30      $511.88
                  Prosthesis.
0049...........  Level I Musculoskeletal    T...............      20.3707    $1,208.86  ...........      $241.77
                  Procedures Except Hand
                  and Foot.
0050...........  Level II Musculoskeletal   T...............      23.9081    $1,418.78  ...........      $283.76
                  Procedures Except Hand
                  and Foot.
0051...........  Level III Musculoskeletal  T...............      36.5271    $2,167.63  ...........      $433.53
                  Procedures Except Hand
                  and Foot.
0052...........  Level IV Musculoskeletal   T...............      43.9378    $2,607.40  ...........      $521.48
                  Procedures Except Hand
                  and Foot.
0053...........  Level I Hand               T...............      15.6795      $930.47      $253.49      $186.09
                  Musculoskeletal
                  Procedures.
0054...........  Level II Hand              T...............      25.3711    $1,505.60  ...........      $301.12
                  Musculoskeletal
                  Procedures.
0055...........  Level I Foot               T...............      20.0692    $1,190.97      $355.34      $238.19
                  Musculoskeletal
                  Procedures.
0056...........  Level II Foot              T...............      40.2957    $2,391.27  ...........      $478.25
                  Musculoskeletal
                  Procedures.
0057...........  Bunion Procedures........  T...............      27.5493    $1,634.86      $475.91      $326.97
0058...........  Level I Strapping and      S...............       1.0934       $64.89  ...........       $12.98
                  Cast Application.
0060...........  Manipulation Therapy.....  S...............       0.4935       $29.29  ...........        $5.86
0068...........  CPAP Initiation..........  S...............       1.2293       $72.95       $29.18       $14.59
0069...........  Thoracoscopy.............  T...............      30.6775    $1,820.49      $591.64      $364.10
0070...........  Thoracentesis/Lavage       T...............       3.2101      $190.50  ...........       $38.10
                  Procedures.
0071...........  Level I Endoscopy Upper    T...............       0.7915       $46.97       $11.31        $9.39
                  Airway.
0072...........  Level II Endoscopy Upper   T...............       1.4361       $85.22       $21.27       $17.04
                  Airway.
0074...........  Level IV Endoscopy Upper   T...............      15.7757      $936.18      $295.70      $187.24
                  Airway.
0075...........  Level V Endoscopy Upper    T...............      21.3426    $1,266.53      $445.92      $253.31
                  Airway.
0076...........  Level I Endoscopy Lower    T...............       9.4592      $561.34      $189.82      $112.27
                  Airway.
0077...........  Level I Pulmonary          S...............       0.3444       $20.44        $7.74        $4.09
                  Treatment.
0078...........  Level II Pulmonary         S...............       1.0236       $60.74       $14.55       $12.15
                  Treatment.
0079...........  Ventilation Initiation     S...............       2.3482      $139.35  ...........       $27.87
                  and Management.
0080...........  Diagnostic Cardiac         T...............      37.1361    $2,203.77      $838.92      $440.75
                  Catheterization.
0081...........  Non-Coronary Angioplasty   T...............      34.4473    $2,044.21  ...........      $408.84
                  or Atherectomy.
0082...........  Coronary Atherectomy.....  T...............      85.0126    $5,044.90    $1,085.20    $1,008.98
0083...........  Coronary Angioplasty and   T...............      50.8925    $3,020.11  ...........      $604.02
                  Percutaneous
                  Valvuloplasty.
0084...........  Level I                    S...............      10.0205      $594.65  ...........      $118.93
                  Electrophysiologic
                  Evaluation.
0085...........  Level II                   T...............      35.1882    $2,088.17      $426.25      $417.63
                  Electrophysiologic
                  Evaluation.

[[Page 50685]]

 
0086...........  Ablate Heart Dysrhythm     T...............      44.2596    $2,626.50      $833.33      $525.30
                  Focus.
0087...........  Cardiac                    T...............      30.7101    $1,822.43  ...........      $364.49
                  Electrophysiologic
                  Recording/Mapping.
0088...........  Thrombectomy.............  T...............      36.5617    $2,169.68      $655.22      $433.94
0089...........  Insertion/Replacement of   T...............     105.6143    $6,267.47    $1,682.28    $1,253.49
                  Permanent Pacemaker and
                  Electrodes.
0090...........  Insertion/Replacement of   T...............      89.1574    $5,290.87    $1,612.80    $1,058.17
                  Pacemaker Pulse
                  Generator.
0091...........  Level II Vascular          T...............      28.9999    $1,720.94      $348.23      $344.19
                  Ligation.
0092...........  Level I Vascular Ligation  T...............      23.4516    $1,391.69  ...........      $278.34
0093...........  Vascular Reconstruction/   ................  ...........  ...........  ...........  ...........
                  Fistula Repair without
                  Device.
0094...........  Level I Resuscitation and  S...............       2.5363      $150.51       $47.62       $30.10
                  Cardioversion.
0095...........  Cardiac Rehabilitation...  S...............       0.5885       $34.92       $13.96        $6.98
0096...........  Non-Invasive Vascular      S...............       1.6307       $96.77       $38.70       $19.35
                  Studies.
0097...........  Cardiac and Ambulatory     X...............       1.0223       $60.67       $23.79       $12.13
                  Blood Pressure
                  Monitoring.
0098...........  Injection of Sclerosing    T...............       1.1346       $67.33  ...........       $13.47
                  Solution.
0099...........  Electrocardiograms.......  S...............       0.3821       $22.67  ...........        $4.53
0100...........  Cardiac Stress Tests.....  X...............       2.4968      $148.17       $41.44       $29.63
0101...........  Tilt Table Evaluation....  S...............       4.2787      $253.91      $101.56       $50.78
0103...........  Miscellaneous Vascular     T...............      14.7142      $873.18      $223.63      $174.64
                  Procedures.
0104...........  Transcatheter Placement    T...............      79.0094    $4,688.65  ...........      $937.73
                  of Intracoronary Stents.
0105...........  Revision/Removal of        T...............      22.3685    $1,327.41      $370.40      $265.48
                  Pacemakers, AICD, or
                  Vascular.
0106...........  Insertion/Replacement/     T...............      45.4851    $2,699.22  ...........      $539.84
                  Repair of Pacemaker and/
                  or Electrodes.
0107...........  Insertion of Cardioverter- T...............     260.0295   $15,430.93    $3,103.22    $3,086.19
                  Defibrillator.
0108...........  Insertion/Replacement/     T...............     349.1681   $20,720.68  ...........    $4,144.14
                  Repair of Cardioverter-
                  Defibrillator Leads.
0109...........  Removal of Implanted       T...............      11.0433      $655.34      $131.49      $131.07
                  Devices.
0110...........  Transfusion..............  S...............       3.6594      $217.16  ...........       $43.43
0111...........  Blood Product Exchange...  S...............      12.3956      $735.59      $200.18      $147.12
0112...........  Apheresis, Photopheresis,  S...............      26.7948    $1,590.08      $438.94      $318.02
                  and Plasmapheresis.
0113...........  Excision Lymphatic System  T...............      21.4653    $1,273.82  ...........      $254.76
0114...........  Thyroid/Lymphadenectomy    T...............      40.7652    $2,419.13      $485.91      $483.83
                  Procedures.
0115...........  Cannula/Access Device      T...............      31.4727    $1,867.68      $459.35      $373.54
                  Procedures.
0116...........  Chemotherapy               S...............       1.1453       $67.97  ...........       $13.59
                  Administration by Other
                  Technique Except
                  Infusion.
0117...........  Chemotherapy               S...............       3.2378      $192.14       $42.54       $38.43
                  Administration by
                  Infusion Only.
0120...........  Infusion Therapy Except    S...............       2.0193      $119.83       $28.21       $23.97
                  Chemotherapy.
0121...........  Level I Tube changes and   T...............       2.2766      $135.10       $43.80       $27.02
                  Repositioning.
0122...........  Level II Tube changes and  T...............       6.9721      $413.75       $84.85       $82.75
                  Repositioning.
0123...........  Bone Marrow Harvesting     S...............      22.9902    $1,364.31  ...........      $272.86
                  and Bone Marrow/Stem
                  Cell Transplant.
0125...........  Refilling of Infusion      T...............       1.9331      $114.72  ...........       $22.94
                  Pump.
0130...........  Level I Laparoscopy......  T...............      31.9271    $1,894.65      $659.53      $378.93
0131...........  Level II Laparoscopy.....  T...............      43.3389    $2,571.86    $1,001.89      $514.37
0132...........  Level III Laparoscopy....  T...............      62.9914    $3,738.10    $1,239.22      $747.62
0140...........  Esophageal Dilation        T...............       5.4737      $324.83       $94.18       $64.97
                  without Endoscopy.
0141...........  Level I Upper GI           T...............       8.1835      $485.63      $143.38       $97.13
                  Procedures.
0142...........  Small Intestine Endoscopy  T...............       9.3487      $554.78      $152.78      $110.96
0143...........  Lower GI Endoscopy.......  T...............       8.6869      $515.51      $186.06      $103.10
0146...........  Level I Sigmoidoscopy and  T...............       4.6374      $275.20       $64.40       $55.04
                  Anoscopy.
0147...........  Level II Sigmoidoscopy     T...............       7.9679      $472.84  ...........       $94.57
                  and Anoscopy.
0148...........  Level I Anal/Rectal        T...............       3.7383      $221.84       $57.21       $44.37
                  Procedures.
0149...........  Level III Anal/Rectal      T...............      18.0726    $1,072.48      $293.06      $214.50
                  Procedures.
0150...........  Level IV Anal/Rectal       T...............      23.8654    $1,416.24      $437.12      $283.25
                  Procedures.
0151...........  Endoscopic Retrograde      T...............      18.7338    $1,111.72      $245.46      $222.34
                  Cholangio-
                  Pancreatography (ERCP).
0152...........  Level I Percutaneous       T...............      12.2833      $728.93  ...........      $145.79
                  Abdominal and Biliary
                  Procedures.
0153...........  Peritoneal and Abdominal   T...............      21.6961    $1,287.51      $382.75      $257.50
                  Procedures.
0154...........  Hernia/Hydrocele           T...............      28.7847    $1,708.17      $464.85      $341.63
                  Procedures.
0155...........  Level II Anal/Rectal       T...............      16.2546      $964.60  ...........      $192.92
                  Procedures.
0156...........  Level II Urinary and Anal  T...............       2.5751      $152.81       $40.52       $30.56
                  Procedures.
0157...........  Colorectal Cancer          S...............       2.2904      $135.92  ...........       $27.18
                  Screening: Barium Enema.
0158...........  Colorectal Cancer          T...............       7.6588      $454.50  ...........      $113.63
                  Screening: Colonoscopy.
0159...........  Colorectal Cancer          S...............       3.1455      $186.66  ...........       $46.67
                  Screening: Flexible
                  Sigmoidoscopy.
0160...........  Level I Cystourethroscopy  T...............       6.6753      $396.13      $105.06       $79.23
                  and other Genitourinary
                  Procedures.
0161...........  Level II                   T...............      18.5576    $1,101.26      $249.36      $220.25
                  Cystourethroscopy and
                  other Genitourinary
                  Procedures.
0162...........  Level III                  T...............      23.3918    $1,388.14  ...........      $277.63
                  Cystourethroscopy and
                  other Genitourinary
                  Procedures.
0163...........  Level IV                   T...............      33.7354    $2,001.96  ...........      $400.39
                  Cystourethroscopy and
                  other Genitourinary
                  Procedures.
0164...........  Level I Urinary and Anal   T...............       1.1855       $70.35       $17.29       $14.07
                  Procedures.

[[Page 50686]]

 
0165...........  Level III Urinary and      T...............      16.6689      $989.18  ...........      $197.84
                  Anal Procedures.
0166...........  Level I Urethral           T...............      17.6743    $1,048.85      $218.73      $209.77
                  Procedures.
0168...........  Level II Urethral          T...............      28.2685    $1,677.54      $388.03      $335.51
                  Procedures.
0169...........  Lithotripsy..............  T...............      43.0133    $2,552.54    $1,021.01      $510.51
0170...........  Dialysis.................  S...............       5.8994      $350.09  ...........       $70.02
0180...........  Circumcision.............  T...............      19.8827    $1,179.90      $304.87      $235.98
0181...........  Penile Procedures........  T...............      30.8663    $1,831.70      $621.82      $366.34
0183...........  Testes/Epididymis          T...............      23.6415    $1,402.96  ...........      $280.59
                  Procedures.
0184...........  Prostate Biopsy..........  T...............       4.3566      $258.53       $96.27       $51.71
0188...........  Level II Female            T...............       1.1400       $67.65  ...........       $13.53
                  Reproductive Proc.
0189...........  Level III Female           T...............       2.3710      $140.70  ...........       $28.14
                  Reproductive Proc.
0190...........  Level I Hysteroscopy.....  T...............      21.0653    $1,250.08      $424.28      $250.02
0191...........  Level I Female             T...............       0.1670        $9.91        $2.78        $1.98
                  Reproductive Proc.
0192...........  Level IV Female            T...............       4.3082      $255.66  ...........       $51.13
                  Reproductive Proc.
0193...........  Level V Female             T...............      14.5843      $865.48  ...........      $173.10
                  Reproductive Proc.
0194...........  Level VIII Female          T...............      20.7525    $1,231.52      $397.84      $246.30
                  Reproductive Proc.
0195...........  Level IX Female            T...............      26.6791    $1,583.22      $483.80      $316.64
                  Reproductive Proc.
0196...........  Dilation and Curettage...  T...............      17.0974    $1,014.61      $338.23      $202.92
0197...........  Infertility Procedures...  T...............       2.3572      $139.88  ...........       $27.98
0198...........  Pregnancy and Neonatal     T...............       1.3683       $81.20       $32.19       $16.24
                  Care Procedures.
0200...........  Level VII Female           T...............      17.8728    $1,060.63      $263.69      $212.13
                  Reproductive Proc.
0201...........  Level VI Female            T...............      17.6047    $1,044.72      $329.65      $208.94
                  Reproductive Proc.
0202...........  Level X Female             T...............      40.3866    $2,396.66      $958.66      $479.33
                  Reproductive Proc.
0203...........  Level IV Nerve Injections  T...............      10.4015      $617.26      $246.90      $123.45
0204...........  Level I Nerve Injections.  T...............       2.1910      $130.02       $40.13       $26.00
0206...........  Level II Nerve Injections  T...............       5.4920      $325.91       $75.55       $65.18
0207...........  Level III Nerve            T...............       6.0109      $356.70       $86.92       $71.34
                  Injections.
0208...........  Laminotomies and           T...............      42.3409    $2,512.64  ...........      $502.53
                  Laminectomies.
0209...........  Extended EEG Studies and   S...............      11.5713      $686.68      $274.67      $137.34
                  Sleep Studies, Level II.
0212...........  Nervous System Injections  T...............       2.9740      $176.49       $70.59       $35.30
0213...........  Extended EEG Studies and   S...............       2.2932      $136.09       $54.43       $27.22
                  Sleep Studies, Level I.
0214...........  Electroencephalogram.....  S...............       1.1353       $67.37       $26.94       $13.47
0215...........  Level I Nerve and Muscle   S...............       0.6115       $36.29       $14.51        $7.26
                  Tests.
0216...........  Level III Nerve and        S...............       2.6720      $158.56  ...........       $31.71
                  Muscle Tests.
0218...........  Level II Nerve and Muscle  S...............       1.1408       $67.70  ...........       $13.54
                  Tests.
0220...........  Level I Nerve Procedures.  T...............      17.3586    $1,030.11  ...........      $206.02
0221...........  Level II Nerve Procedures  T...............      29.9209    $1,775.60      $463.62      $355.12
0222...........  Implantation of            T...............     179.0982   $10,628.22  ...........    $2,125.64
                  Neurological Device.
0223...........  Implantation or Revision   T...............      28.1230    $1,668.90  ...........      $333.78
                  of Pain Management
                  Catheter.
0224...........  Implantation of Reservoir/ T...............      40.6455    $2,412.03  ...........      $482.41
                  Pump/Shunt.
0225...........  Level II Implantation of   S...............     234.6925   $13,927.36  ...........    $2,785.47
                  Neurostimulator
                  Electrodes.
0226...........  Implantation of Drug       T...............     138.8695    $8,240.93  ...........    $1,648.19
                  Infusion Reservoir.
0227...........  Implantation of Drug       T...............     136.4922    $8,099.86  ...........    $1,619.97
                  Infusion Device.
0228...........  Creation of Lumbar         T...............      51.7258    $3,069.56  ...........      $613.91
                  Subarachnoid Shunt.
0229...........  Transcatherter Placement   T...............      64.4545    $3,824.92      $771.23      $764.98
                  of Intravascular Shunts.
0230...........  Level I Eye Tests &        S...............       0.7858       $46.63       $14.97        $9.33
                  Treatments.
0231...........  Level III Eye Tests &      S...............       1.9278      $114.40       $44.61       $22.88
                  Treatments.
0232...........  Level I Anterior Segment   T...............       6.6732      $396.01      $103.17       $79.20
                  Eye Procedures.
0233...........  Level II Anterior Segment  T...............      14.9673      $888.20      $266.33      $177.64
                  Eye Procedures.
0234...........  Level III Anterior         T...............      21.9741    $1,304.01      $511.31      $260.80
                  Segment Eye Procedures.
0235...........  Level I Posterior Segment  T...............       4.6593      $276.50       $67.40       $55.30
                  Eye Procedures.
0236...........  Level II Posterior         T...............      17.0229    $1,010.19  ...........      $202.04
                  Segment Eye Procedures.
0237...........  Level III Posterior        T...............      28.9401    $1,717.39  ...........      $343.48
                  Segment Eye Procedures.
0238...........  Level I Repair and         T...............       2.5933      $153.89  ...........       $30.78
                  Plastic Eye Procedures.
0239...........  Level II Repair and        T...............       6.9097      $410.04  ...........       $82.01
                  Plastic Eye Procedures.
0240...........  Level III Repair and       T...............      18.1508    $1,077.12      $315.31      $215.42
                  Plastic Eye Procedures.
0241...........  Level IV Repair and        T...............      23.3036    $1,382.91      $384.47      $276.58
                  Plastic Eye Procedures.
0242...........  Level V Repair and         T...............      30.5464    $1,812.72      $597.36      $362.54
                  Plastic Eye Procedures.
0243...........  Strabismus/Muscle          T...............      22.1671    $1,315.46      $431.39      $263.09
                  Procedures.
0244...........  Corneal Transplant.......  T...............      38.3723    $2,277.13      $803.26      $455.43
0245...........  Level I Cataract           T...............      13.3625      $792.97      $221.89      $158.59
                  Procedures without IOL
                  Insert.
0246...........  Cataract Procedures with   T...............      23.4597    $1,392.17      $495.96      $278.43
                  IOL Insert.
0247...........  Laser Eye Procedures       T...............       5.0330      $298.67      $104.31       $59.73
                  Except Retinal.
0248...........  Laser Retinal Procedures.  T...............       4.6769      $277.54       $93.98       $55.51
0249...........  Level II Cataract          T...............      27.9369    $1,657.86      $524.67      $331.57
                  Procedures without IOL
                  Insert.
0250...........  Nasal Cauterization/       T...............       1.2896       $76.53       $26.79       $15.31
                  Packing.
0251...........  Level I ENT Procedures...  T...............       2.0101      $119.29  ...........       $23.86
0252...........  Level II ENT Procedures..  T...............       7.8673      $466.87      $113.41       $93.37
0253...........  Level III ENT Procedures.  T...............      16.1357      $957.54      $282.29      $191.51

[[Page 50687]]

 
0254...........  Level IV ENT Procedures..  T...............      23.4040    $1,388.86      $321.35      $277.77
0256...........  Level V ENT Procedures...  T...............      37.3204    $2,214.70  ...........      $442.94
0258...........  Tonsil and Adenoid         T...............      22.2466    $1,320.18      $437.25      $264.04
                  Procedures.
0259...........  Level VI ENT Procedures..  T...............     366.3317   $21,739.22    $8,070.21    $4,347.84
0260...........  Level I Plain Film Except  X...............       0.7555       $44.83       $17.93        $8.97
                  Teeth.
0261...........  Level II Plain Film        X...............       1.2901       $76.56  ...........       $15.31
                  Except Teeth Including
                  Bone Density Measurement.
0262...........  Plain Film of Teeth......  X...............       0.9228       $54.76  ...........       $10.95
0263...........  Level I Miscellaneous      X...............       1.7476      $103.71       $24.40       $20.74
                  Radiology Procedures.
0264...........  Level II Miscellaneous     X...............       3.5240      $209.12       $79.41       $41.82
                  Radiology Procedures.
0265...........  Level I Diagnostic         S...............       1.0213       $60.61       $24.24       $12.12
                  Ultrasound.
0266...........  Level II Diagnostic        S...............       1.6393       $97.28       $38.91       $19.46
                  Ultrasound.
0267...........  Level III Diagnostic       S...............       2.6327      $156.23       $62.18       $31.25
                  Ultrasound.
0268...........  Ultrasound Guidance        S...............       1.0610       $62.96  ...........       $12.59
                  Procedures.
0269...........  Level III Echocardiogram   S...............       3.2437      $192.49       $76.99       $38.50
                  Except Transesophageal.
0270...........  Transesophageal            S...............       6.0192      $357.20      $142.88       $71.44
                  Echocardiogram.
0272...........  Level I Fluoroscopy......  X...............       1.3801       $81.90       $32.76       $16.38
0274...........  Myelography..............  S...............       3.0413      $180.48       $72.19       $36.10
0275...........  Arthrography.............  S...............       3.5779      $212.32       $69.09       $42.46
0276...........  Level I Digestive          S...............       1.5319       $90.91       $36.36       $18.18
                  Radiology.
0277...........  Level II Digestive         S...............       2.3852      $141.54       $56.61       $28.31
                  Radiology.
0278...........  Diagnostic Urography.....  S...............       2.6434      $156.87       $62.74       $31.37
0279...........  Level II Angiography and   S...............       8.9319      $530.05      $150.03      $106.01
                  Venography except
                  Extremity.
0280...........  Level III Angiography and  S...............      20.7902    $1,233.75      $353.85      $246.75
                  Venography except
                  Extremity.
0282...........  Miscellaneous              S...............       1.6542       $98.17       $39.26       $19.63
                  Computerized Axial
                  Tomography.
0283...........  Computerized Axial         S...............       4.4253      $262.61      $105.04       $52.52
                  Tomography with Contrast
                  Material.
0284...........  Magnetic Resonance         S...............       6.4201      $380.99      $152.39       $76.20
                  Imaging and Magnetic
                  Resonance Angiography
                  with Contras.
0285...........  Myocardial Positron        S...............      17.1798    $1,019.50      $318.72      $203.90
                  Emission Tomography
                  (PET).
0288...........  Bone Density: Axial        S...............       1.2568       $74.58  ...........       $14.92
                  Skeleton.
0296...........  Level I Therapeutic        S...............       2.2452      $133.24       $53.29       $26.65
                  Radiologic Procedures.
0297...........  Level II Therapeutic       S...............       5.2530      $311.73      $122.13       $62.35
                  Radiologic Procedures.
0299...........  Miscellaneous Radiation    S...............       5.8482      $347.05  ...........       $69.41
                  Treatment.
0300...........  Level I Radiation Therapy  S...............       1.5198       $90.19  ...........       $18.04
0301...........  Level II Radiation         S...............       2.2195      $131.71  ...........       $26.34
                  Therapy.
0302...........  Level III Radiation        S...............       4.6145      $273.84      $103.74       $54.77
                  Therapy.
0303...........  Treatment Device           X...............       2.8356      $168.27       $66.95       $33.65
                  Construction.
0304...........  Level I Therapeutic        X...............       1.7738      $105.26       $41.52       $21.05
                  Radiation Treatment
                  Preparation.
0305...........  Level II Therapeutic       X...............       4.0036      $237.59       $91.38       $47.52
                  Radiation Treatment
                  Preparation.
0310...........  Level III Therapeutic      X...............      13.9490      $827.78      $325.27      $165.56
                  Radiation Treatment
                  Preparation.
0312...........  Radioelement Applications  S...............       5.0032      $296.90  ...........       $59.38
0313...........  Brachytherapy............  S...............      12.8655      $763.48  ...........      $152.70
0314...........  Hyperthermic Therapies...  S...............       5.9945      $355.73       $98.36       $71.15
0315...........  Level II Implantation of   T...............     290.6470   $17,247.86  ...........    $3,449.57
                  Neurostimulator.
0320...........  Electroconvulsive Therapy  S...............       5.3765      $319.06       $80.06       $63.81
0321...........  Biofeedback and Other      S...............       1.3579       $80.58       $21.71       $16.12
                  Training.
0322...........  Brief Individual           S...............       1.2319       $73.10  ...........       $14.62
                  Psychotherapy.
0323...........  Extended Individual        S...............       1.6227       $96.30       $20.08       $19.26
                  Psychotherapy.
0324...........  Family Psychotherapy.....  S...............       2.0997      $124.60  ...........       $24.92
0325...........  Group Psychotherapy......  S...............       1.3189       $78.27       $17.10       $15.65
0330...........  Dental Procedures........  S...............       7.1756      $425.82  ...........       $85.16
0332...........  Computerized Axial         S...............       3.2694      $194.02       $77.60       $38.80
                  Tomography and
                  Computerized Angiography
                  without Contras.
0333...........  Computerized Axial         S...............       5.2836      $313.54      $125.41       $62.71
                  Tomography and
                  Computerized Angio w/o
                  Contrast Material.
0335...........  Magnetic Resonance         S...............       5.1581      $306.10      $122.43       $61.22
                  Imaging, Miscellaneous.
0336...........  Magnetic Resonance         S...............       6.0742      $360.46      $144.18       $72.09
                  Imaging and Magnetic
                  Resonance Angiography
                  without Cont.
0337...........  MRI and Magnetic           S...............       8.7945      $521.89      $208.75      $104.38
                  Resonance Angiography
                  without Contrast
                  Material followed.
0339...........  Observation..............  S...............       7.1403      $423.73  ...........       $84.75
0340...........  Minor Ancillary            X...............       0.6384       $37.88  ...........        $7.58
                  Procedures.
0341...........  Skin Tests...............  X...............       0.1112        $6.60        $2.62        $1.32
0342...........  Level I Pathology........  X...............       0.1560        $9.26        $3.70        $1.85
0343...........  Level III Pathology......  X...............       0.4786       $28.40       $11.10        $5.68
0344...........  Level IV Pathology.......  X...............       0.7996       $47.45       $15.66        $9.49
0345...........  Level I Transfusion        X...............       0.2277       $13.51        $3.01        $2.70
                  Laboratory Procedures.
0346...........  Level II Transfusion       X...............       0.3434       $20.38        $4.54        $4.08
                  Laboratory Procedures.
0347...........  Level III Transfusion      X...............       0.8434       $50.05       $12.35       $10.01
                  Laboratory Procedures.

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0348...........
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